April 15, 2025 • 37 mins
Dr. Mark Moran explores spinal cord stimulation therapy with Boston Scientific Neuromodulation representatives Mark Waters and Reed Clark, uncovering how this technology intercepts pain signals before they reach the brain. The discussion reveals why this unique treatment allows patients to "test drive" pain relief before committing to an implant—a rare opportunity in medical interventions.
• Spinal cord stimulation works by interrupting electrical pain signals traveling through nerves
• The technology has evolved significantly since the 1960s, with major advances in the last 15-20 years
• Approximately 15 million Americans could potentially benefit from spinal cord stimulation
• Patients undergo a 7-day trial period before deciding on permanent implantation
• Success rates range from 75-85% with significant pain reduction for most patients
• Treatment can be customized with different stimulation patterns for individual needs
• Recently approved for diabetic peripheral neuropathy in addition to back pain
• New "Intercept" technology targets pain by treating nerves inside vertebral bones
• Knowledge empowers patients to make informed decisions about pain management options
Contact us to learn if spinal cord stimulation might be right for your chronic pain condition, and visit markmoranmd.com or onemonthmd.com for more information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Welcome to our next episode of Back to Back.
I am Dr Mark Moran.
We are here to help youunderstand as much as you can
about low back pain and healthand wellness.
Our two guests today are fromBoston Scientific, which is a
medical device company that doesmany different things, and one
of the things they do for usspecifically is something called
spinal cord stimulation.
(00:28):
So which one of you guys iscooler?
Speaker 2 (00:31):
Definitely Mark.
Okay, so Mark.
Speaker 1 (00:33):
Waters is here, and then Reed Clark is also here.
They take very well care of mypatients and we're going to
learn a lot from them aboutspinal cord stimulation and
maybe a little bit aboutintercept.
Okay, what is intercept, youmight might say, and we will get
back to you about that.
So, first things first, whichone of you guys can bench more?
Speaker 2 (00:54):
oh, definitely read, that's yeah that's read all day
how much is that?
Speaker 1 (00:57):
five pounds 10 I do kilograms.
Speaker 2 (01:01):
I figure nobody can convert it, so so I can make up
numbers.
Okay, so 45.
That's Mark 45.
Mark yeah.
Speaker 3 (01:09):
I got some weight, some weight.
I'll put some weight.
Speaker 1 (01:12):
If I said, drop and give me push-ups until you're
fatigued, how many push-ups?
Speaker 3 (01:15):
would you be able to give me?
I can, if you want me to behonest and I'm not bragging.
There is room.
I can probably do more than 100.
Speaker 1 (01:22):
More than 100 push-ups.
Yes, reed 30, 40.
Speaker 2 (01:29):
Hey, I appreciate the honesty.
Yeah, that's good, I got nopride left, okay.
Speaker 1 (01:35):
Do you have a?
Speaker 3 (01:35):
max a PB.
So I'm gauging it off of ourprevious PT test, right, Because
I'm still in the military.
We have a two minute drill partof the PT test where you do
pushups for two minutes.
In two minutes I can accomplish85 pushups.
Speaker 1 (01:52):
Okay, in two minutes that's pretty good.
So like one and a half a second.
Speaker 3 (01:55):
About that's pretty good.
Speaker 1 (01:56):
Yeah, it is, and thank you very much for your
service.
Speaker 3 (01:59):
Thank you.
Thank you for your support andall those who support.
Speaker 1 (02:03):
And are you?
You're a major.
Speaker 3 (02:06):
Major, yes, promotable major.
Speaker 1 (02:09):
Do I need to call you major?
Speaker 3 (02:11):
You just call me Mark .
Speaker 1 (02:13):
Can I say hey, bro.
Speaker 3 (02:14):
You can do that too.
Speaker 1 (02:16):
Do I have to salute?
Speaker 3 (02:16):
you, you do not, you do not.
Speaker 1 (02:18):
Okay, that's only for other officers, right.
Speaker 3 (02:26):
Actually, it's not even for the officers.
It's for officers that are umsubordinate to me, and the
enlisted, all enlisted, okay,and that's out of respect, not a
something that I earned I grewup on uh wilford hall and
lackland, lackland.
Yeah, it's good that's.
Speaker 1 (02:37):
That was a air force.
Speaker 3 (02:38):
Uh, major there oh for like 25 years so I grew up
in in Fort Bliss, el Paso, texas.
That's a birthplace and that'skind of I guess that's
motivation of the Army.
I always grew up around that,surrounded by it.
Surrounded by it, inevitablyjoined it, even though I didn't
think I was going to, did itanyways, did it anyways, and now
(03:00):
you're on part-time.
Part-time, that's right.
I serve primarily the state, somy direct boss, if you will, is
the governor.
Governor Abbott, we respond tolocal well, we respond
nationally too, but mostlystatewide interventions border,
(03:20):
which is probably going to bevery big within this next couple
of years.
Speaker 1 (03:26):
So yeah, things like that.
Well, thank you for yourservice.
Speaker 3 (03:29):
Appreciate it.
Speaker 1 (03:30):
And you are a UTSA graduate.
Speaker 3 (03:32):
I am.
I am UTSA alumni go runners.
You know part of the inauguralfootball team, so still always
go runners, that's right Forever.
