General Practitioners

• Osteoporosis
• Arthritis
• Primary Care
  If the patient is referred by another doctor known to the patient and trusted by the patient, then the first step is easy. If the patient chooses a physician because their name appeared in their insurance reference book, then the first moments may be clouded by a natural uncertainty on both sides. Do patients ask themselves on the way to the new physician's office, did I enroll in an expensive enough insurance policy to guarantee me a top of the class primary care physician or specialist? Do physicians ask themselves, what monetary value does society, let alone the individual patient place on their consultation and advice?
• Emergency Care

Gynecologists

• Labor and Delivery
  After surgery, can increase the effectiveness of a narcotic analgesic afterwards. General anesthetics do not prevent the activation of nociceptors nor do they prevent hyperalgesia. Even after surgery, epidural continuous infusions of morphine or intermittent anesthetics can significantly improve the patient's comfort level. Their perception of pain after surgery or during labor and delivery can be improved dramatically. Surgeons realize that there is a significant clinical benefit measurable in terms of outcome Secondary co-morbidity aspect of an illness, especially after surgery, should be reduced. The patients will have an improved appetite, better sleep, quicker ambulation, a reduction of fatigue and an improved sense of well-being. Overall their healing should be enhanced.

Internists

• Urology
  The Ho:YAG laser is rapidly becoming the standard of care among practicing urologists for the treatment of renal calculi approached in a retrograde fashion, ureteral stones, bladder stones, superficial bladder carcinoma, strictures and BPH requiring surgical intervention. Click HoLRP (Holmium Laser Resection of the Prostate or HoLEP ( Holmiu m Laser Enucleation of the Prostate) to link to the authors' web page for more detailed information.
• Prostate Cancer
  Regardless of the current illness, common, benign, painful conditions can co-exist in patients with cancer. Large disc herniations can be present in a patient with prostate cancer metastasis to the spine. Patient with known coronary artery disease can still have severe chest and arm pain related to a disc herniation in their neck, especially at the C6-7 level.

Neurologists

• Neurology
  Patients expect consumer product information related to medications. This information will be given to them from physicians' office computer files when the prescription is written and then from their pharmacists and even later off the Internet. They will expect detailed information on diseases and will use this information to manage their own disease. In my own practice I have identified a slow evolution toward a surgical neurology practice. Often multiple individuals are better informed with Internet information and come into the office with stacks of paper and huge numbers of x-rays. The time required to effectively treat these patients has increased substantially. Often one hour of time has become a minimum in order to perform a history, physical, review of records, review of x-rays and then discussion of treatment alternatives with the patient.

