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Hello I'm Jennifer Blomquist.

Welcome to HealthLine.

I'm so glad you joined us tonight.

I have the privilege of hosting the program I guarantee especially if you're new to this show that you will learn something.

Everyone will learn something.

I know myself included I always appreciate that.

But I want to let you know too that this is a live program.

That's why we have the phone number up at the bottom the screen and we will keep it up for you throughout the program because you have an opportunity to get some free medical advice tonight and it is truly free.

First of all, the number if you want to call in and ask a question is (969) 27 to zero.

It is still a free call if you put if you're outside of Fort Wayne you can just put an 866- in front of there.

So here are your options when you call in.

First of all, I want to assure you that you will never just be thrown on the air.

You will talk to a call screener, a very nice lady and you have the option of asking the question live during the show which is great and I would encourage it if you want to do that if you feel comfortable going that route because that way you can discuss the situation with the doctor.

Maybe he will need to ask you more questions to better answer your question.

>> The other option which is also a good one is you can just tell the call screener what you want to find out and they will pass that information along to me and I will ask the doctor the question for you so do whatever you feel most comfortable doing.

But like I said, it's a it's a great opportunity to get some help.

Maybe you just need a little advice or be pointed in a certain direction to figure out how to solve an issue maybe having so tonight we're talking about knee neck pain, joint pain, things like that.

We have a pain medicine specialist here who are so grateful to have him on the show.

>> This is Dr. Sean Kokanee and he will be he's got some props as you can see a spinal prop and a knee prop there.

So if you have questions if you're having issues with those parts of your bodies he was telling me before the show he specializes a lot of times with people who have chronic pain, not so much acute pain but if you have chronic pain that is miserable.

But he may have some some advice for you so please call in any time we're going to be talking about a certain kind of procedure that they offer to try and resolve some of these issues but feel free to interrupt us at any time if you're having issues related to knee pain, back pain, spinal pain, things like that, give us a call and we can get you taken care of .

>> So Dr. Kokanee, thank you so much again.

Thanks, Jennifer.

>> Thanks for bringing the props to especially with the spine.

It's so involved it's great that you have that so you can show us exactly what were you talking about.

We don't always yeah.

Those of us not in your field, you know, we may not know what exactly you're talking about.

>> It's a complicated structure so it's nice to actually see and show patients what's actually happening.

>> I was going to say and from just from shows I've done in the past it seems like what happens in the lower spine can be so much different than what you can experience in the upper spine.

>> That's true in the anatomy is much different the lower back because you move up to the thoracic spine as you can see here, the lower back you have the joints, you have your tailbone, you have the larger lumbar vertebrae, the joints thoracic spine is much different because you have ribs here.

So it really does restrict a lot of the movement in this area so it's less likely to cause pain in the thoracic area.

The neck again we have a lot of movement so people got lower lower neck pain.

>> So it's another problematic area for arthritis and injuries and always look so you know, when you get toward the neck everything I guess just since it's smaller it looks so much more delicate it must be here at the bottom.

>> Yeah, that's correct.

So all right.

>> But if you're having issues in any part of your spine, of course it's going to be uncomfortable so sure.

Absolutely.

Well, you and I were talking before the show and I was asking you, you know, most of the patients that come to see you, they've already been to somebody else for their issue.

>> You're kind of the last you know, and you know, the end of the game here just trying to find last resort trying to resolve this issue.

>> So what kinds of things can you offer people?

You know, maybe they do have some chronic back pain or knee pain.

What kinds of things can you offer them?

And I know you like to start conservatively so yeah, for most people who have chronic pain we always ask them have you had physical therapy?

>> What medicines you're taking?

Are you exercising other healthy things that they can do to maximize their own personal wellbeing?

>> If they fail those then we can talk about is it more joint pain or is it more nerve pain?

>> Those are two ways to differentiate.

We need to start treating patients.

We always X-ray patients in the office if they don't have other imaging at least gives us a good idea where they have It's had bad disc degeneration that's extremely helpful MRI you don't always have to do an MRI.

So it all really depends on if they're getting arm and leg pain, been in motor vehicle accidents or severe sport injuries and they're like OK, we probably should do an MRI to assess what the spinal cord might look like.

Is there a disc herniation?

Is there any nerve compression anywhere or if there's any other concerning things like this severe pain or history of cancer then we should do an MRI to make sure OK, yeah.

