Ketamine Therapy: A True Game Changer

Lower left back pain is typically caused by either of the following sources: Damage to the soft tissues supporting the spine and/or certain spinal structures, such as muscles, ligaments, and jointsSee Lumbar Spine Anatomy and Pain A problem or disease involving an internal organ in the mid back, abdominal or pelvic region, such as the kidneys, reproductive organs, and intestines Most cases of lower back pain stem from minor injuries, such as a strained lower back muscle or ligament. While a muscle strain is minor and will heal within a few days or weeks, the pain may be severe and incapacitating.

For everyday causes of lower back pain, standard at-home pain management is a reasonable approach. In fact, most cases of lower back pain are caused by a muscle strain and will get better relatively quickly and do not require treatment from a medical professional. If pain has lasted longer than one to two weeks, or begins to interfere with one’s mobility and daily activities, or if there are troubling symptoms, seeking care from a medical professional is recommended. Back Care: First Line Treatments In most cases, back pain is caused by a simple muscle strain and can be managed by the individual through common self-care practices. A short period of rest, limited to one or two days, in which strenuous activity is minimized and excess pressure is kept off the spine. Sitting in a reclined position, with the legs supported and elevated (such as in recliner, or in bed supported by cushions) is typically a comfortable position that minimizes stress on the lower back. Over-the-counter pain medication, including NSAIDs(such as ibuprofen, naproxen, or aspirin) or acetaminophen. Popular brand names include Tylenol, Advil, and Aleve. Application of ice or a cold pack to the lower back to decrease local inflammation, which often accompanies back pain as a response to injury. Ice is typically recommended within the first 48 hours of the onset of pain. It is important to avoid direct application of ice to the skin (to avoid ice burn). Application of heat to ease muscle tension, relieve muscle spasms, and increase oxygenated blood flow to the area to facilitate healing. Most of the time, heatworks best when used after the first 48 hours of back pain. Small adjustments to posture or daily activities that take pressure off the spine. For example, move carefully and/or with assistance from a sitting to a standing position, and take frequent short walks, as tolerated, to maintain a healthy blood flow and reduce stiffness. After a short rest period, it is recommended that patients stay active, as too much rest can add to stiffness and discomfort. Stretches that mobilize the spine’s joints and gently stretch back muscles can help the patient return to normal daily function. The sooner a patient can return to everyday activity, the sooner low back pain is likely to alleviate. Physical Activity and Low Back Care Regular physical activity is necessary even during an episode of back pain, as exercise helps maintain muscle strength and joint function. Regular exercise also encourages the healing process by increasing oxygen and nutrient rich blood flow to the spine. People with back pain may find that low-impact aerobic exercise, which raises the heart rate without jolting the spine, allows for adequate exercise despite pain. Examples of simple, low-impact aerobic exercises include: Exercise walking or walking briskly enough to elevate the heart rate for between 30 and 40 minutes. Walking can serve as a good starting point for someone looking to improve their physical health, and it is versatile enough to be done anywhere the patient is comfortable—on the track or treadmill at a local gym, around the neighborhood, or at a shopping mall. For many with lower back pain, it is a good idea to start with shorter walks and gradually, over a period of weeks, build up to walking for 30 minutes or more at a time. If walking is too painful or makes pain worse, water therapy may be a good alternative. The buoyancy of the water helps to support the patient’s weight in a more controlled manner, allowing for adequate exercise without putting as much pressure on the spine. Other low-impact aerobics include the use of stationary bicycles or elliptical machines. Finding effective exercise that does not exacerbate pain may be a process of trial and error, and is typically up to the preference of the patient.

In order to better focus the best type of treatment, patients who have been told they have spondylosis should ask their treating physician several questions for clarification about which part of the spine is degenerating. For example: If it is degeneration in the facet joints, then it is likely to be osteoarthritis. If it is degeneration of the spinal discs, it is likely to be degenerative disc disease. Patients should also ask whether or not any related conditions, such as spinal stenosis, require attention. If a person can get these questions answered, he or she is likely to have a better idea of what is causing the pain and thus is more likely to find effective treatments. Finally, patients who have evidence of spondylosis on an MRI or a CT scan should not assume that their pain is being caused by the degeneration. Spinal degeneration is a natural part of aging, and the patient’s pain may or may not be caused by it.

The aorta is the main artery that transports blood away from the heart to deliver it throughout the body, moving blood directly down through the chest and abdomen. All along the aorta are smaller arteries branching off to the various organs and systems of the body. The abdominal aorta is the portion of the artery that sits deep in the abdomen below the kidneys and near the front of the spine. Because the aorta is near the lower spine, sudden intense pain that is felt in the lower back is a common symptom. Aortic aneurysms are most common in the abdominal aorta, with some estimates suggesting as many as 80% of aortic aneurysms occur in the abdomen.

Over 80% of the population will suffer from lower back pain during their lives. Most cases of lower back pain can be linked to a general cause—such as muscle strain, injury, or overuse—or can be attributed to a specific condition of the spine, most commonly: Herniated Disc Degenerative Disc Disease Spondylolisthesis Spinal Stenosis Osteoarthritis

Axial low back pain can vary widely. It can be a sharp or dull pain, it can be felt constantly or intermittently, and the pain can range from mild to severe. The most common type of axial back pain is "mechanical” and is characterized as: Low back pain that gets worse with certain activities (e.g. certain sports) Low back pain that gets worse with certain positions (e.g. sitting for long periods) Low back pain that is relieved by rest Axial pain represents the most common type of low back pain, and it is usually non-specific – meaning that the anatomical structure responsible for the pain need not be identified because symptoms are usually self-limited and resolve with time. Area of Pain Distribution Axial pain is confined to the low back area. Unlike other low back problems, this type of pain does not travel into the buttock, legs and feet, or other areas of the body. Diagnosis of Axial Back Pain The exact diagnosis as to which structure is causing the low back pain rarely has significance to treatment. Only in chronic and severe cases is further evaluation and diagnosis helpful. With axial pain, the presence of an anatomical lesion that can be seen on an MRI scan, such as a herniated disc, may have nothing to do with the low back pain episode. This common finding is part of what makes diagnosis difficult. A variety of structures in the low back can cause axial or mechanical lower back pain, such as a degenerated disc, facet joint problems, and damage to soft tissues – muscles, ligaments, and tendons - and it is often difficult to identify which anatomical structure(s) is the underlying cause of the patient’s pain.

Health conditions associated with a heightened risk for abdominal aortic aneurysm include the following: Atherosclerosis. This condition occurs when plaque buildup in the bloodstream causes the body’s blood vessels to harden and narrow. Atherosclerosis may develop during young adulthood, but only becomes problematic later in life. High cholesterol. Cholesterol may build up in the blood vessels, which can narrow the bloodstream and harden the arterial walls. High blood pressure. A sustained increased force of blood moving through the aorta can weaken the artery walls. High blood pressure is a common condition that is most prevalent in those who smoke cigarettes, people who are overweight, and older adults. An estimated 65% of people over age 60 have high blood pressure. 1 Inflamed arteries. Inflammation can constrict blood flow and cause the arterial walls to weaken, increasing the risk for aneurysm. Arteries may become inflamed by trauma to the abdomen, disease (such as vasculitis), genetic predisposition, and conditions such as atherosclerosis and high cholesterol. Connective tissue disorders. Hereditary conditions that weaken the body’s connective tissues can lead to degeneration of the aortic walls and raise a person’s risk for aneurysm. Two of the most common connective tissue disorders are Ehlers-Danlos syndrome, a group of conditions that affect collagen production, and Marfan Syndrome, which increases production of the protein fibrillin. Other health and lifestyle factors put additional strain on the cardiovascular system and increase the risk of weakened or damaged blood vessels, raising the chance an abdominal aortic aneurysm will develop. Such risk factors include: Smoking and tobacco oral use is one of the biggest contributors to diminished cardiovascular health. People with a history of smoking are 3 to 5 times more likely to develop an abdominal aortic aneurysm. 2 Advanced age. Aneurysm is most common in older adults who are more predisposed to cardiovascular problems and are more likely to have higher levels of plaque buildup in the arteries.See Low Back Pain in Older Adults Genetics and family history. Between 12% and 19% of immediate relatives of a patient with an abdominal aortic aneurysm will also develop the condition. 3 Physical activity level. Not receiving adequate exercise puts a person at a higher risk for heart and cardiovascular disease. Regular aerobic exercise increases the heart rate and blood flow through the body, keeping tissues and blood vessels strong. Gender. Two-thirds of those affected by abdominal aortic aneurysms are men, and men are more likely to experience heart and cardiovascular problems in general. While the above factors contribute to an increased likelihood of developing an abdominal aortic aneurysm, people who have not known risk factors may also develop the condition. Treatment strategies for abdominal aortic aneurysm are not dependent on the cause of aneurysm, but rather on its size and risk for complications. Treatments may range from regular monitoring and lifestyle changes to urgent or emergency surgery.