Speaker 1 (03:42):
That's right.
What was your degree inKinesiology, kinesiology, and
what position did you play?
Center?
Speaker 3 (03:47):
Safety Center, safety Number 25.
Speaker 1 (03:50):
Yeah, google it it shrunk a little bit Now.
I thought safeties were fastand athletic.
Speaker 3 (03:57):
How did?
Speaker 1 (03:57):
you get that place.
Speaker 3 (03:58):
See, time passes, oh, and that goes away.
Oh, okay, right, some of itstays, but most of it goes away,
okay, I understand Very goodand, reed, you are an A&M
graduate.
Speaker 2 (04:09):
I'm an Aggie yep Gig'em.
Gig'em.
Speaker 1 (04:12):
Did you guys notice what I did for your school alma
maters?
Speaker 3 (04:15):
Which one, I don't know.
I'm representing both you dohave.
There's no orange, but thatdoesn't count, but there's blue.
Speaker 1 (04:23):
Orange.
I don't have orange scrubs.
Orange is just so repulsive.
Speaker 2 (04:27):
I thought I did pretty good.
I'm going to find a compromise.
Speaker 1 (04:29):
I thought I did pretty good just matching this
with Giggum maroon and blue.
Speaker 2 (04:33):
That was good.
Speaker 1 (04:34):
Come on, I'm not really good at matching colors,
that's pretty good, so A&M now.
Speaker 2 (04:43):
I know, are they doing biomedical?
No, no, they're smart.
Speaker 3 (04:51):
They are finding their own way, so that's good.
Speaker 1 (04:53):
We're really proud of them.
That's good, okay.
And two young kids.
Speaker 2 (04:59):
Two older kids, two older kids.
I have a daughter who's aboutto start driving this coming
summer, and my son is 12.
Speaker 1 (05:05):
Okay, so that's good.
Speaker 2 (05:07):
You have younger kids .
Speaker 3 (05:08):
I have three younger kids.
Oh my gosh, I got a whole possehere.
Speaker 1 (05:12):
Okay.
Speaker 3 (05:13):
Ten seven six, so prayers are always welcome.
Speaker 1 (05:16):
So you don't really want to go home that fast, you
want to drag this out.
Speaker 3 (05:20):
You know what I do?
Because I still get thatdaddy's home.
I still get that they come andI have to throw them up in there
, regardless of how tired I am.
They run and I've got to throwthem up in there.
Speaker 2 (05:32):
Did they?
Did you tell them you weredoing a podcast?
Did they just start up and tellthem you were doing?
Speaker 3 (05:35):
this today?
Absolutely not.
Speaker 1 (05:37):
They're going to think you're a star.
Speaker 3 (05:40):
I'm the GOAT Dad.
I'm the GOAT dad.
My kids are too old to thinkI'm a star.
Speaker 1 (05:43):
They know this, they still want to know They'll think
you're a star.
Say yeah, I did a podcast today, Just another day Going to get
tons of followers.
Speaker 3 (05:50):
I told them I'm going to talk to Dr Moran and we're
going to talk on a video.
They watch.
Youtube.
I told them you're going to seethat on YouTube too, there you
go Well.
Speaker 1 (06:00):
Thank you guys very much for being here.
I appreciate that, and BostonScientific is a great company.
There's lots of great companies, but specifically Boston
Scientific.
You guys are vital to the careof our patients and I'm honored
to have you guys helping me outwith that.
Thank you, let's talk a littlebit about Boston Scientific
spinal cord stimulation.
Okay, I don't know anythingabout that.
Speaker 2 (06:38):
So what is spinal cord stimulation?
The idea there is your nerves,you have motor nerves and you
have sensory nerves.
And the sensory nerves take allthe sensations to the brain and
if you've got chronic pain,those nerves are taking a pain
(07:00):
signal to the brain for no goodreason typically, and they do
that via electrical impulse.
So they communicate viaelectrical impulse and they do
that via electrical impulse.
So they communicate viaelectrical impulse and this is
just a way that some reallysmart doctor back in the day
figured out to basically kind ofinterrupt or intercept that
signal and either deliver alittle like a light, soothing,
like tingling sensation, or, asresearch has gone on, we found
(07:21):
that we don't even have todeliver any sensation to the
patient for them to get really,really significant pain relief.
Speaker 1 (07:27):
Okay, let me clarify.
So you're saying we can putelectricity or use electricity
into the spinal area andstimulate nerves like an on-off
switch to make the pain not befelt?
Speaker 2 (07:38):
Basically, is that a good summary.
Yes, a great summary.
Speaker 1 (07:41):
Very good.
And how long has thistechnology been around?
A long time.
Speaker 2 (07:46):
So I tell patients, if I can go a little beyond that
the first stimulator was put ina patient like in the 60s and
people are always like that'scrazy, but I think it wasn't
commercially available to likethe 80s and then even then I bet
most doctors didn't even knowwhat it was until like the early
2000s.
That's when it really reallytook off.
The technology kind of tooksome like leaps and bounds.
(08:11):
The technology became muchbetter, it started gaining more
acceptance and I the bestanalogy I have is like it's like
cell phones.
So there were probably cellphones in the 60s.
I know there were in the 80s.