>> So once and the nice thing is that when I was talking to you before it sounds like you can do everything in an office.

I think people are not very especially you're dealing with pain on top of it having to go through a whole bunch of different locations.

But it sounds like most of this can be treated in depending on the setup of that physicians have.

>> They can do a lot of the procedure stuff in an office and X-rays.

>> Yes, good deal.

So once you have all the imagery does that usually give you a pretty good idea of what you're dealing with or do you have to even take it a step further?

>> To me the most important thing when you talk to a patient is what they're telling you about how their pain is that really tells you what's happening with them on a day to day basis.

And the other part of it is your exam because I think most of my Decision-Making comes from what they tell me about my exam shows versus when an imaging study is so for example, you can look at an old car and you think well I wouldn't want to drive that looks really bad but it could work great.

>> The same thing in the spine.

So if you look at your spine you can have severe arthritis and some people have no pain.

>> So just because you have arthritis doesn't mean it's causing pain.

So it's even younger patients who play sports or have injuries.

>> They don't have arthritis but they have horrible pain.

Yeah.

So you can't always judge in imaging studies and just go to that remember treating you not the imaging study.

>> Right, right.

That's interesting that you said sometimes things can look really bad but not result in comfort so absolutely.

>> So tell me about this frequency procedure.

>> What does it do and who's a good candidate for it?

So patients who have Alschuler model here if you have chronic joint pain I'll take the low back for an example this is a common problem.

These joints are about the size of your thumb knuckle joint and they have sensory nerves next to them.

They're actually outside the spine so they're very easy to access.

>> So to prove that you have pain there we would under X-ray take a needle and numb the nerves up there and if you get temporary pain reduction that's helping us to diagnose your pain is coming from these specific structures that are arthritis in it or if you had an injury even if it's not from arthritis and that can help us determine if you're a candidate for a radiofrequency which basically means the fancy term for saying we're going to burn that sensory nerve away with a needle and that will help eliminate the pain from those specific joints.

OK, and the benefit can last for some people up to three years.

>> Wow.

I was going to say I was going to say because I hear about people having things like epidurals but those don't last very long.

>> It depends on what their condition is.

So this is specifically treating joint pain epidurals target more nerve pain so OK, wholly different treatments for sure.

Yeah.

OK, so I have a lot of patients who are like to play sports for a lot of my snowbirds.

Hey they come in and say to me I want this done before I take off for the winter.

>> Right.

And they have a great time because once you get rid of that pain they can start enjoying a lot of the recreational activities they want to do.

>> So how do you do that in the office?

Is somebody are you looking at like an X-ray or how how are you finding out exactly how to do the rotating X-ray so we can take pictures from various angles and that helps us pinpoint exactly where to place the needle under X-ray guidance.

How uncomfortable or not is the procedure or do are they given something to some patients if they want to take an oral medicine technique if they want OK, we do use local anesthetic OK needles we use our little thin wires so stick needles at all.

>> It's like the needle that you draw blood out of .

Oh OK.

So they're very thin wires we can just drop there OK and put the anesthetic right over those areas and then we see the patient back like a week later to see how much relief they get from a test shot.

>> Yeah.

How quickly might they notice a change.

What's going to be immediate.

So it's going to last maybe in between two to four to eight hours depending on the anesthetic that we use.

>> OK, but they I mean a lot of people if that if that is effective I mean they would notice the results right away and be good.

>> You might notice a result before they walk out the door.

Oh wow.

OK, absolutely.

If that doesn't work is there do would you repeat it maybe if it doesn't work the first time that we would need to see is it more disk nerve pain?

Is it even these larger side joints they have nerve supply to it so people have a lot of lower back pain.

These big joints actually bigger than hip joint they can be a pain generator too.

>> And as you can see, these nerves essentially are very easy to get to.

Oh yeah.

So under an X-ray you can just drop needles there in those areas of the pin pinpoint maybe this is causing pain.

OK, the interesting about the Lobach is you have so many structures in a tight space and have all different nerve supply.

OK so almost have to tease out what is causing your pain to make sure we treat it correctly.

>> Yeah yeah it yeah like you saying before the show it's a very complicated story.

There's a lot going on there for sure.

I want to continue talking about this but we did have a gentleman who called him on it to ask you a question Doctor.

