Pill Mills part 1
When I came to Fort Lauderdale in 2000 I was the first fellowship trained pain specialist in the county. There were about seven other physicians in five locations who were practicing different aspects of pain management in the area; we all knew who each other were and shared a variety of patients. Over the next seven years this number ebbed and flowed but never exceeded 10-12 legitimate practitioners. Starting in 2007 I began to notice an increase of Pain Clinic signs throughout the county and at last count there were 122 Pain Clinics registered in the county.
Many of these clinics Pill Mills are not owned by physicians, and the employed physicians have no formal training in Pain Management. Many are retired physicians who have come out of retirement to make some extra money. These clinics are generally treating patients with pills only, and sometimes extremely high doses of dangerous medications. This has resulted in disastrous results.
There are as of last count 10.4 patients dying per day due to prescription drug overdose. I dare to say if 10 manatees died per day there would be an uproar in the media. The percentage of overdose deaths in Broward County are 80% prescription drugs and 20% heroine. The ratios are reversed in Dade and Palm Beach counties.
Next Blog—What is being done to fix this
Last weekend I participated in a national training seminar for top physicians who use spinal cord stimulators to treat patients with chronic lower back pain and sciatica. Among the most popular of these small, implantable devices are the Penta 5-Column Paddle Lead and the EON Mini. The Penta Paddle Lead contains tiny electrodes in a five-column array that allow for selective nerve fiber stimulation. The small size of the Penta Paddle Lead and its five-column design allow for more precise targeting of specific nerve fibers – a very innovate tool! Please see my previous blog for more information on the EON Mini.
The Neuromodulation Faculty, who routinely train physicians in the use and implementation of spinal cord stimulators, held the seminar. Designed for physicians from many specialties (including neurosurgery, pain medicine, anesthesia, and physiatry) the seminar was aimed at improving presentation skills and career development. The Neuromodulation Faculty (of which I am a proud member) consists of thirty physicians from across the United States with half of the members serving as mentors for the remaining half. The purpose of this group is to improve patient care in chronic pain by training physicians, engaging in research, and increasing awareness about the effectiveness of spinal cord stimulation. The ultimate goal is making it possible for more patients to benefit from this treatment.
The part of the seminar I enjoyed the most involved being filmed by a professional media group after giving a brief presentation on the science of neuromodulation. The feedback will allow me to better communicate to patients and other physicians. I also enjoyed being paired up with a senior physician in the field who is going to mentor me by setting goals in publishing papers. My mentor has already helped me by reviewing book chapters I have written for a Neurosurgery textbook that is coming out early 2011.
Introduction: Kevin D. Cairns, M.D.
We here at Florida Spine Specialists have recently made a commitment to “blogging.” Our goal is to inform and entertain all who take the time to read our posts; whether you have a casual interest in the field of spinal care or are seeking solutions for your own spinal condition. We also hope that readers feel obliged to participate, ask questions, and interact. We’re here to help!
Born in Los Angeles in 1972, I’ve had the opportunity to study physical medicine and spinal care at several outstanding institutions. After graduating with my Doctorate of Medicine from New York Medical College in 1999. In 2000, I relocated to Boston to begin my Physical Medicine and Rehabilitation Residency with Harvard University. Completing my Residency in 2003, I was fortunate to continue with a Harvard Fellowship in Neurology in the subspecialty of Nerve and Muscle disorders. Finally, I completed my training as a fellow in Interventional Spine at Emory University.
With running, biking, and swimming among my favorite hobbies, I was excited to make the permanent move to South Florida. I spend my early mornings before work training for triatholons and my hope is to one day complete an IronMan race. Now working alongside fellow spine specialists Dr. Kalman Blumberg and Dr. Harold L. Dalton, I get to do what I love most: help patients suffering with spinal conditions return to active and healthy lives.
Please check out the other posts, comment, ask questions, and provide feedback. We look forward to continuing the Florida Spine Specialists blog and hope you will too!
Best Regards,
Kevin D. Cairns, M.D.
The EON Mini
One of my specialties is implantation of the EON Mini, a neurostimulator that has changed the lives of many since its debut in 2008. As the world’s smallest spinal cord stimulator (SCS) battery, the EON Mini (sometimes called a “pain pump”) is an implantable pulse generator (IPG) about the size of a silver dollar.
In very basic terms, the purpose of a spinal cord stimulator is to send electrical signals to the spinal cord. These electrical pulses disrupt the transmission of pain signals from the spinal cord to the brain and thus reduce chronic back pain. This reduction of pain most often leads to accelerated spinal rehabilitation and a decrease in the need for pain medications.
The first EON Mini was tested less than two years ago at St. Jude Medical in St. Paul, Minnesota. The device was implanted into Adam Hammond, a former member of the U.S. Army “Golden Knights” Parachute Team. In 2006, Hammond impacted the ground at more than 45 miles an hour when his parachute didn’t deploy correctly. Among his injuries were a broken femur, shattered pelvis, and severed spine.