My dad had one and it was abrick, you know, like car one,
two yeah, and so it wasn't untillike the early 2000s, cell
(08:32):
phones kind of became small anduseful and everybody had one
affordable, and I thinkstimulators have really kind of
almost paralleled that, likearound 2010, 2015,.
You see these big like leaps inthe technology and now, like,
what we have compared to just 15years ago is pretty crazy.
(08:52):
So from a hardware perspectiveto a software perspective, so
yeah, it's been around a whilebut it hadn't really been
popular and common until maybethe last 20 years.
Speaker 1 (09:05):
Perfect, I agree with that.
It's been around since I everstarted practicing.
And how many patients aroundthe country?
Speaker 2 (09:12):
Is that in the 60s?
Is it in the 60s?
67, 68-ish I started practicing40-ish.
Speaker 1 (09:17):
How many people in the country would qualify for
something like spinal cordstimulation for low back pain?
Just roughly Within two?
Speaker 3 (09:27):
Within two.
Speaker 1 (09:28):
Yeah, plus or minus two, I'm not sure I have.
Speaker 2 (09:29):
Bad odds.
Tens of thousands, oh yeah.
Speaker 3 (09:32):
Tens of thousands, easily Hundreds of thousands.
Speaker 2 (09:35):
I would say so yeah.
Speaker 3 (09:36):
I'd be confident, as you know you talk about it in
your video series.
Speaker 2 (09:44):
The most common reason people go to the doctor
as an adult anyways is back pain, specifically back pain.
There's a lot of reasons whypeople have that pain.
Some of them are notappropriate for spinal cord
stimulation, but a lot of themare, or a lot of those diagnoses
are.
So I don't.
I never thought about what thenumber is, but it's huge.
Speaker 1 (10:05):
do you know a percentage of people that have
back pain that could be treatedJust rough Back?
Pain that could be treated Withspinal cord stimulators.
Is it 5% of the population?
Is it 10% of the population?
What do you think?
I would guess it's somewhere inthere.
5% to 10%.
Let's be conservative and say5%, and there's about 330
million people in America rightnow.
So let's make it easy and say300 million people.
(10:26):
5% of that is I need acalculator Well, 10% is going to
be 30 million, so it's going tobe 15 million.
So 15 million people roughlyjust guessing off the top of my
head that might or could be agood candidate for spinal cord
stimulation.
The point is there's plenty ofpatients out there that could be
(10:46):
candidates to benefit fromspinal cord stimulation out
there that could be candidatesto benefit from spinal cord
stimulation, and the reason Ilike spinal cord stimulation is
because it's exactly like a cartest drive.
Do you know the analogy I'mtalking about?
I do.
Do you want to explain it toour follower.
Speaker 2 (11:02):
Yeah, so what Dr Moran is saying, I think I agree
, is one of the coolest thingsabout what we do with spinal
cord stimulators.
They're very effective.
Dr Moran has a very highsuccess rate.
He created identifying patientsbut for some reason, some
unknown reason, they don't workfor everybody.
Even patients that kind of fitthe profile.
But they work for the vastmajority.
(11:23):
So before we go and put anactual implant into a patient,
just assuming hey, you fit allthe criteria, before we just
stick an implant in them, eachpatient gets to do their own
little seven-day test drive.
We call it a trial, but it'stypically seven days.
Some doctors do shorter.
Very rarely do they do longerthan that.
(11:43):
But like Dr Moran does those inhis office, it's a very safe
procedure.
It's kind of like getting anepidural steroid injection.
A lot of patients have had that.
Basically it's kind of a way forthe patient to have the actual
stimulator in and the actualeffect.
But some of the components areexternal and they get to go home
(12:07):
with it for a week and theytake the week-long test drive if
you will.
And what's important about thatis we don't just want to, we
could test it right there in theoffice and say, hey, does this
feel good?
Does it help your pain?
But a patient really needs,they need to go home and live
with it.
They need to see if it improvestheir functionality.
That's how does it affect yourlife.
And so it's more than justgoing to the auto dealership and
(12:29):
saying, hey, I like the car, itlooks great, it's going home
and kind of live with it for afew days.
Speaker 3 (12:36):
And if I could chime in, I like to tell most of my
patients it's one of the veryfew things in medicine that you
get to try before you actuallyproceed with the.
We call it a permanent implant,but the actual implant right an
implant, but the actual implantright when you go into surgery.
The intent for surgery is foryou to get better when you walk
out of there, assuming that youhave some time to heal.
(12:57):
Well, there are some cases, aswe all know in medicine, that
you may go into a surgery andmay not come out as great as you
want it to.
Our stimulator, the deviceitself, gives you an opportunity
to try and determine whether ornot you want to proceed.
I tell my patients all the timevery few things that you get to
try before you say I like it, Iwant it, I want to move forward
(13:19):
.
And so that's very importantfor patients to really
understand is we aren't the oneswho determine whether or not
you move forward.
It is you.
It is always a patient.
Speaker 1 (13:29):
The patient's always in control, regardless of what a
doctor says or a rep says oranything else, the patient's
always in control.
I agree with you guys.
You guys are right.
The reason I like thesestimulators is because you get
to test drive it before you haveanything implanted in you.
It's like the car.