So let's see we got a call from John and he is saying that he has pain in his foreign L5 vertebrae and other other than a steroid shot.

>> What can he do to help with that kind of pain?

The 04 05?

Yeah.

So I think if the steroid shot if it did not help then you may want to consider doing a diagnostic medial branch blog to see whether or not you have a joint related pain.

Absolutely.

So just what we were talking about right now.

>> So is it common if somebody has that kind of pain like John was saying sounds like it's impacting two vertebrae for him but I mean how that seems like a small area but could it be a really big area that is usually when we treat patients particularly the medial branch blocks to before we do the radio frequency or even epidurals we might target two levels, OK, because some patients have multiple areas of pathology.

>> So while we're in the suite we will just target those areas for them.

>> Yeah, OK.

Correct.

Yeah.

All right.

Great job.

Thank you so much for your question and just want to remind everybody else watching can be just as easy is as what John did.

He called and talked to the call screener and gave his question to the call screener.

But again you have that other option of calling and talking live during the show.

I promise you will be very nice.

Dr. Kokanee is very kind.

We it will be a pleasant experience.

So if the one thing I like about that when people call and talk to the doctor live is that he can ask you questions to get more information and that might help you to help and help him so he can better answer what what you need to know.

So there's a number again (969) 27 two zero still free if you're outside of Fort Wayne, just put an 866- in front of there.

>> We'll get you through so we are talking about the radio radio frequency procedure showing it as far as the spine goes but you also have a knee prop.

>> So absolutely what what would that involve if you having knee pain you could still do that same procedure.

>> There's a lot of patients who have horrible knee pain.

Yeah, Either it's post surgical pain even after a knee replacement or even if you're just an athlete injuring knee if you have chronic pain.

OK, do you have sensory nerves here that you can block just like we talked about in the back?

>> Right.

You can block the nerves or there are three major ones that under an X-ray we can remember them up to see does that temporarily reduce the pain around the knee, particularly the part of the knee?

OK, if that works really well, just like we talked about, you can do the radiofrequency in the back.

You can do it here too.

So it's a very effective and it can last for a year and a half maybe two years for patients.

>> Yeah OK so not quite as long as you with a knee and the nurse can go back a little faster OK but yeah it has seen success.

>> Yeah.

Same type of situation where they would have immediate relief if if you use a long acting anesthetic so they may get close to four to six hours of pain relief if it's going to work OK and if it is successful and reduces pain our goal to get 80 percent reduction with the test shot with the anesthetic that does that then we can do the radiofrequency the great thing about a radio frequency is all done with needles.

You're not it's not surgery not cut open.

>> You can resume your normal activity the next day.

There's no restrictions on you at all.

That's amazing when you think about years ago, you know something like this would have required probably a hospital stay.

So this is all that outpatient is very nice.

So even patients have had knee replacements who still have pain afterwards we do this for them.

>> Yeah, well and we've had many programs about knee replacement and so forth and for some people it works great but for others and I know that can be a long lasting solution for others I would think that would be kind of disheartening because that's not an easy surgery or recovery .

>> So it's good to know that there that there is still some hope.

Yeah, yeah.

So I mean surgery fix is something anatomic but it's not a guarantee it's a guarantee that it gets rid of pain.

>> So sometimes we have to do this for them.

OK, so yeah I want to remind you again we only have doctor here until a little before eight o'clock so call sooner rather than later.

There's a phone number on the screen.

We'll leave it up through the end of the program.

In the meantime I did want to turn to somebody Doctor.

>> We want to ask the question life so turn it over to you, Paul.

Are you still there?

Oh yes.

I'm in the last two or three months regarding neck pain and lower back pain no form of treatment I believe it's regenerate and no surgery or drugs.

Can you comment on that and also acupuncture.

>> Thank you.

I think far as the acupuncture part I don't know how well that will work for this degeneration if you're getting nerve root pain that may not be very successful.

I know I've had patients try it and it's kind of a mixed bag.

Sometimes they feel like it might help, sometimes it doesn't.

Far as regenerative medicine, I think the jury's still out on that because it's still using stem cell or using platelets because platelets have growth factors in there so they just draw blood, spin it down and try to inject it in the disk space or even into the larger joints.

We do that for patients like say joints and in the knee.

I'm not sure how well that's going to work in the spine yet that still needs to be figured out better in research.