Injury to the muscles, ligaments, and/or tendons surrounding and supporting the spine (collectively called soft tissues) Problems with the spinal structures, such as the facet joints or intervertebral discs Issues or diseases affecting the internal organs in the mid-back, abdominal, or pelvic regions Seeing a doctor is recommended if lower right back pain continues or worsens after a few days, or if there is sudden onset of severe pain, or if it occurs with other concerning symptoms. See When Back Pain May Be a Medical Emergency Most cases of low back pain stem from minor injuries to the muscles and/or ligaments in the lower back, and the body is usually well-equipped to heal itself after these types of injuries. While the initial pain of a muscle strain may be significant, the pain tends to subside on its own over a few days or weeks.

The weakened aorta may develop a leak, called a rupture, or blood may pool up between layers in the arterial walls and quickly lead to rupture, called a dissection. Internal bleeding caused by a ruptured aorta is the primary complication from an abdominal aortic aneurysm. The loss of blood from aortic rupture is considered a catastrophic and potentially fatal medical emergency; the mortality rate for this condition increases significantly when the artery leaks. There are few ways of forecasting when an abdominal aortic aneurysm will rupture, making the condition important to detect, monitor, and manage when possible. An aneurysm’s risk for rupture is typically dependent on the following factors: Size of aneurysm. Abdominal aortic aneurysms that are smaller than 5 cm in diameter tend to be considered a low risk for rupture, while aneurysms larger than 5 cm in diameter are typically considered a high risk. An aneurysm’s size tends to be the best predictor for its chance of rupturing. Rate of growth. Aneurysms that expand by more than half a centimeter over 6 months of regular monitoring are considered fast-growing and high risk. 1Aneurysm growth tends to be faster in people who smoke or have high blood pressure. Abdominal aortic aneurysms generally do not produce severe abdominal and/or lower back pain or other symptoms until the artery has ruptured. In some cases, if an abdominal aortic aneurysm has significantly expanded it may cause symptoms similar to a rupture.

The aorta is the body’s main artery that stretches from the heart and down through the abdomen. When it weakens or balloons in size, the condition is known as an aortic aneurysm. This condition can cause significant abdominal pain and back pain and may lead to the artery’s leak or rupture, at which point it becomes a life- An aortic enlargement occurs when the arterial walls are weakened, and is considered an aneurysm when the artery grows to at least 1 or 1.5 times its original size, or 3 cm in diameter for the abdominal aorta. In the elderly population, abdominal aortic aneurysms are not uncommon and are rarely symptomatic. Abdominal aneurysms are most common after age 65, and are more prevalent among men and those who smoke cigarettes.

Cervical degenerative disc disease is a common cause of neck pain and radiating arm pain. It develops when one or more of the cushioning discs in the cervical spine starts to break down due to wear and tear. There may be a genetic component that predisposes some people to more rapid wear. Injury may also accelerate and sometimes cause the development of the degenerative changes. How Cervical Discs Can Degenerate Normally, there are six gel-like cervical discs (one between each of the cervical spine’s vertebrae) that absorb shock and prevent vertebral bones from rubbing against each other while the neck moves. Each disc is comprised of a tough but flexible outer layer of woven cartilage strands, called the annulus fibrosus. Sealed inside the annulus fibrosus is a soft interior filled with a mucoprotein gel called the nucleus pulposus. The nucleus gives the disc its shock absorption property. Watch Cervical Disc Anatomy Animation In children, the discs are about 85% water. The discs begin to naturally lose hydration during the aging process. Some estimates have the disc’s water content typically falling to 70% by age 70, 1 but in some people the disc can lose hydration much more quickly. As the disc loses hydration, it offers less cushioning and becomes more prone to cracks and tears. The disc is not able to truly repair itself because it does not have a direct blood supply (instead getting nutrients and metabolites via diffusion with adjacent vertebrae through the cartilaginous endplates). As such, a tear in the disc either will not heal or will develop weaker scar tissue that has potential to break again. The Course of Cervical Degenerative Disc Disease Cervical degenerative disc disease is not technically a disease, but rather a description of the degenerative process that discs located in the cervical spine go through. Essentially all people who live long enough will develop degenerated discs. Studies show that a plurality of adults have no symptoms related to degenerative disc disease, even though a high percentage of these adults still shows signs of disc degeneration on an MRI somewhere on the spine. One study found that about half of people start showing some signs of disc degeneration on an MRI by their early 20s. 2 Another study found that about 75% of people under age 50 have disc degeneration while more than 90% of people over age 50 have it. When degenerative disc disease develops in the cervical spine, it can occur in any of the cervical discs but is slightly more likely to occur at the C5-C6 level. In cases where cervical degenerative disc disease does cause pain, it can happen in various ways. In some instances, the disc itself can become painful. People are more likely to experience this type of discogenic pain in their 30s, 40s, or 50s. When symptoms from cervical degenerative disc disease become chronic, the pain and/or symptoms are likely related to conditions associated with disc degeneration, such as a herniated disc, osteoarthritis, or spinal stenosis. Depending on the cause, the pain may be temporary, or may become chronic. To give an example, pain from a herniated disc is likely to eventually go away on its own, but pain from osteoarthritis may require treatment on a chronic basis. Risk Factors for Cervical Degenerative Disc Disease While nearly everyone eventually gets cervical degenerative disc disease with age, there are some factors that can make it more likely to develop sooner and/or become symptomatic. These risk factors could include: Genetics. Some studies of twins indicate genetics play a bigger role than lifestyle in determining when cervical degenerative disc disease develops and if it becomes painful. Obesity. Weight has been linked to risk for developing degenerative disc disease.See Nutrition and Diet for Weight Loss Smoking. This habit can hinder nutrients from reaching the discs and cause them to lose hydration more quickly.See Ways to Quit Smoking In addition, an injury to the spine, such as a herniated disc, can sometimes start or accelerate cervical degenerative disc disease.

Lifestyle factors that affect overall health can have an impact on the spinal discs. Risk factors for degenerative disc disease include: Family history of back pain or musculoskeletal disorders Excessive strain on the low back caused by sports, frequent heavy lifting, or labor-intensive jobs Strain on the lumbar spinal discs due to prolonged sitting and/or poor posture Lack of support for the discs due to weak core muscles Obesity Smoking, or any form of nicotine intake Disc degeneration is a common part of aging, but not all people develop pain or any remarkable symptoms. Symptoms tend to arise when spinal instability, muscle tension, and possibly nerve root irritation occurs.

Pain from degenerative disc disease is typically caused by strain on the muscles supporting the spine and inflammation around the disc space. Degeneration occurs because of age-related wear-and-tear on a spinal disc, and may be accelerated by injury, health and lifestyle factors, and possibly by genetic predisposition to joint pain or musculoskeletal disorders. Degenerative disc disease rarely starts from a major trauma such as a car accident. It is most likely due to a low-energy injury to the disc. Lumbar Degenerative Disc Disease Causes The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of following sources: Inflammation, as the proteins in the disc space irritate the surrounding nerves—both the small nerve within the disc space and potentially the larger nerves that go to the legs (the sciatic nerve). Abnormal micro-motion instability, when the outer rings of the disc, called the annulus fibrosis, are worn down and cannot absorb stress on the spine effectively, resulting in movement along the vertebral segment. Over a long period of time the pain from lumbar degenerative disc disease eventually decreases, rather than becoming progressively worse. This pain relief occurs because a fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position, eliminating the micro-motion that generates the pain. The Degenerative Cascade When a disc endplate is damaged, the blood supply to the discs is compromised, leading to a lack of nutrients and oxygen that are essential for restoring damaged tissues. Once one stress or injury occurs, a disc can begin to wear down relatively quickly in a process called the degenerative cascade. The degenerative cascade is a slow process that typically continues for 10 to 30 years and usually consists of the following cycle: An initial stress or injury may occur, causing acute pain that may be severe. Stiffness and limited mobility may occur immediately after the initial injury or stress to the disc. In many cases, there is no clear injury that causes the onset of symptoms. The affected spinal segment then undergoes a long period of relative instability. As the disc height decreases, the muscles, ligaments, and facet joints around the disc space gradually adjust to stabilize the spine again. During this phase, there are periodic flare-ups of moderate or intense low back pain. Once the spinal segment stabilizes, pain and other symptoms tend to alleviate. It is common that back pain from degenerative disc disease is more severe between ages 30 and 40 than past age 60.