You go to the car dealership,you say I want to try this one.
Speaker 3 (13:46):
You test drive it if you don't like it, you turn it
back in and nothing has changed.
Speaker 1 (13:51):
It's the same thing with the stim trials you come in
, we put the wires in.
It takes 20 or 30 minutes, andthen you go home and live with
it for a week because we don'twant to just see how much it
benefits you that day.
We want to see how much itbenefits you not just with pain,
but with activity and energyand sleeping and smiling and
everything with your overallquality of life.
And we that only comes if youwear it for five to seven days.
(14:13):
Correct?
You'll come back after five toseven days.
We pull it out.
It's very easy.
You just take the tape off andpull it out and then we ask you
these questions and then thepatient will give us this
overall quality of lifeimprovement.
The insurance requires you tohave at least 50 improvement to
to qualify for the implant.
But if you do qualify, it'sstill 100% up to the patient if
(14:33):
they want to have it implantedor not.
Speaker 3 (14:34):
So it's a test drive If you like it.
Speaker 1 (14:36):
You decide if you want it implanted.
If you don't like it, we moveon to other options.
So I like that technology.
We've done dozens of patientswith them over the years.
Are we in the hundreds?
Speaker 2 (14:47):
yet oh, we're in the hundreds.
I must be busier than I think.
I am.
There you go.
Speaker 1 (14:52):
And we have very good success rate.
I usually tell my patientsroughly 75 to 85% of them will
get roughly 75 to 85% of benefit.
Some of them it doesn't work,it's not meant for everyone, but
the vast majority of peoplewill get some benefit.
And this is only for back pain,or can you use it for other
types of pain too?
Speaker 2 (15:11):
It does have a few indications.
Back pain is the most common.
The most common is a patientwho's had a back surgery and
they're still in pain.
But it can be used for patientsthat haven't had back surgery.
It can also be but have crackedback pain.
Also things like radicular legpain.
That's usually pain that'scoming from the back.
(15:31):
But also some of the newerindications are complex regional
pain syndrome, which is you'vehad several patients that have
done really well with that.
Speaker 1 (15:44):
Usually they respond very well to stimulation.
Speaker 2 (15:46):
Yeah, they do, they do well.
I won't get into the nature ofthat condition because I don't
really fully understand it, butit's usually of the extremities,
sometimes it's of the arms orthe foot, so you can use
stimulation for arm pain too.
Yes.
Speaker 1 (16:02):
Okay, so you can do it in the low back and or the
neck.
Speaker 2 (16:06):
Correct.
Well, it's not on label for theneck, but it is on label for
the CRPS.
Speaker 1 (16:12):
I understand you have to be careful because the
lawyers, we love lawyers.
We're not doing anythingillegal, but we are trying to
help the patients as much as wecan and in the end it's up to
the insurance company.
Absolutely If the insurancecompany is going to approve it,
then we're going to go ahead anddo what the insurance will
approve, and certainly it's verycommon for doctors to do spinal
cord stimulator trials for neckand arm pain.
Speaker 3 (16:33):
Correct.
Yes, In addition to that, I'vegot to add DPN diabetic
peripheral neuropathy right, andthat mostly stems from patients
who have diabetes a lot of painin their feet.
We have acquired thatindication for spinal cord
stimulation too, so that's veryimportant.
Speaker 2 (16:48):
Yeah, that's the newest indication.
Speaker 1 (16:50):
It's very exciting and that was just acquired a
couple months ago.
Speaker 2 (16:53):
Six months ago.
Speaker 3 (16:53):
About a year ago.
About a year ago, yeah, okay.
Speaker 1 (16:55):
Which is great, because diabetic patients with
peripheral neuropathy usuallyit's just medicines that they
can take to treat their pain.
Now, this is a very powerful,effective way to treat their
diabetic pain, because this typeof pain really helps a lot with
nerve pain, and dpn, ordiabetic peripheral neuropathy,
is nerve pain that can betreated with these stimulators I
(17:16):
agree with that.
Uh, lots of benefits for dpnpatients or diabetic peripheral
nerve patients.
Good, all right, um which oneyou guys is funnier?
Speaker 2 (17:26):
oh, it's definitely that's free he keeps yeah, it's
free
Speaker 3 (17:30):
it's free I think, I have, uh, I have humor in my
mind.
Speaker 1 (17:37):
That only works in my mind, but you know he has more
experience as a dad, so he hasmore dad jokes.
Speaker 3 (17:42):
That's right, that's right.
Right, I'm gonna catch up.
Maybe use that one maybe that'swhat's going on here I don't
know if they'll get it, and acouple more things with
stimulation westerns.
Speaker 1 (17:51):
Is this something that you'd go to right away when
you have back pain, or do youusually want to try other things
first?
Speaker 2 (17:56):
I mean I'm up for it.
Yeah, let's do it, but but no,truthfully, no, we it's.
This is kind of at the end of,uh, at the end of the algorithm.
It might be moving up.
I think it is moving up.
Um, some of that is dictated, alot of that is dictated by
insurance.
But obviously you want to startas a doctor, right?
(18:16):
you want to start with what'sone most easy obtainable, you
know, like the insides over thecounter stuff.
So you're gonna start withwhat's easiest, and of course
safety is considered there.