Having undergone two subsequent years of surgery, the resulting pain was crippling. Hammond’s rehabilitation rate jumped significantly after the EON Mini implant, resulting in much more mobility and allowing him to begin a return to life as it should be.
The EON Mini is my professional choice for many reasons. Because of its small size, it requires the smallest implant incision of any IPG. It’s also the only rechargeable SCS to receive a 10-year battery life approval by the FDA. Together, this means fast recovery time, fewer battery replacement surgeries, and accordingly a faster return to healthy and pain free life.
Please feel free to provide feedback and ask questions about the EON Mini.
Best Regards,
Kevin D. Cairns, M.D.
The most common question
The most common question I am asked when I see a patient who is a surgical candidate is, “You’re an orthopedic surgeon, right?”. “Yes”. “Well….should I have you do my surgery or a neurosurgeon?”. I often try to help my patient by restating the question for them. They are nervous and are trying to ask this question without upsetting their doctor. The question might be, Should I have a neurosurgeon or an orthopedic surgeon do my surgery? My answer “Neither!”. You don’t want an orthopedic surgeon that does sports medicine, joint replacement and/or hand surgery. You also don’t want a neurosurgeon that does brain tumors, peripheral nerve releases and carotid surgery. You want an orthopedic surgeon or neurosurgeon who has completed their residency in their respective primary field of training and then gone on to complete a minimum twelve month fellowship in spine surgery and limits their practice to surgery of the spine.
This is important for a number or reasons. The single highest risk factor for surgical complications is the training level of the operating surgeon. Those surgeons performing spine surgery without having a fellowship in spine surgery will have the highest complication rates. Of course any surgeon can have a complication of surgery such as infection, neurologic deficit, failure of fusion etc…. The issue is one of risk for the patient and our opinion is that the risk is the lowest when the surgery is performed by a fellowship trained surgeon.
So if you are contemplating having a spine surgery to correct a problem not amenable to nonsurgical care, make sure your surgeon has a fellowship in spine surgery and limits their practice to surgery of the spine.
This is my first blog entry so I thought I would give some background info about myself and our group. I was born a Navy brat in Norfolk Va. and moved to Melbourne Fl. In 1971. I attended the University of Florida where I graduated with both a Bachelors and Masters Degree in Exercise Physiology. I met my wife while attending UF and we have been married for over 20 years. We have 2 wonderful children.
I attended Nova Southeastern University for medical school. I was blessed to do a residency at the Rehabilitation Institute of Chicago, and my fellowship through Emory University. We were very eager to return to sunny South Florida after the long cold winters in the windy city. (The first January that I was there; there was a total of 14 minutes of sunlight the entire month—I missed them all)
Returning to Florida was always our goal and it allowed me to be the first fellowship trained Interventional Pain Management Specialist in Broward County. Joining forces with Dr. Kalman Blumberg, who is fellowship trained in spine surgery and Dr. Kevin Cairns who is fellowship trained in both EMG & Nerve Conduction studies as well as Interventional Pain, has been a wonderful experience. We are the only group of three physicians who are fellowship trained in diagnosing and treating complex spinal conditions in the area.
I look forward to blogging with you, and hope you will find it informative, useful, and occasionally funny.
Harold L. Dalton, DO, FAAPM&R
Florida Spine Specialists
Fort Lauderdale, FL
Up until a few weeks ago I had to ask my kids, “what’s a blog”? They of course just rolled their eyes wondering if I would ever join them in the modern blagosphere or at least join them in the 21st century. So here I am, writing my first blog. Why would I do this? Well it turns out I have a lot to say and I want you to hear me. This blog will be about all things spine related. We (my fellow bloggers, Dr Cairns and Dr Dalton) will only speak the truth about what we know and feel strongly about. We want this blog to be helpful and educational for our readers. We hope to be able to interact with you, answer your questions and become your go to source for spine information.
So who am I? I am a 53 year old spine surgeon born in Miami, Florida raised in fort lauderdale, Florida and various other eastern cities, went to school in new Orleans, medical school in Miami, went for my orthopedic residency in Richmond, Virginia and finished my formal training at the Rothman/Simeone spine fellowship in Philadelphia, PA.
As one of the first fellowship trained spine surgeons in south Florida I have spent the last 20 plus years providing the best care possible to my patients and showing those patients and their referring physicians that good quality, safe spine surgery is possible and should be the norm. We want to discuss the positive aspects of spine care but we also can’t ignore the recent explosion of “snake oil” type of claims often being made by those marketing their spine care on the Internet. The public is enamored with terms like laser, minimally invasive and is at great risk for loss physically, emotionally and financially at the hands of those that would use these terms for the purpose of building and maintaining their spine practices.
So here we are, blogging to those of you who may have interest in what we have to say. We hope to meet your needs and provide a valuable service. We will discuss a wide array of spine issues and look for any suggestions you may have.