Chronic pain, especially joint pain, is the classic symptom of arthritis. Pain may occur in any joint and can occur at rest. Joint stiffness, tenderness, and swelling are also common. Fatigue may occur as part of the disease or may be related to disrupted sleep from pain. Patients may develop muscle weakness or decreased the range of motion as joints become increasingly stiff or deformed. Bumps on the fingers and bony outgrowths in fingers and toes may also occur. Symptoms may periodically become worse (flare-up), especially in rheumatoid arthritis.

Medications for arthritis include pain relievers and anti-inflammatory drugs. Sometimes, treatment can cause arthritis to go into remission – remove most or all of the symptoms for a period of time. Exercise, massage, physical therapy and nutritional counseling can be effective in some forms of arthritis. For example, sugar can increase the inflammatory response in arthritis, while gout flares often occur after drinking wine. Cortisone injections are also effective in treating arthritis. Biologics target specific parts of the immune system and may be used in inflammatory conditions like rheumatoid or psoriatic arthritis. In these conditions, Dr. Tilak will co-manage with the Rheumatologist who prescribes the biologics while Dr. Tilak helps the patients to manage the pain.

Cervical osteoarthritis involves the breakdown of the cartilage within the neck’s joints, which may occur due to wear-and-tear over time or may be accelerated by an injury. Rheumatoid arthritis is an autoimmune disease that can cause damage to joints. When rheumatoid arthritis occurs in the cervical spine, it is most likely to occur in the upper neck or base of the skull. Ankylosing spondylitis is a type of arthritis that causes enthesitis, which is inflammation where the ligaments and tendons attach to bone. While ankylosing spondylitis typically starts in the hips and lower back, it can eventually work its way up to the neck in severe cases.

In addition to taking medications as prescribed, self-management strategies can help people who are living with arthritis. Excess weight can increase the stress on joints, so weight loss and weight maintenance can be vitally important in keeping pain under control. Although exercise is important to keep joints flexible, rest is also necessary. Each patient must work out a balance between the two. Supportive treatments like massage therapy, ice for inflammation or heat for muscle soreness can promote day-to-day comfort. Changing to an anti-inflammatory diet as well as using anti-inflammatory nutritional supplements may also improve arthritis symptoms as well as joint swelling. Keeping a positive attitude also has an effect.

Although there are more than 100 different kinds of arthritis, the most common forms are degenerative arthritis and rheumatoid arthritis. Degenerative arthritis occurs from wear and tear on the joints; the cartilage that covers the ends of the bone wears away, causing friction and pain. Rheumatoid arthritis is an inflammatory condition in which the immune system mistakenly attacks the body. It is more common in women. Other types of arthritis include metabolic arthritis (gout) and infectious arthritis, which results from a bacterial, viral or fungal infection in the joints.

We see patients in both our clinics for outpatient Narcotics addiction medical treatment. We specialize in treating young adults to seniors who want to stop using heroin as well as others who have gotten hooked on to pain medications like oxycodone, Vicodin or Norco to treat chronic pain. Many patients come in after they have tried unsuccessfully to detox on their own and others come in after discharge from rehab for continued care. Either way, we can help and we are glad you are here.

We provide safe, effective and non-judgmental medical treatment for your alcohol and drug problems. We specialize in using the latest treatments, based on research in neuroscience, to help your brain heal and recover from alcohol or drug use. We use FDA-approved medication treatments including Suboxone® (Buprenorphine/naloxone) and Subutex (Buprenorphine) to help patients with addiction. These medications help mitigate the symptoms of withdrawal, curbing the physical addiction while learning to manage and control the psychological aspects of addiction. If needed, we can also prescribe other medications for depression, anxiety or insomnia.

For many Americans, opiate addiction begins with legitimate, prescribed medication to treat chronic pain. However, with regular use over time, pain medications change the function of the nerve cells in the brain. Eventually, this leads to developing a tolerance and needing an increasing amount of the drug to maintain the same results or to avoid withdrawal symptoms. Withdrawal symptoms occur when the body is deprived of a substance it has come to rely on. Withdrawal symptoms typically include: Nausea Vomiting Diarrhea Cramps Joint pain Tremors Chills and sweats Anxiety, depression, and insomnia In some cases, patients not able secure sufficient prescription drugs to manage their pain and avoid withdrawal symptoms, may turn to heroin use.

The simplest explanation of how buprenorphine works is that it helps reduce opiate use by reducing the cravings for opiates. Buprenorphine reduces cravings by occupying the same opiate receptors in the brain in which other chemical opiates attach. In fact, buprenorphine actually binds much longer and much stronger than other opiates, like oxycodone or heroin, which helps people stabilize, reduce drug consumption and overcome addiction. After a few days of being on the medication, the vast majority of patients feel “normal,” with little to no cravings and can drive, go to work, take care of their kids and move on with their lives.

There are three phases to Suboxone or Buprenorphine treatment. Stabilization phase: In your first visit, Dr. Tilak will review your history and help you decide the right next step for treatment. If you are being prescribed buprenorphine (Suboxone or Subutex), you will leave your first appointment with a prescription to fill at a local pharmacy and detailed instructions on home induction and stabilization. You are closely monitored after your first visit and have follow-up appointments at least every week until you have stabilized and are ready to enter the maintenance phase of treatment. These appointments allow the doctor to monitor your well-being and adjust your dose if necessary. Maintenance phase: The maintenance phase is the longest part of your physician-supervised recovery program. This phase begins when your medication dosage is stabilized. During the maintenance phase, you begin to feel normal, both physically and emotionally. Your visits become less frequent during this phase and you spend more time dealing with the psychological aspects of your addiction. Then as you recover from all aspects of your addiction, you finally enter the tapering phase. Maintenance phase can last for many months to years depending on patient preference and need. Many adult conditions need lifelong medications. Buprenorphine should also be looked upon as long term medication to avoid risk of relapse and many patients feel unwell and uneasy or get mild withdrawal symptoms without it. Tapering phase: During this phase, you slowly reduce your dose of Suboxone or Buprenorphine with an end goal of being free from reliance on all drugs. The tapering of your prescription is tailored to meet your needs and preference and is never forced upon you. Once you have tapered off your prescription and are doing well, you are officially discharged.

To access care, call our office at 904-298-1994 to make an appointment.

You may experience symptoms right after the traumatic event, or your symptoms may be delayed. Once symptoms begin, they recur and cause significant anxiety. PTSD symptoms include: Having flashbacks or dreams about the event Having extreme emotions Feeling on edge or angry Being easily startled Feeling depressed Avoiding the people and places that remind you of the event Some patients find that they have a hard time remembering all the details about the event.

Trauma-focused cognitive behavioral therapy and other types of psychotherapy are the first treatments recommended for patients with PTSD. Unfortunately, about half of all patients continue to have symptoms after their psychotherapy is over. You may receive medications to treat specific symptoms such as anxiety and insomnia, and there are two FDA-recommended medications for PTSD. However, 20-40% of all patients fail to improve with these medications. You have another more effective option for PTSD treatment, and that’s ketamine.