But patients are pretty muchgoing to have to go through a
series of other treatments thatyou would try, and you know a
(18:37):
lot of those can be veryeffective for a long time and
then maybe over time they don'tget the same effect, and so as
that efficacy wears off, theymight become a candidate.
As that, as efficacy wears off,they might become a candidate.
Um, but also, you know, I dothink it is moving up in the
algorithm.
Oh, you're that we're seeingthat?
Speaker 1 (18:58):
yeah, I see that.
Yeah, so reed is correct.
Uh, usually most doctors aregoing to try conservative things
first, because we know the vastmajority of patients are going
to get benefit from conservativeoptions like chiropractor,
physical therapy, acupuncture,these type of stretches.
The next option would bemedicines, whether non-narcotic
or over-the-counter medicines,and then prescription medicines.
Then after that, you start toconsider interventions like
(19:20):
injections.
Then after that you start toconsider spinal cord stimulator
and or surgical options fortreating pain correct.
Speaker 3 (19:26):
So that's sort of a rough algae analogy or algorithm
.
Speaker 1 (19:30):
patients need to go through, so you're right, it's
not initially.
But I have had patients thathave come to me and they've
tried those other things, andthen we do go initially to right
spinal cord stimulation.
Speaker 3 (19:39):
And we always tell patients right is when you've
come to us, there have beenprocedures and interventions
done, like you already statedright, and they have this
success and they're like whydidn't it start here?
It is a procedure, right.
Once you proceed to the actualimplant, there's surgery
involved, and so the doctor doestheir due diligence to make
(20:06):
sure that they can try to treatas with little intervention as
possible, or it's not the wordthat I'm waiting for Minimally
invasive.
Speaker 2 (20:11):
Minimally invasive.
Speaker 3 (20:12):
Thank you, reed.
Thank you.
So they get to us kind of atthe middle or the end of the
road of pain and hopefully wecan help that.
But the doctor is doing theirdue diligence, like Dr Moran
does, to see if other thingswork before we have to move to
that route.
Speaker 1 (20:29):
Okay, Okay, so we have tens of people listening.
Okay, who knows how viral thisis going to go.
What is like the top three bestpieces of advice you guys can
give to people consideringspinal cord stimulation?
Speaker 2 (20:47):
As a patient.
Speaker 1 (20:49):
As anyone, as a rep or a patient or a friend.
Speaker 3 (20:51):
Very first one I'd say is don't be afraid of it.
I think that we come acrossmore fear than anything and I
think that comes from lack ofeducation, where we try to
intervene in that part and makesure patients understand what to
expect, and that's why I'm verycareful.
I said earlier, we have animplant.
(21:12):
We typically refer to it as apermanent implant and most
patients kind of are weary ofthat and it's not permanent
whatsoever.
It can always come out ifmedically necessity.
But I think the number one,biggest advice is don't be
scared of this.
Speaker 1 (21:29):
I agree with that.
I think a lot of times peopleget caught up by the name spinal
cord stimulation and they'relike I don't want to mess with
my spinal cord.
So technically it's not goinginto the spinal cord, it's
resting on top of the spinalcord Correct.
So that's why it's a stimulatingthing.
I agree with that.
Also, and I tell patientsfrequently don't confuse
possibility with probability.
Certainly, possibility withprobability.
Certainly.
It's possible right now that weget hit by a meteor, but that's
(21:54):
not going to happen.
None of us are worried aboutthat because the probability is
so low we don't worry about that.
It's the same thing with anymedical procedure.
Don't confuse possibility withprobability.
Certainly it's possible.
There's complications, but theprobability of it, especially
with this technology, is verylow, correct.
Speaker 2 (22:06):
Correct, so that's a good one.
Do you have anything?
Well, I have a couple of things, but I also kind of want to add
on to that.
Like we were lucky enough inyour office to get to educate
some patients, sometimes earlyon.
You know, maybe they're they'rejust they're asking about, they
see stuff in your office andthey want to know, like, what is
this all about?
Maybe they're not even close tobeing ready for it, but
educating those patients earlyon I think goes a long way,
(22:29):
because I always encourage themlike hey, go do your homework.
Obviously you always want to becareful when you're looking at
reviews and stuff online.
You're going to get someextremes on both ends, but I
think every patient should dotheir homework.
But, like Mark said, you knowit's natural to be kind of a
little apprehensive, like, ohman, you're going to do what.
But you know, do your homework.
(22:51):
And also reach out to theoffice and ask if there's.
I know we've got a lot ofpatients that you've treated
that are have told me expressedthey're willing to talk to other
patients.
In other words, patients thathave gone through the trial,
they've gone through the implant.
They're so happy with what theydid that they want to talk to
other patients and because theyknow that they had those same
fears.
So you know, ask if you're.
(23:11):
If you're, don't just dismissit If those same fears.
So you know, ask if you're.
If you're, don't just dismissit.
If you're nervous about it,don't dismiss it.
Talk to the office.
If you've already been incontact with a rep, you know,
let them know.
Beyond that, I would say partof it is setting expectations.
So you know, have goodexpectations.
Ask the reps, ask the doctor,like you know what.
(23:32):
What does successful look like?
You know you mentioned at least50% improvement.