Sure.

Before we can really offer that to patients and say this is really going to work because it's a Kaspi thing that's very expensive and wouldn't want to put patients through a procedure and have them pay that much money and then oh we didn't do anything wrong, you know and you know, given what we know about FAS, what epidurals can do and radiofrequency do, we can get rid of a substantial amount of pain for patients with these techniques and then obviously if you fail that then you can look at something for as you know, stem cell or other stuff like that.

>> OK, yeah.

I mean there's a lot of research that's always ongoing to know what we're talking about tonight could be totally different and quite a bit more advanced in just five years.

>> Absolutely.

We wanted to I just I just want remind you to go ahead and call any time we're going to keep talking about this, you know, issues that people can have with their neck, their back knee pain and solutions that may be available to you but feel free to call and ask a question at any time you could do it like Paul just did where he has to live, which is great.

We had a gentleman named John Call earlier and I asked the question for him perfect option as well.

>> So take advantage of getting some free advice tonight.

Yeah, you know, I was wondering if you have the radio frequency procedure is you said the pain goes away but is there any thing anything else the patient would have to do like physical therapy or certain exercises to prevent it?

>> Sure.

That's a great question.

So prior to doing a radio frequency, make sure the patient is doing therapy, they should always tell them you have to stick with it because the radio frequency can get rid of the pain but it can't improve your muscle strength.

It won't do that.

It's not going to help your flexibility.

OK, so those are things that the patient has to do.

I mean we can do our part but once we're done with our end the patient needs to carry that going forward.

Sure.

Other things like exercising help I usually tell patients if you find a sport do that do something active because it's good for the body staying active weight loss, all these simple things can benefit them.

>> Sure.

Absolutely.

Yeah.

You know, I've a lot of my children I've had to go to physical therapy for orthopedic things and what I'm finding now is a lot of the therapists because it can be tolling and expensive to keep going back the way I think it is.

>> But a lot of them will give us stuff that we can just work on at home.

You know, you might not have to go every week.

I'm finding that some of them will say hey, two weeks, do what I told you to do and then you know, you can go in and maybe they need to, you know, do things where they're doing like massaging or treatments in the office.

>> But I feel like it's physical therapy is changed a little bit over the years.

It's a different issue.

So if you're a post surgical patient you probably need the supervised therapy because they want to be sure you don't do something wrong.

>> Right.

But a non-surgical patient well, they can teach you how to do something and they can let you go with a home exercise program and then you have to do it on a daily basis.

Sure.

I used tell people stretching do the stretching daily.

Yeah.

Because there's nothing worse than you know we have a set of sedentary lifestyle.

Yeah.

Things start stiffening up and you go do something on the weekend you pull something.

>> Yeah yeah.

So that's not helpful.

Yeah no and I noticed as I get older feels good to stretch it no matter what for sure.

I think we have a couple of people that wanted to ask you a question so let's see I think there's somebody named Marshall are you there Marshall that's me.

Yeah go ahead Marshall.

And like I said stay on the line if you want so that you can converse with doctor.

It might help him better answer your question.

>> OK, well I would like to know I have knee pain from arthritis now but would that help with my knee pain if I moved to Arizona or New Mexico is is dry and warm and dry there with that help.

>> But yeah, some patients feel that the warmer, drier weather does help them probably more you don't get such a barometric pressure change on those arthritic joints you have patients say I know what it's going to rain because their joints hurt the day before.

>> I've heard people say that.

But yeah, if you're in Arizona it doesn't rain there so you never worry about it then.

>> Mark Marshall, did you want to ask Dr. Kokanee anything else?

Well, also I have like I had much surgery like I had a lot poma taken three months ago but my neck still hurts and it could be a little swelling in there.

>> What could that be?

You probably need to get an X-ray done.

A lipoma is mostly a soft tissue mass outside maybe close to the muscle area but you need an X-ray if you just have pain just in the joint area.

>> If you're getting arm pain, if you need to get an MRI done .

OK, all right.

Marshall, thank you so much and thank you for staying on the line too.

I appreciate that you can do what Marshall did he call in, get a question answered?

Sounds like he's going to be maybe relocating to Arizona.

>> Sounds pretty good to me actually the older I get I am not so crazy about the cold climate but yeah, feel free to give us a call (969) 27 to zero.

Let's see there's holding up the card.