PTSD occurs after a terrifying or dangerous event. You may be directly involved in the event, but you can also develop PTSD after hearing about a traumatic event experienced by a family member or friend. The top events responsible for causing PTSD include: Military duty Gun violence Severe accident Sexual or physical assault Natural or man-made disaster Recurrent emotional assault The sudden death of a loved one, being robbed, and many other traumatic events can also lead to PTSD.

Dr. Tilak administers ketamine through an intramuscular or IM infusion. While your symptoms may improve with one treatment, a series of IM infusions over the course of about 4-6 weeks produces optimal and long-lasting results. Like other medications, each person’s response to ketamine is different. Dr. Tilak works closely with you to ensure you achieve the best possible results. To learn if you’re a good candidate for ketamine treatment, call our Jacksonville or Middleburg clinic or request an appointment today.

Ketamine is a medication that treats PTSD through two pathways. First, it balances levels of glutamate, a brain chemical that regulates psychological conditions such as PTSD, depression, and anxiety. As ketamine directly and quickly changes brain chemicals, it rapidly improves PTSD symptoms. The second way ketamine helps PTSD is by improving nerve connectivity. This action may be especially important for patients with PTSD because experiencing trauma disrupts nerve communication.

High Success Rate Research shows a high success rate for patients undergoing ketamine therapy. More than half of patients in a study reported experiencing significant relief after a single treatment. They feel even better after several infusions.1 Quick Onset of Action Unlike SSRIs, ketamine’s effects don’t take weeks to manifest. Patients report feeling better after a few sessions, and often within hours. This makes ketamine an attractive option for those needing immediate relief from symptoms. Long-Lasting Relief Besides its quick onset, ketamine offers longer-lasting results. Traditional antidepressants are only effective as long as the patient is taking them daily. But with ketamine treatment, relief can last for weeks. Patients may even enjoy relief for months. Ketamine therapy stimulates brain changes that lead to extended relief, rather than just masking symptoms. A typical treatment plan involves six infusions over several weeks. Ketamine Therapy LA at CRMC will monitor your progress and suggest booster infusions as needed.

A good candidate for ketamine therapy is someone who hasn’t seen improvement with standard treatments for: Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) Bipolar disorder Anxiety Depression Other treatment-resistant mental health illnesses Patients with suicidal thoughts or suicidal ideation can get ketamine treatment under close monitoring and suicide risk assessment. If you’re in Los Angeles, CA, visit Ketamine Therapy LA at CRMC for a free consultation. Source: Antidepressant Efficacy and Tolerability of Ketamine and Esketamine: A Critical Review, National Library of Medicine, P Molero, J A Ramos-Quiroga, R Martin-Santos, E Calvo-Sánchez, L Gutiérrez-Rojas, J J Meana How Ketamine Drug Helps with Depression, Yale Medicine, Jennifer Chen

Receiving ketamine infusions can be nerve-wracking, but don’t fret. Our team will be with you every step of the way. You won’t be alone at any time during the treatment. Some of our patients experience mild side effects like floating sensations and hallucinations. These dissipate once we complete the treatment. It’s normal to feel fatigued after, so you’ll need a driver to take you home. Within an hour of your session, you’ll start to get relief.

Besides the usual IV infusion method, patients can get ketamine through a nasal spray (esketamine). It works by binding to a specific receptor in the brain called the NMDA receptor. This binding leads to changes in the activity of certain neurotransmitters like glutamate. These neurotransmitters regulate mood and emotional processing. When you receive esketamine via nasal spray, it rapidly absorbs into the bloodstream and reaches the brain. You’ll experience an immediate change in brain chemistry and a rapid reduction in depression symptoms.2

Many patients notice distinct improvement within a few hours or upto a day of IM infusion. For longer lasting relief, weekly or biweekly treatments for 6 to 8 weeks is recommended.

Research done at Yale University lab and later at other University labs show that Ketamine triggers production of glutamate in brain, allowing it to rewire and reconnect Glutamate helps the brain create new neural connections and makes it more adaptable Ketamine boosts neurotransmitters and balances brain chemicals that cause Anxiety and Depression Multiple studies show Ketamine enhances structural plasticity (also called neuroplasticity) of dopaminergic neurons thereby causing happiness

Sadness of mood Inability to feel pleasure or happiness Feeling of life as a failure Chronic fatigue or low energy Sleep changes, usually Insomnia Feeling overwhelmed, difficulty focusing Loss of self-esteem, indecisiveness Difficulty in concentration

Relief of sadness, stress, anxiety, and restoring mental balance and wellness Very quick results in hours or upto a day Ketamine therapy can be used in conjunction with prescription medications and psychotherapy Relief of fatigue and stress, patients feel energetic and blissful

Ketamine has been used as Anesthetic since 1970 and has a proven track record of being very safe. You will also be closely monitored for about an hour after the Ketamine Infusion.

Research initially done at Yale University lab and later at other labs show that Ketamine triggers production of glutamate in brain, allowing it to rewire and reconnect Glutamate helps the brain create new neural connections and makes it more adaptable Ketamine boosts neurotransmitters and balances brain chemicals that cause Anxiety and Depression

Many patients notice distinct improvement within an hour of IM infusion. For longer lasting relief, weekly or biweekly treatments for 6 to 8 weeks is recommended.

Relief of stress, anxiety, and restoring mental balance and wellness Near instant results Ketamine therapy can be used in conjunction with prescription medications and psychotherapy With relief of fatigue and stress, patients feel energetic and blissful

Ketamine has been used as Anesthetic since 1970 and has a proven track record of being very safe. You will also be closely monitored for about an hour after the Ketamine Infusion.

Persistent fears, worries, unwanted thoughts, fatigue Heart palpitations,sweating,nausea,restlessness Tightness in chest on abdomen Feeling overwhelmed, with difficulty sleeping Anger, frustration or depression/sadness of mood

The symptoms of mania include: High activity level Difficulty sleeping Racing thoughts Rapid speech Feeling irritable Many patients engage in risky behaviors such as excessive use of alcohol and/or drugs, reckless driving, or spending too much money.

Ketamine has proven to be a safe and effective treatment for depression, including bipolar depression and treatment-resistant depression. When used at a low dose, ketamine balances a brain chemical called glutamate, which in turn lifts depression symptoms. Dr. Tilak administers ketamine in the office using an intramuscular infusion, allowing your body to receive the full dose with 95% bioavailability. Most patients respond quickly as ketamine normalizes their brain chemicals, with symptom improvement evident within 24 hours. Though a single ketamine treatment may last a week, with a series of about six treatments, your results may last at least several months and possibly longer. Then you need only an occasional maintenance treatment.

Bipolar depression causes the same symptoms as clinical depression: Low energy Feeling sad and hopeless Losing interest in activities Sleeping too much or too little Eating too much or too little Difficulty concentrating Thinking about suicide You may experience major depression before having your first manic episode. Additionally, many patients with bipolar disorder are depressed more often than they’re manic or hypomanic.

Bipolar disorder was once called manic depression because it causes swings in mood, energy, and activity levels. While many people expect bipolar disorder to have identifiable cycles of low-energy depression and high-energy mania, there are several types of bipolar disorder with different degrees of mania. Some patients have severe mania that seriously disrupts their life. Others have hypomania, which causes similar symptoms, but they’re mild and usually don’t interfere with everyday functioning.

Bipolar disorder is treated with a combination of medications and psychotherapy. Since it’s a lifelong condition, you need ongoing support to keep your mood swings managed. Mood stabilizing medications such as atypical antipsychotic medications help to control manic and depressive episodes. Antidepressants are used with caution because they often make bipolar symptoms worse. If you continue to struggle with bipolar depression despite mood-stabilizing medications, ketamine is a safe and effective alternative to antidepressants.

IV route is cumbersome. Many patients find it uncomfortable and require more intense monitoring. It is associated with risk of fluid extravasation and infection. Many studies have demonstrated no significant difference in results of IM and IV therapy, both short term and long term as bioavailability of IM route is about 95%. Thus, minor dose adjustment will give the same amount of Ketamine as IV route. IM Ketamine is more cost effective, more convenient thus patients can afford more treatments for long term results. IM therapy doses can be spaced out at 15–30-minute intervals depending on patient preference. We can also give a small dose of Benzodiazepine or anti-nausea medication if needed.