It's all subjective, it's up toyou, the patient.
Was this successful for you, um, but I always do preface with
patients.
I'm not looking for a hundredpercent success.
It's just not realistic.
Um one, you've probably gotother little ailments that this
isn't going to help.
(23:52):
It's not going to help withyour arthritic knee, it's not
going to help with your stufflike that.
But in my opinion it should bevery significant improvement
that you've experienced with thetrial before you move on.
But you have that expectation.
It's not going to help with theaches and pains that we all
deal with, but it should reallyknock out most of that
(24:15):
neuropathic pain, that's, that'sthe, the big source of pain.
And then I have something elseneuropathic pain, meaning nerve
pain and I agree that knowledgeis power.
Speaker 1 (24:26):
I advocate that to my patients all the time.
Knowledge is power, and be anactive participant, not a
passive recipient, in yourhealth.
If you are considering this,then do your research.
There's lots of information outthere and you can go to my
website it's markmoranemdcom tolearn all kinds of things about
options for back pain, includingspinal cord stimulator.
Another thing is you can alwaysgo to onemonthmdcom, which is
(24:50):
my website, to help peopleeducate them about all types of
treatments and options andcauses for low back pain, and
one of the options I give isspinal cord stimulation because
of the success we've had withyou guys.
So I agree with that Knowledgeis power.
Encourage the patients tobecome active participants, not
passive recipients, in theirhealth.
They come to me and say whatare you going to do for me?
(25:11):
I say nope, we're a team.
You're going to beparticipating with this
treatment problem.
So go learn as much as you canand always bring us questions.
Right, correct, good, did youguys have like one thing that
patients that have stimulatorsdo that you wish?
You could just say all tens ofpeople that are watching what
would be one piece ofrecommendation.
Speaker 3 (25:34):
My very first one that I go to is as far as Boston
Scientific is concerned.
Our ability to navigate andcreate customized therapy is
again.
This is a bias, but it's beyondeverybody else.
So what I tell patients is thatas you start to utilize the
(25:54):
spinal cord stimulation therapy,be willing to change right,
just like you would when youcome into this office, if
something is not working or youwant to make adjustments.
We purposefully, intentionallyplace different modes of therapy
so you don't just get one typeof therapy.
So try the different therapiesthat we initiate for the
(26:17):
patients.
Don't just stick to one.
Don't be afraid of the remoteright, it looks a little wonky.
Change the channel.
That's what I tell the patients.
Speaker 1 (26:24):
And you mean you give patients different options with
their stimulator during thetrial?
So they can see which one worksbest and they like better or
not as much.
Absolutely so they have optionsduring the trial to see which
one works.
Speaker 3 (26:34):
They have options during the trial that have even
more options when they actuallyhave the device right.
We have a limited timeframe.
Our intent during the trial isjust to see if that actually
works right.
We want to see if spinal cordstimulation works for your
patients.
The limited amount of time iswhere we try to make sure that
we have the right parameters setand that's kind of the entirety
(26:55):
of the trial.
Once we find out what the rightparameter is, then we know
where to gauge and where to aimwhen you have the actual implant
.
And so when you have the actualimplant, just like everything
else, you kind of habituate tothe type that you like or a
level and we tell patientschange it, change the channel a
little while, like change thechannel every now and then,
(27:16):
change up your routine every nowand then.
Uh, that's the very first thingthat I typically tell my
patients.
Speaker 1 (27:21):
Good, so good, very good.
Do you guys have anything else?
Speaker 2 (27:25):
yeah, I was gonna say , uh, kind of along those lines.
Like some people also getintimidated by they're just from
the off, the right off the bat.
They're like they don't want totouch the remote.
They're like I don't dotechnology and we can with
boston scientific.
We can make it as simple andset it as and forget it as, as
you like, um, or we can, likemark said, we can create crazy
(27:50):
customizations for you that youcan.
If you're somebody that youlike to mess with stuff and you
want to change things all thetime, we can do it however you
want.
So, um, and if, if you are alittle intimidated and you think
you might want to try thosethings, we can teach you and get
you there.
But we can set it however youlike.
We have automated um.
We have an automated version ofour fast, that's the fast
(28:12):
acting sub perception Therapy.
So you're not feeling thistherapy, but it's unique in that
it works quick and you don'tfeel it.
A lot of the old programs thatpatients wouldn't feel it would
take a couple of days for thetherapy to wash in.
So with this we can turn it onand you'll get almost instant
relief.
Speaker 1 (28:30):
So this is like young Mark's safety as compared to
current Mark's safety, correct?
Speaker 2 (28:35):
It's much faster, very fast.
Speaker 3 (28:38):
Very fast.
Speaker 1 (28:39):
Very fast back then.
Very fast Did you beat me in arace?
Speaker 3 (28:41):
Absolutely 100%.
Speaker 1 (28:43):
Sound a little confident there.
Speaker 3 (28:45):
There are very few people that can beat me.
Speaker 1 (28:47):
I don't know, is there a Chick-fil-A at the end
line?
I might be pushing your limits,right there, those Chipotle
guys.
Speaker 3 (28:54):
No, no, very good.
What's your 40 speed?
Like my top 40 speed.
No, your lowest Top top.
I ran officially in a combine440.
So that's my fastest time,that's my official time.