Psychiatrists

• Depression
• Anxiety

Radiologist

• MRI
  Review an entire medical record, MRI/CT images or insurance information on any patient immediately on a video monitor. Use templates to order tests and prescribe medications legibly.
• X-Rays
• Computed Tomography
  THE CERVICAL DISC HERNIATION SEEN BELOW AT THIS C 5-6 LEVEL CAUSES COMPRESSION OF THE C6 NERVE ROOT WHICH EXITS LATERALLY THROUGH THE NEURAL FORAMEN. THE C6 NERVE ROOT IS ONE OF FIVE MAJOR NERVE ROOTS WHICH LEAVE THE SPINAL CORD IN THE NECK AND THEN CONTROL THE IPSILATERAL SHOULDER, ARM AND HAND MUSCLES AND PROVIDE THE PATHWAYS FOR SENSATION FROM THE SKIN AND JOINTS OF THE ARM OR HAND. THE C6 NERVE ROOT DOES NOT FILL WITH CONTRAST DURING THE MYELOGRAM AND ALSO THE ANTERIOR SURFACE OF THE SPINAL CORD IS SIGNIFICANTLY COMPRESSED OR FLATTENED ON THE SAME SIDE. THIS CT SCAN AXIAL IMAGE FROM A MYELOGRAM CLEARLY DEMONSTRATES THE COMPRESSIVE EFFECTS OF A LARGE CERVICAL DISC HERNIATION.
• Chemotherapy
  These primary brain tumors originate in brain tissue. Metastatic brain tumors spread to the brain tissue through the blood stream predominately. Gliomas are often designated as benign or malignant types although further subtypes are generally determined after biopsy tissue is evaluated by the neuropathologist. The treatments vary based on the clinical condition of the patient and the growth potential of the tumor type. The effects of the tumor vary based on the area of the brain involved and can also include seizures or headaches or symptoms of increased intracranial pressure from the mass effect of the tumor and surrounding cerebral edema. MRI scans generally clearly defne the tumor and the area of the brain involved and can be used to follow the growth of the tumor and side effects of edema or hydrocephalus. Surgery is often performed to remove or at least biopsy the tumor using stereotactic techniques to precisely localize the tumor within the skull. Radiation therapy or chemotherapy are often utilized in the treatment of the malignant gliomas. Surgical implantation of chemotherapy wafers directly on the tumor surface can be considered especially for recurrent malignant glioblastoma multiforme tumors. Tumor protocols have also included treatment by infecting the cerebral gliomas first with a virus and then following surgery, giving anti-viral drugs The tumor mass can be reduced by the effects of drugs on infected cells and the inflammatory response of the brain against the infected tissue. Gamma Knife stereotactic radiation can be used as a primary treatment if the diagnosis is already determined or for small recurrent tumor re-growth. The gold standard is usually surgical resection of all tumor microscopically followed by radiation therapy. Decadron is often given for 3 days or more pre-operatively to reduce cerebral edema. All the options required careful clinical individual evaluation by your physician and discussion of the treatment alternatives.
• Radiation Therapy
  1. Heat and Cold Applications are commonly used superficial techniques for pain modulation. Care should be exercises when cold is applied to a limb affected by peripheral vascular disease or tissues receiving radiation therapy.

Surgeons

• Minimally Invasive Surgery
• Neurosurgery
  Access to pertinent medical information on national neurosurgery web sites and other medical web sites containing pharmacy and drug information simultaneously with an office visit has been a wonderful addition to this busy physician's practice.

Dermatologists

• Lesions
  What happens if we stimulate the somatosensory cortex of the parietal lobe? Pain can be reproduced. If you resect the postcentral gyrus, often 80% patients will have pain relief, but long-term relief does not occur. Indeed this is one example of how clinical applications for performing lesions in the central nervous system may not achieve a long-term benefit. In cancer patients, ablative lesions have a place in pain management, but overall the perception of pain will return. Most likely there are two systems present that help the cerebral cortex understand the sensory input. The neospinothalamic system probably has sensory discriminative input keeping the spatial and the temporal localization of a pain stimulus organized. Whereas the paleospinothalamic system including the dorsal horn gray neurons and brain stem reticular nuclei and hypothalamus with multisynaptic fibers from both intralaminar and medial thalamic nuclei have more to do with behavior reactions. These ingrained actions may be the result of evolutionary effects. Yet the limbic system and the reticular activating system probably have input into the motivational and affective behavior of the individual patient. Also information has to be processed such as previous experience with pain. The data integration of the frontal lobes and limbic systems will also use previous memory input to determine what action is taken when a pain stimulus is present. This cognitive evaluation of pain may be a separate functional system or a combination of both of these.

Physical Therapists

• Physical Therapy
  However I am a conservative neurosurgeon and the majority of patient's referred to me for their degenerative spinal disease and are treated at first medically and with physical therapy and rehabilitation and pain management.
• Occupational Therapy
  After your operation and hospital stay, especially if you have a spinal disorder, teaching you to focus on a better upright posture and proper methods of preventative care and rehabilitation are mandatory. Patients with spinal disorders need instructions and follow up evaluation of their reconditioning exercise program including often with physical or occupational therapy. Such treatment has a profound beneficial effect and increases the likelihood of an excellent outcome.
• Back Pain