We have five minutes left but we could we could sneak in a couple of calls no problem.

So take advantage of getting some free advice tonight in fact of doctor before we continue talking, I'm seeing a call coming in right now.

>> So is Jackie on the line?

>> Hi, Jackie.

Are you there?

Yes.

You go ahead with your question .

Doctor seems to be talking I'm watching the program so oh, just turn the sound out on your TV because there's a little bit of a delay.

>> OK, I get a little confused so yeah.

>> Go ahead, turn the volume down on your television and then you'll be better just listen to us on the phone.

All righty.

All right.

>> Go ahead with your question any time she's still OK. >> I'm sorry.

OK, that's talking.

Is there something real quickly that you can you could ask and then maybe you can hang up and just listen to the TV for your OK whatever I gave you or whoever I was talking to.

>> Oh here we go.

Okay thank you.

Hello.

Yes it said do you have scoliosis and discussions Jackie are you still there.

Yes I feel bad.

>> I think there's a I think there's a little bit of a delay.

Well so I mean I'm familiar with scoliosis crooked spine or maybe uneven spine.

She was having some disc issues.

Is she a candidate for radiofrequency?

>> You can be as you get older that as a disk wear down you get more pressure on the joints so depending on where it's located, yes, you can do the diagnostic workup and look at doing a radio frequency for the laser.

So we do patients who have scoliosis.

>> Absolutely.

All right.

Yeah, we could maybe sneak in another question.

So if you want to call in real quickly, feel free to do so.

Just as I said we got another person calling and so he's got it looks like I'm going to be asking a question for him.

Before I forget though, Dr. with once you do the radio frequency I know you said it last for a while but do they have to come back for regular checkups like if you said I could last for three years for the spine but are they going to have to come back and see a physician in the meantime?

>> Usually once you do the radiofrequency we see the next six weeks later make sure thing is good.

They're fine with discharge then they will have to probably come back if as a nerves can regrow OK and that pain in those areas can recur.

So we just have retested if it's the same area then we would just repeat it for them and the effectiveness is just the same good good.

You got to keep on top of stuff it sounds like I'll just quickly ask you this.

So John, another man named John called and he said he's had a cortisone shot, had his nerve burned but he's still having pain.

What with the next steps B I'm not sure if he's talking about back pain or OK. >> Yeah so the other issue is patients who had it's only maybe an epidural injection or radiofrequency if you're still having pain.

>> The other thing you have to think about patients can get pain just from the disc itself .

Oh, it has a lot of innovation around it so they're harder to treat just because the only really option is to do like a disc replacement or a fusion.

OK, so if you've had epidural shots and failed if you did a radio frequency and that helps some but not enough and you're still getting pain, you probably want to talk to a surgeon to see if you may need a disc replacement for one level that's gone bad or if fusion.

>> Yeah, OK, so he's definitely have some options.

I just want to review very quickly because a lot of people like you said they this chronic pain and so they come to you and the testing that you can do can kind of give you an idea of exactly what what is going wrong if they're going to go this route.

I mean is this kind of the end all or are there even things that the radio frequency fails that maybe you could try down the road the success rate with the rate of eighty five percent OK, so to me I think out of all the procedures we do this is the best one OK is highly effective if they still have residual we probably like epidural injection different levels because if they have discrimination's canal stenosis then we would do that for them.

>> Yeah yeah.

>> Unfortunately you were saying before the show you really can't bring the pain to zero zero close.

You know I'm a rehab doctor by training so I tell patients I want to see you're functioning better.

Can you go to work?

Can you do your recreational activities?

Those are things that are meaningful to be sure you have to live and do your stuff.

>> Right?

Right.

Yeah, that's what I know.

We've had all the doctors who specialize in knee.

They tell the patient hey, you tell me when you're ready for surgery.

Correct?

That's because you know when you some people get to that point where they just can't take it can't take it anymore.

Right.

Great to know that they have some options.

So thank you.

There's hope out there.

So thank you to everybody who called in tonight.

Dr. Kokanee, thank you so much.

Thanks for having me.

I certainly appreciate you have to come back.

A lot of people have neck the spine, all sorts of pain like that.

So yeah, All right.

>> Good to know there's some options for you.

Thank you so much for joining tonight and for asking some great questions.

Take here and we'll see on HealthLine one week from tonight.

>> Bye bye