I ran faster than that, butthat's.
Speaker 1 (29:10):
I got 4.5 on one leg hopping.
I'm just saying.
Speaker 3 (29:16):
With a Boston Scientific Stimulator.
Speaker 1 (29:17):
4.4 ever okay, remember, we are trying to teach
people some stuff here.
I agree with that.
Spinal cord stimulator verygood technology.
What you're saying is you canpersonalize individual options
for each patient when they comein with stimulation.
Absolutely, it's not a cut block, cookie cutter type thing.
(29:39):
Everyone gets the same.
Every patient getsindividualized treatment.
Absolutely Got it.
Good, it should be that way.
Next thing we want to talkabout a little bit because we're
starting to run out of time.
I know our watchers andlisteners really want us to keep
going, but I do want to quicklymention do you?
want to say hi to your mom, heymom, okay, reed, yeah, hey,
(30:01):
mark's mom, we want to talk alittle bit about something
that's relatively new for BostonScientific called Intercept,
and you're kind of in charge ofthis for the VA, right.
Speaker 3 (30:15):
No.
So I'd say that I wouldn't becomfortable talking about
Intercept as much as I'd like.
Okay, we manage the flow, butwe do have a rep, beth Irwin,
who is completely in charge ofeducating.
Beyond that, then I wouldn'tfeel as comfortable.
I wouldn't feel as comfortable.
(30:35):
Well, do you mind if I take ashot?
No, please.
Speaker 1 (30:37):
I thought we should teach them about stimulators and
Intercept yeah.
So Intercept is a procedure forpeople with back pain where a
lot of people try somethingcalled radiofrequency ablation,
where you put a needle in andyou burn a nerve that's on the
outside of the vertebral body.
This is a procedure where theneedles go inside the vertebral
body.
Now, as we find more resultsfrom research and medicine,
(31:02):
where we used to think that thediscs, the cushions between the
bones, were causes for a lot ofpain, now we realize that it's
not the discs, it's the bonesthat are the cause for a bunch
of back pain.
So instead of treating discproblems for back pain, we now
know that there's a lot ofresearch that shows getting a
needle into the actual bone andburning the nerves inside the
(31:23):
bone can have significantbenefit for back pain absolutely
right, that's what theintercept procedure is correct
rf or radio frequency is burningon the nerves that are outside
the bone.
Intercept is inside thevertebral body and putting a
probe in there and heating it upand burning the nerves that go
to the vertebral body inside thebody.
Speaker 3 (31:41):
Correct, correct.
Speaker 1 (31:42):
That's just a guess.
Is that a good?
Speaker 3 (31:43):
guess?
No, that's.
I mean, we've got to take youto Vegas.
Totally guessed Going to Vegastomorrow.
Speaker 1 (31:49):
And this is an up-and-coming technology.
Speaker 2 (31:55):
How long has?
Speaker 3 (31:55):
that been around.
Speaker 1 (31:56):
Boston.
Speaker 2 (31:56):
Scientific acquired it probably about a year ago,
but I think it was out maybe twoyears before that.
Don't quote me on that, butit's been out a few years.
Speaker 1 (32:04):
I know that the five-year data is just now
recently coming out tosubstantiate it, and I know that
the results are really good.
That's why I'm going to startdoing it.
Yeah, we're excited to startdoing it.
Yes, yeah, so another bullet inmy holster to try and help the
patients out with their backpain.
On top of that, another thingwe can do is knowledge is power,
(32:27):
so learning about the causesand treatments and options for
back pain before they even getstarted is very valuable, which
is why you guys should rememberto check out One Month MD to see
if you can learn anything thatway as well, because we want
patients to be activeparticipants, not passive
recipients, and a lot of timesyou can prevent pain just by
doing yoga.
I've had several people tell merecently, when I finally bugged
(32:50):
them enough, they started tryingto yoga.
They said I did it for thefirst week and my pain in my
hips and knees and shoulders isgone.
Speaker 3 (32:57):
I believe it Absolutely.
Speaker 1 (32:58):
I'm telling you, I know a couple things about pain.
Absolutely, if you're over 40,yoga is very good for your back
pain.
Yeah, I'll have to figure thatout when I get there.
Speaker 3 (33:12):
No back pain for Dr Moran.
Speaker 1 (33:14):
When I turn 40.
Speaker 3 (33:15):
Oh that's right.
21 tomorrow.
Speaker 1 (33:18):
Really Happy birthday .
Speaker 3 (33:20):
Thank you.
Speaker 1 (33:21):
You going out for a drink?
Speaker 3 (33:22):
Two, just two.
Speaker 1 (33:25):
Okay, very good, alright, did you guys have
anything else you want to shareor tell or any questions you
want for me?
What else can we do to helpempower the patients with
knowledge?
Speaker 3 (33:38):
No, I think you covered it very well.
I think for your audience it'svery important to know that
spinal cord stimulation is notfor everybody, right?
We try to do our due diligenceto make sure that Dr Moran is in
front of the appropriatepatients for the appropriate
time, but at the same time, doyour due diligence in learning
about spinal cord stimulation.
(33:58):
It may not be now, it may bedown.
The road.
Time is against us all as westart to deteriorate in age and
time.