Yes. Consultation is required so Dr. Tilak can perform a medical and mental health assessment to optimize therapy and to ensure patients will benefit from the therapy. Prior medical records if available will be reviewed. Alternatives to Ketamine therapy will also be discussed and patients will be educated about the process of Ketamine infusion, its side effects, expected benefits and duration of benefits will be discussed.

* Relief of sadness, stress, anxiety, and restoring mental balance and wellness and happiness *Very quick results in hours or up to a day * Ketamine therapy can be used in conjunction with prescription medications and psychotherapy * With relief of fatigue and stress, patients feel energetic and blissful *Ketamine enables the brain to develop new neural connections (synapses), a new treatment * Excellent option for Treatment resistant conditions as above * Longer term results over weeks to months with multiple infusions

Ketamine interacts with multiple receptors in the brain. The main receptor is the NMDA receptor. Its interaction with this releases Glutamate which explains some of its effect on mood disorders, as Glutamate release uplifts the mood and causes happiness. Ketamine's effect on AMPA receptors also causes glutamate release. Another important action is on brain structure which probably explains its longer-term effects. Studies pioneered at Yale by Neuroimaging showed that Ketamine creates new neural connections in various parts of the brain (anterior cingulate cortex, prefrontal cortex, limbic system) which were found suppressed by chronic stresses be it Mood disorders or Drug abuse or chronic pain. This is called Neuroplasticity: brain adaptability by changing its structure. Studies show that it probably does this by release of Neuronal vascular endothelial growth factor. Ketamine is also an opioid receptor agonist which explains its effect on pain conditions.

Patients will be closely monitored during Ketamine therapy and psychological support will be provided to tackle the side effects should they arise. The beauty of Ketamine therapy lies in low risk of side effects and high success rate. Most side effects are mild and transient. Side effects are directly related to the dose of Ketamine administered. Many studies have indicated that smaller doses of Ketamine will have very similar results in improvement of the conditions than higher doses with much less side effects. Our approach is to get patient preference for selecting the dosage. Dissociation or out of body experience can be uncomfortable for some. Nausea and rarely vomiting can occur and will be treated with medications like Zofran as needed. Using Zofran prophylactically before the infusion is also an option. Blood pressure or pulse may increase during treatment, and this will be monitored. Hardly ever this needs additional treatment. Transient hallucinations, transient difficulty in muscle coordination and cognition may occur, thus we require that patients not drive after treatment till next day or call ride services like Uber. Headache if disabling can be treated with IM Toradol (strong anti-inflammatory like Motrin) in the clinic. Please note that most patients will not get troublesome side effects.

Many patients notice distinct improvement within a few hours or up to a day of IM infusion. Some patients start to feel better with improvement in day-to-day functioning, before distinct improvement in mood lifting or pain relief. The duration of these positive effects from the first infusion typically depends on the severity of the underlying condition but may last from a few days to 1-2 weeks or longer. For longer lasting relief, weekly or biweekly treatments for 6 to 8 weeks is recommended. Booster injections may be given on a monthly basis or longer as needed.

Ketamine has been used as Anesthetic since 1970 and has a proven track record of being very safe even when it is given at much higher dose when used as Anesthetic for children and adults. You will also be closely monitored for about an hour after the Ketamine Infusion. Dr. Tilak is board certified in both Internal Medicine and Interventional Pain management with added training in taking care of patients undergoing complex procedures with moderate sedation. He has been practicing for over 30 years as a physician with a proven safety record.

With proper patient selection, many studies have reported success rates upwards of 70%, although the overall success rate of current studies is around 70%. Success rate is mainly calculated by patients feeling significantly better than before the treatment. In general, the duration of relief has lasted from a few days to 1-2 weeks following a single infusion (sometimes longer), a series of infusions over 4–6-week period (one to two infusions per week depending on the severity of the condition) can provide longer term relief for weeks to months. Booster injections may be needed once a month or longer if condition returns or as a proactive measure.

Ketamine was first approved by the FDA in 1970 to be used as Anesthetic. Yale School of Medicine first published a trial in 2000 showing its effectiveness against Depression. Many institutions then conducted several other trials showing similar results. Hundreds of clinics in various countries including the US are currently offering Ketamine for above indications with good success for a variety of conditions as above. Ketamine discussions have taken place in multiple TV shows and media. with physicians and patients presenting their success stories. Separate tab on Ketamine in the news is included on this website for those interested.

If you are struggling with the negative symptoms of aging, then HRT may be perfect for you. By optimizing hormone levels that work specifically for your system, Dr. Tilak can boost your vitality and battle back against the exhaustion of time.

Hormone replacement is safe. But like with all medical procedures, there can be risks. HRT is a complex process, which is why you should not meddle with your chemical balance without the help of a knowledgeable, trained medical professional. Dr. Tilak has experience of practicing internal medicine over 25 years and is well suited for hormone replacement therapies.

It may take a few weeks for you to feel the initial effects of hormone replacement therapy. These benefits will increase over the next few months as your body adjusts. The key to successful HRT is respecting your body’s unique chemistry and complementing it with the correct formula. To learn more about how hormone replacement therapy can work for you, contact our clinic at 904-298-1994.

Neck pain from cervical osteoarthritis typically starts gradually and progresses over time. The neck may feel particularly stiff and achy in the morning and then feel better as the day goes on. Some common symptoms of cervical osteoarthritis can include one or more of the following: Neck pain that typically feels dull but can also be sharp or burning Referred pain up to the head or down into the upper back Stiff neck or reduced range of motion Neck tenderness when touched On occasion, bone spurs may impinge on a nerve root in your neck. This impingement can cause radicular pain into the arm, which can feel electric shock-like. If nerve root inflammation results in neurological deficits, such as numbness or weakness in the arm or hand, it is called cervical radiculopathy.

Pairs of small facet joints run down the back of your cervical spine. Each of your facet joints is lined with cartilage. This cartilage is surrounded by a capsule filled with synovial fluid, which lubricates your facet joints and enables smooth movements between adjacent vertebrae.

Cervical osteoarthritis can usually be successfully managed without surgery. Common treatments include: Rest or activity modification. Going easy on the neck during a painful flare-up may ease pain. Also, you may need to modify some activities, such as using a different swim stroke if you enjoy swimming. Physical therapy. A physiatrist, physical therapist, or other medical professional can customize a neck exercise program for you. A stronger and more flexible neck has improved function, which may reduce pain. Over-the-counter medications. Non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve inflammation from osteoarthritis. A few examples include ibuprofen (Advil) and naproxen (Aleve). Remember to carefully read the instructions before using any medication to reduce the risk for serious complications. Heat and/or cold therapy. Applying ice can help reduce inflammation and numb the pain. Other people may prefer to apply heat therapy, which can increase blood flow and relax the muscles. When applying heat or cold therapy, applications should last about 15 minutes with about 2 hours of rest in between. Keep a layer between your skin and the heat/cold source.

When neck arthritis strikes, it can cause painful joint inflammation and stiffness. There are various types of neck arthritis, such as the following: Cervical osteoarthritis involves the breakdown of the cartilage within the neck’s joints, which may occur due to wear-and-tear over time or may be accelerated by an injury. Rheumatoid arthritis is an autoimmune disease that can cause damage to joints. When rheumatoid arthritis occurs in the cervical spine, it is most likely to occur in the upper neck or base of the skull. Ankylosing spondylitis is a type of arthritis that causes enthesitis, which is inflammation where the ligaments and tendons attach to bone. While ankylosing spondylitis typically starts in the hips and lower back, it can eventually work its way up to the neck in severe cases.

Twenty to thirty minutes after the procedure, the patient will be asked to try to provoke the usual pain. Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether or not the area injected is the main source of the patient's upper back pain. On occasion, patients may feel numb or a slightly weak/odd feeling for a few hours after the injection. This may last several hours, but the patient should be able to function safely, if proper precautions are taken. On the day of the injection, patients are advised to avoid doing any strenuous activities, unless instructed by their physician. The patient should not drive the day of the injection unless approved by the treating physician. If sedation was used, the patient should not drive for 24 hours after the procedure. Patients may notice a slight increase in pain lasting for several days as the numbing medicine wears off and before the cortisone starts to take effect. If the area is uncomfortable in the first two to three days after the injection, applying ice or a cold pack to the general area of the injection site will typically provide pain relief. On the day after the procedure, patients may return to their regular pre-injection level of activity. When the pain is improved, it is advisable to start regular exercise and activities in moderation. Even if the pain relief is significant, it is still important to gradually increase activities over one to two weeks to avoid recurrence of pain. Patients may continue to take their regular pain medicine after the procedure, with the exception of limiting pain medicine within the first four to six hours after the injection so that the diagnostic information obtained is accurate. Patients may also be referred for physical therapy or manual therapy, and this may be an appropriate time for the patient to have manipulation, while the numbing medicine from the injection is effective and/or over the next several weeks while the cortisone is working. The patient may begin to notice longer lasting pain relief starting two to five days after the injection. If no improvement occurs within ten days after the injection, then the patient is unlikely to gain any pain relief from the injection and further diagnostic tests may be needed to accurately diagnose the patient's upper back pain and other symptoms. Ideally, patients will record the levels of pain relief in a 'pain diary' for the week following the injection. A pain diary is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or treatment, as needed. Potential Risks and Complications As with all invasive medical procedures, there are potential risks associated with costovertebral and costotransverse joint injections. However, in general the risk is low, and complications are rare. Potential risks include: Allergic reaction. Usually an allergy to X-ray contrast or steroid; rarely to local anesthetic. Infection. Minor infections occur in less than 1% to 2% of all injections. Severe infections are rare, occurring in 0.1% to 0.01% of injections. Bleeding. A rare complication, bleeding is more common for patients with underlying bleeding disorders. Nerve or spinal cord damage or paralysis. While very rare, damage can occur from direct trauma from the needle, or secondarily from infection, bleeding resulting in compression, or injection into an artery causing blockage. Punctured lung (pneumothorax). This complication is uncommon, but at times requires that a small catheter be placed in the chest wall to re-inflate the lung. In addition to risks from the injection, some patients will experience side effects from the steroid medication, such as: Transient flushing with a feeling of warmth ('hot flashes') for several days Fluid retention, weight gain, or increased appetite Elevated blood pressure Mood swings, irritability, anxiety, insomnia High blood sugar - diabetic patients should inform their primary care physicians about the injection prior to their appointment Transient decrease in immunity Cataracts - a rare result of excessive and/or prolonged steroid usage Severe arthritis of the hips or shoulders (avascular necrosis) - a rare result of excessive and/or prolonged steroid usage Costovertebral and costotransverse joint injections should not be performed on patients who are taking blood thinners (Coumadin), aspirin or other antiplatelet drugs (e.g. Ticlid, Plavix). Baby aspirin (81mg) may be an exception, depending upon the specific injection and the physician's discretion. Costovertebral and costotransverse joint injections should not be performed on patients who have a local or systemic bacterial infection, are pregnant (if fluoroscopy is used), or have bleeding problems. Patients should also let their doctor know of any allergies they have to medications that may be used for the procedure.

An epidural steroid injection is a minimally invasive procedure that is performed at a doctor’s office, surgical center, or hospital. Patients usually return home the same day. The injection may be administered by spine and pain management specialists, such as physiatrists, anesthesiologists, radiologists, neurologists, and spine surgeons. A complete list of current medications and medications taken in the recent past, such as blood thinners and antibiotics, must be discussed with the doctor. Some of these medications may need to be stopped a few days before the injection procedure to avoid complications. It will also be necessary to sign a consent form before the procedure after the possible benefits and risks have been discussed with the doctor. Preparing to Receive an Epidural Steroid Injection The injection procedure is usually scheduled for the morning. Instructions typically include no eating and drinking for about 6 hours before the procedure. A hospital gown is worn to allow better access to the injection site. Conscious sedation using relaxation medication may be given to ease the patient’s anxiety. Procedure for Lumbar Epidural Steroid Injection: Steps and Precautions The injection is usually given while the patient lies on their stomach (prone position) on a fluoroscopy (live x-ray) table. The procedure may take up to 30 minutes. The doctor may decide to use a transforaminal, interlaminar, or caudal route to administer the injection. An intravenous (IV) line is started if relaxation medicine is needed. The common steps involved in the injection procedure are as follows 1 : The skin over the injection site is marked and cleaned with betadine. A fluoroscopic x-ray is used to locate the correct vertebral level for needle guidance; the live images can be seen on a computer screen. A local anesthetic is injected into the skin and underlying tissues to numb the area. An epidural spinal needle is inserted into the intended injection site and guided using fluoroscopy. A contrast dye is injected into the epidural space to check the spread of the injected contents. Once the spread is confirmed, the steroid medication is injected into the epidural space. A tingling or mild burning sensation or the feeling of pressure may be experienced as the medication enters the epidural space. When the injection is completed, the irritation and discomfort usually disappear within a few minutes. The patient is usually monitored in a recovery room for 30 minutes to an hour where vital signs are continuously monitored. Driving and strenuous physical activities and flying in an airplane are not recommended on the same day after the procedure. Recovery and Post-Injection Care Following Epidural Injection While the local anesthetic in an epidural steroid injection usually provides immediate pain relief, it may take up to 2 weeks for the steroids to take effect. Regular activities may be resumed slowly on the day after the injection. Ice packs may be used at home if pain occurs at the injection site. Ice packs are usually used for 15 to 20 minutes at a time with a break of at least two hours in between to avoid skin injury. Hot baths, sauna, and swimming are usually not recommended for 2 to 3 days after the injection to avoid the risk of infection. The epidural injection procedure is usually painless, but light soreness or discomfort may occur in some patients over the next day or two. With adequate precautionary measures and post-injection care of the treatment site, patients can typically resume all their daily activities within a week of the injection.

Rib dysfunction syndromes may cause one or a combination of the following symptoms: upper back pain, arm pain, pain between the ribs, and/or generalized upper back area discomfort. Patients with upper back pain and the above symptoms may be candidates for a costotransverse or costovertebral joint injection to both help diagnose the condition and provide pain relief. It is important to note that these injections should not be considered a cure for upper back pain: rather, the goal is to help patients get enough pain relief in order to be able to progress with their rehabilitation program. Costotransverse and costovertebral joint injections both involve carefully injecting medication into the small joints where the ribs join with the spine in the upper back. These injections are types of pain blocks and may also be referred to as a costovertebral block or a costotransverse block. Costotransverse and costovertebral joint injections are used to both confirm a diagnosis that these joints are the source of the patient's upper back pain as well as to provide pain relief. Diagnostic goals: by placing numbing medicine into the joint, the amount of immediate pain relief that the patient experiences will help confirm or deny the joint as a source of the upper back pain. If complete pain relief is achieved while the joints are numb it means that these joints are likely the source of patient’s upper back pain and other symptoms, and if not, then there is likely another pain generator. If partial pain relief is obtained, then the joints may be part of the problem. Pain relief function: along with the numbing medication, time release cortisone is also injected into these joints. The cortisone helps reduce any inflammation, which usually surrounds the painful joints in the upper back. Reducing inflammation in the upper back area can often provide long term pain relief. These injections are typically done by a pain management specialist, such as an anesthesiologist, physiatrist, radiologist, or other medical specialist with advanced training (which may include board certification in pain medicine and pain management). Anatomy of the Upper Back and Costovertebral and Costotransverse Joints At each level of the thoracic spine (the upper back), the ribs are attached to the corresponding vertebrae (the bony building blocks of the spine) on the right side and left side with small joints. The rib joints from the second to the tenth vertebrae in the upper back comprise costotransverse and costovertebral joints that are located in the back of the vertebrae. These joints provide stability to the upper back and chest wall. The joints are supported by ligaments, which add strength to the junction of bones and limit the motion of the joints in the upper back. Costotransverse and Costovertebral Injection Procedure Costovertebral and costotransverse joint injections, as with many spinal injections, should only be performed using fluoroscopy (live X-ray). Fluoroscopy allows for guidance in properly placing the needle into the target, and helps avoid injury to adjacent structures. The injection procedure includes the following steps: An IV line may be placed so that relaxation medicine can be given, as needed. The patient lies on an X-ray table and the skin over the mid-back is well cleaned with an antiseptic solution. The physician numbs a small area of skin with local anesthetic, which may sting for a few seconds. The physician uses X-ray guidance (fluoroscopy) to direct a very small needle into the joint. Several drops of contrast dye are then injected to confirm that the medicine only goes into the joint. Following this confirmation, a mixture of small amount of numbing medicine (anesthetic) and anti-inflammatory (steroid) will then be slowly injected into the joint in the upper back. The procedure usually takes approximately 15-30 minutes, followed by about 30-45 minutes of recovery time at the clinic.

The success rates of epidural steroid injections can vary depending on several factors. While some patients experience significant pain relief, others may not experience any pain relief from this procedure. The effects of the injection may be short-term, such as a week, or may continue for a year. Factors that Contribute to a Successful Epidural Steroid Injection: All You Need to Know The efficacy of an epidural depends on many factors, including but not limited to: Underlying condition. This injection treatment is usually more effective in managing lower back pain with radiating leg pain or sciatica versus lower back pain alone. While the injection may also be used to treat non-radicular, localized back pain, the efficacy may be low. Route of administration. Research indicates that the transforaminal and interlaminar routes may obtain more effective results compared to the caudal route. Type of steroid. Poorly soluble or particulate steroids, such as methylprednisolone or triamcinolone, have a long duration of action. Water-soluble or non-particulate steroids, such as dexamethasone, are considered safer than particulate steroids but tend to have a short-term effect. The injection may sometimes be used in combination with a comprehensive rehabilitation program to increase the likelihood of longer-term pain relief and return to everyday activities. Other factors that may affect the outcome of this treatment include the physician’s skill and experience in administering the injection, the use of guided fluoroscopy, and the patient’s general health. The treatment may also be more effective in treating acute pain (versus chronic symptoms). The success rates of epidural steroid injections for the treatment of a few common conditions are discussed below. Epidural Steroid Injections: Success Rates for Treating Sciatica from Different Conditions Sciatica, which is medically known as lumbar radiculopathy, is nerve pain that originates deep in the buttock and travels down to the thigh and/or leg. Sciatica is commonly caused when a herniated disc or narrowing of the bony opening for spinal nerves (foraminal spinal stenosis) compresses a nerve root in the lumbar spine. 1 Clinical trial results in the treatment of sciatica pain with epidural steroid injections have the following success rates: Lumbar herniated disc. An analysis of several large clinical trials indicated that 40% to 80% of patients experienced over 50% improvement in sciatica pain and functional outcome from 3 months up to 1 year when 1 to 4 injections were given in that year. Typically, a better outcome is seen in acute sciatica pain of recent onset with a lesser degree of spinal nerve compression. Foraminal spinal stenosis. In a study group of 60 participants, sciatica pain was relieved in 87% of patients with mild to moderate stenosis and 42% of patients with severe stenosis. The treatment included 1 injection and the effects lasted up to 3 months. Other conditions such as spinal cysts or ligament thickening that cause spinal nerve compression and radicular nerve pain in the legs may also yield similar results when treated with these injections. Effectiveness of Epidural Injections for Axial Back Pain Localized lower back pain is typically caused due to inflammatory changes within the spinal soft tissues or lumbar discs. In a study involving 120 participants with axial low back pain, treatment with 4 injections given over a span of 1 year showed more than 50% improvement in pain and functional outcome in 68% of patients. Other studies have reported pain relief for 2 years when 6 injections were spaced out and given during this period. Analyzing Success Rates for Neurogenic Claudication Neurogenic claudication, characterized by pain felt in both legs while walking variable distances, is usually treated with bilateral transforaminal epidural steroid injections (given on both sides of the spine). A study involving 22 participants showed 30% of patients experiencing pain relief at 1 month, 53% at 3 months, and 44% at 6 months after receiving bilateral injections. Other studies have reported pain relief for 2 years when 6 injections were spaced out and given during this period. Number of Epidural Steroid Injections Needed for Pain Relief Research indicates that an additional injection may be given if the following criteria are met: More than 50% of pain reduction was experienced after the first injection The effect of the first injection decreased after a considerable relief period, for example, over 1 month Common guidelines recommend that if more than 4 epidural steroid injections are needed in 1 year, the underlying condition must be managed by other treatment methods. To improve the overall outcome of the procedure and reduce the risk of side effects, using a blunt needle, live fluoroscopy, and administering a small test dose initially may be helpful. Benefits of Combining Physical Therapy with Epidural Steroid Injection A guided physical therapy program may be combined with the epidural steroid injection treatment for an added benefit. Studies suggest that combining physical therapy with the injection treatment of herniated discs may improve the quality of pain relief and overall satisfaction in the patient. 16Injection treatment of lower back conditions such as spinal stenosis may benefit from improved quality of life and overall health when combined with physical therapy; with no direct effect on pain-relief values

Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back. A cervical, thoracic or lumbar facet joint injection involves injecting a small amount of local anesthetic (numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition. See Facet Joint Injections and Medial Branch Blocks Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief: Diagnostic goals: By placing numbing medicine into the facet joint, the amount of immediate pain relief experienced by the patient will help determine if the facet joint is a source of pain. If complete pain relief is achieved while the facet joint is numb, it means that joint is likely a source of pain. Pain relief goals: Along with the numbing medication, a facet joint injection also includes injecting time-release steroid (cortisone) into the facet joint to reduce inflammation, which can sometimes provide longer-term pain relief. The injection procedure may also be called a facet block, as its purpose is to block the pain. Facet Joint Anatomy The facet joints are paired joints in the back and neck, one pair at each vertebral level (one joint on each side of the vertebrae). These joints have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule that is filled with synovial fluid, which reduces the friction between bones that rub together.

The spine is composed of 33 bones (vertebrae), with a spongy cushion of cartilage between each bone called a disc. Each vertebra has a hole in the center, through which runs the spinal cord. The nerves that control the rest of the body run off the spinal cord along the length of the spine. The spine is stabilized by muscles, tendons and ligaments, which provide strength and allow the body to twist, bend, rotate and flex backward. Flexibility and multiple interlinked moving parts mean that if any structure is weakened, damaged or diseased, other structures in the spine must take up the load, which can result in pain.

Back pain problems usually have one of three main causes: injuries like falls or automobile accidents or trauma in contact sports like football can result in chronic back pain. Poor body mechanics (like improper lifting) and poor posture may cause back pain because of chronic muscle tension and spasm. Degenerative problems are often the primary cause of back pain. As people age, the cartilage between the bones of the spine may degenerate from wear and tear. Degeneration can also occur from overuse, such as work that regularly stresses the spine. Arthritis of the spine is another possible source of back pain.

Treatment for back pain depends on the cause of the problem and the severity of symptoms. A muscle sprain is usually treated with a few days of rest, ice and/or heat. Medications to reduce inflammation may be helpful, especially in the early stages of an acute injury. Exercise is important in any back pain treatment program. Strong muscles support the spine, and flexibility helps prevent injury. Walking also helps provide oxygen to muscles and promote tissue healing. Massage may be helpful. Oral pain medication and muscle relaxants may relieve symptoms. For pain that persists beyond more than a few days, physical therapy may be prescribed. An epidural steroid injection and/or joint injections in the spine can relieve pain in some cases. In most cases, surgery should be considered only after all conservative treatments have been tried.

Reducing tension in muscles supporting the spine; tension in these muscles can worsen pain from any number of back pain conditions Improving range of motion and overall mobility Reducing risk of disability caused by back pain Pain that lasts longer than 3 months (chronic pain) may require weeks or months of regular stretching to successfully reduce pain. Stretches may be included as part of a physical therapy program, and/or recommended to be done at home on a daily basis.

Stretches that are not recommended include neck circles (where the head is repeatedly rolled around the neck) or quickly stretching the neck forward and backward or side to side. These stretches may cause muscles strain or place additional stress on the cervical spine. Back Flexion Stretch. Lying on the back, pull both knees to the chest while simultaneously flexing the head forward until a comfortable stretch is felt across the mid and low back. Knee to Chest Stretch. Lie on the back with the knees bent and both heels on the floor, then place both hands behind one knee and pull it toward the chest, stretching the gluteus and piriformis muscles in the buttock. Kneeling Lunge Stretch. Starting on both knees, move one leg forward so the foot is flat on the ground, keeping weight evenly distributed through both hips (rather than on one side or the other). Place both hands on the top of the thigh, and gently lean the body forward to feel a stretch in the front of the other leg. This stretch affects the hip flexor muscles, which attach to the pelvis and can impact posture if too tight. Piriformis Muscle Stretch. Lie on the back with knees bent and both heels on the floor. Cross one leg over the other, resting the ankle on the bent knee, then gently pull the bottom knee toward the chest until a stretch is felt in the buttock. Or, lying on the floor, cross one leg over the other and pull it forward over the body at the knee, keeping the other leg flat. The above are representative samples of the types of stretches commonly prescribed. Most stretches are adaptable to accommodate an individual’s flexibility and level of pain, and can be made easier by using a wall, door jamb, or chair for added stability during the stretch.

Basic stretches for neck pain are convenient enough to be done on a regular basis throughout the day, such as at home, at work, or even in the car. Some examples include: Flexion stretch—Chin to Chest. Gently bend the head forward, bringing the chin toward the chest until a stretch is felt in the back of the neck. Lateral Flexion Stretch—Ear to Shoulder. Bend the neck to one side as if to touch the ear to the shoulder until a stretch is felt in the side of the neck. Keep the shoulders down and back in a comfortable but healthy posture. Levator scapula stretch. Rest one arm against a wall or doorjamb with the elbow slightly above the shoulder, then turn the head to face the opposite direction. Bring the chin down toward the collarbone to feel a stretch in the back of the neck. It may be helpful to gently pull the head forward with the other hand to hold the stretch for the desired time. Corner stretch. Stand facing the corner of a room, and place the forearms on each wall with the elbows around shoulder height. Then lean forward until a stretch is felt under the collarbone. Keeping the following in mind can help effectively stretch the muscles without injury: Wear comfortable clothing that won’t bind or constrict movements Do not force the body into difficult or painful positions—stretching should be pain free Move into a stretch slowly and avoid bouncing, which can cause muscle strain Stretch on a clean, flat surface that is large enough to move freely Hold stretches long enough (15 to 30 seconds) to adequately lengthen muscles and improve range of motion 1 Repeat a stretch between 2 and 5 times—a muscle usually reaches maximum elongation after about 4 repetitions 1 Stretch one side of the body at a time

Depending upon the specific diagnosis and pain level, different exercises may be recommended for neck pain. It is important for patients to seek a cervical spine specialist who is trained to evaluate neck pain and develop an individualized exercise program. If the patient’s neck hurts too much to do neck exercises, other treatments may be recommended first, such as medications to help reduce the pain enough for the neck to start moving. Some other tips that may alleviate pain and make the exercises more comfortable include: Prior to exercise, apply a heating pad to warm up stiff muscles and joints and make it easier to stretch. After exercise, apply a cold pack (or frozen bag of peas wrapped in a towel) to reduce inflammation in the joints and muscles. If a neck exercise feels painful, it should either be modified or discontinued. A medical professional can help ensure that neck exercises are done in a manner that does not cause pain.

When neck, chest, and upper back muscles become weakened, tightened, and/or elongated, the shoulders can become rounded and the head sags forward. This poor posture in turn puts more stress on the cervical spine’s facet joints and intervertebral discs, as well as the muscles and ligaments. Poor posture with the head too far forward may lead to chronic or recurrent neck pain that can also be accompanied by stiff joints, upper back pain, shoulder blade pain, and headaches. Fortunately, a neck exercise program may be able to help address most of these symptoms as follows: Neck stretches Flexibility and stretching exercises can expand or preserve the range of motion and elasticity in affected cervical (neck) joints, and thus relieve the stiffness that accompanies pain. As a general rule, neck stretching is best done every day, and some stretches can be done several times a day. Neck strengthening Specific strengthening exercises can help maintain improved posture, which in turn can lessen or eliminate recurrent flare-ups of pain. As a general rule, neck strengthening exercises should be done every other day to allow muscles time to repair themselves. Aerobic conditioning Aerobic exercise, commonly called “cardio,” is fueled by a steady intake of oxygen and keeps the heart rate and breathing levels elevated for the duration of the workout. Aerobic exercises increase blood flow to the muscles and soft tissues of the neck and upper back, which can help loosen the muscles and increase range of motion. In addition, after about 30 or more minutes of aerobic exercise, the body’s natural painkillers—called endorphins—are released and can help reduce neck pain. Aerobic exercise can be done every day. Some good options include using a treadmill, stationary bike, or an elliptical machine, as well as an upper body ergometer or arm bike. For someone who has not done aerobic conditioning in a while, going for a brisk walk can be a good start. In addition to helping provide relief for neck pain, these exercises can also help prevent future recurrences of neck pain by maintaining a strong and flexible neck that naturally holds better posture.

a.) Cancer (b.) Epilepsy (c.) Glaucoma (d.) HIV (e.) AIDS (f.) PTSD (g.) ALS (h.) Crohn’s Disease (i.) Parkinson’s disease (j.) Multiple Sclerosis (k.) * Medical conditions of the same kind or class as or comparable to those enumerated in (a)-(j) above. Examples might include: Painful muscle spasms, Generalized Anxiety Disorder with or without Panic Attacks, , Autism with disabling Anxiety Component, fibromyalgia, Dementia or Alzheimer’s with disabling Anxiety Component, nerve pain or neuropathies, muscular dystrophy or other muscle disorders if accompanied by painful muscle spasm. Physician *must send the Board of Medicine a documentation letter for any patient certified under (k.) (l) A terminal condition ( less than one year survival if condition is to follow its natural course) diagnosed by a Physician other than the physician issuing Medical Marijuana certification. AND (m.) CHRONIC NON-MALIGNANT PAIN caused by a qualified medical condition and persists beyond the usual course of that qualifying medical condition. FEES: (no medical Insurance in FL currently covers visits related to Medical Marijuana) New Patient: 1st visit: $229, 2nd visit: about 3 months later: $150, subsequent visits: typically every 6 months: $150 Established patients: must have had at least 1 visit with us not related to use of Medical Marijuana, last visit must have been in last 9 months: 1st visit: $175, 2nd visit: about 3 months later: $150, subsequent vsits: typically every 6 months: $150 Get PREQUALIFIED by: bringing or signing the release of medical records mentioning your any of the above Qualified Medical Condition. Last 3 clinic visit notes and summary page of your Diagnoses from your treating Physician usually suffice. Please see release of Information under Forms Tab of this web site. Steps to Treatment for New patient seeking Medical Marijuana or low dose THC: Become a Qualified Patient : 1) Be a permanent or seasonal (more on this later) FL resident. 2) Be diagnosed with a Qualifying medical condition (described above) by a qualified physician. 3) Be entered into Medical Marijuana Use Registry 4) Obtain a Medical Marijuana Use Registry Identification Card 5) Go to FL state approved Dispensaries to get the product/s. Get the treatment you need and FEEL BETTER !! Latest: US House of Representatives has already approved Medical Marijuana for recreational use, but it will meet HURDLES in US Senate and then the Individual states!! Site to study in Details to learn more: FL Dept of Health: Office of Medical Marijuana Use: OMMU: knowthefactsmmj.com

Cannabinoids -- the active chemicals in medical marijuana -- are similar to chemicals the body makes that are involved in appetite, memory, movement, and pain. Research suggests cannabinoids and THC might: Reduce anxiety Reduce inflammation and relieve pain Control nausea and vomiting caused by chemotherapy Kill cancer cells and slow tumor growth Relax tight muscles in people with multiple sclerosis Stimulate appetite and improve weight gain in people with cancer and AIDS Greatest benefits of Medical Marijuana and low dose THC seem to be : reduce chronic pains, reduce muscle stiffness (spasticity) , Anxiety Disorders and relieve Nausea and Vomiting (especially Chemotherapy related) .

How you take it is up to you. Each method works differently in your body. Smoking or vaporizing will make you feel the effects of cannabis almost immediately. However, it can take up to 2 hours for edibles to take effect. Smoke it Inhale it through a device called a vaporizer that turns it into a mist Eat it -- for example, in a brownie or lollipop Apply it to your skin in a lotion, spray, oil, or cream Place a few drops of a liquid under your tongue