Speaker 1 (34:07):
I like to say, as people get more life experience.
Speaker 3 (34:10):
Yeah, I like that one .
Speaker 1 (34:11):
No one gets older, they get more life experience.
Yeah, I like that one.
Speaker 3 (34:14):
No one gets older.
They get more life experience.
They get more wise as we wisen.
If that's a word, it's a newword.
Just prepare yourself for theopportunity or the possibility
that spinal cord stimulation maybe down the road for you Maybe
not now, but later on down theline.
So educate yourself a littleearly on.
Reach out to myself or read.
We're always in Dr Moran'soffice willing on down the line.
So educate yourself a littleearly on.
Reach out to myself or Reed.
We're always in Dr Moran'soffice willing to share the
(34:37):
information, even if it's notfor you now.
Maybe you need the informationfor one of your parents or
friends or anything.
Speaker 1 (34:44):
I agree, reed gig him , yeah, gig him.
Speaker 2 (34:48):
I think you know what Mark said is kind of summarizes
everything.
But, you know, ask questions,find out what other options are
there.
Um, I think the earlier you geteducated and start looking into
options, I think the better offyou'll be in the long run.
Um, maybe, maybe it's intercept, maybe it's spinal cord
(35:08):
stimulation, maybe it'ssomething else radiofrequency
ablation, stuff like that thatDr Moran offers, or your pain
doctor.
If you start asking about thosethings and learning about them,
when it does come up and it issomething that the doctor thinks
you're ready to try, I thinkit'll be you set yourself up for
more success because you'llhave kind of prepared yourself,
(35:29):
you'll done your research.
You're not like surprised tohear about it.
So, yeah, knowledge is power.
I think that's a great way toput it.
And definitely you know, onceyou, if you do get to a point
where you have you're doing atrial, you've done a, you've had
an implant rely heavily on yourreps.
You know where that's.
Our job is to make sure you'recomfortable with the device,
(35:51):
make sure the device is workingoptimally for you and so be,
like Dr Moran said, be an activeparticipant.
You know you've got to takepart in your care and you know,
we'll get you there.
Speaker 3 (36:06):
Big shout-out to Dr Moran.
No, no, I think it's importantfor patients to also understand.
You know there are multiplepain doctors locally here in San
Antonio, but not all of themare so interventional, and what
I mean by that is that you mayrun into a doctor that has a
very stringent one way foreverybody.
(36:29):
When patients go into youroffice, they should be very
confident in knowing that you'llbe able to approach them in
different manners.
And we said this earlier.
Spinal cord stimulation may notbe for everybody, but Dr Moran
will have an option for you.
That's appropriate and I thinkit's important for patients to
understand that you want to bein an office where a doctor is
willing to go left and right anddown the middle and maybe a
(36:52):
little off the path a little bitif necessary.
But uh, not everybody's likethat.
Speaker 1 (36:57):
Not everybody has the sound hands minds to be an
interventionist well, Iappreciate that, and I guess you
just want me to buy you a drinkfor your 21st birthday too.
Okay too, but you're right.
I tell my patients the patientsare the boss like I work for
them.
I'm just giving them advice andanswering their questions.
But the patients decide whatthey want to do, and if they
don't want to do something, thenwe find another option.
(37:18):
So you're absolutely right.
Very well, I encourage everyoneto continue to become an active
participant in their health andnot a passive recipient.
If you have anyone that youwould like to be on the show or
know that would want to be onthe show, we're happy to have
anyone, because we're alwayshere trying to educate the
community about options, abouthealth and wellness and taking
(37:38):
care of themselves.
Thank you guys very much, Iappreciate your time and
dedication taking good care ofour patients.
We appreciate that and we'llsee you guys next time.
On back to back.
Welcome to our next episode of Back to Back.
I am Dr Mark Moran.
We are here to help youunderstand as much as you can
about low back pain and healthand wellness.
Our two guests today are fromBoston Scientific, which is a
medical device company that doesmany different things, and one
of the things they do for usspecifically is something called
spinal cord stimulation.
(00:28):
So which one of you guys iscooler?
Speaker 2 (00:31):
Definitely Mark.
Okay, so Mark.
Speaker 1 (00:33):
Waters is here, and then Reed Clark is also here.
They take very well care of mypatients and we're going to
learn a lot from them aboutspinal cord stimulation and
maybe a little bit aboutintercept.
Okay, what is intercept, youmight might say, and we will get
back to you about that.
So, first things first, whichone of you guys can bench more?
Speaker 2 (00:54):
oh, definitely read, that's yeah that's read all day
how much is that?
Speaker 1 (00:57):
five pounds 10 I do kilograms.
Speaker 2 (01:01):
I figure nobody can convert it, so so I can make up
numbers.
Okay, so 45.
That's Mark 45.
Mark yeah.
Speaker 3 (01:09):
I got some weight, some weight.
I'll put some weight.
Speaker 1 (01:12):
If I said, drop and give me push-ups until you're
fatigued, how many push-ups?
Speaker 3 (01:15):
would you be able to give me?
I can, if you want me to behonest and I'm not bragging.
There is room.
I can probably do more than 100.
Speaker 1 (01:22):
More than 100 push-ups.
Yes, reed 30, 40.
Speaker 2 (01:29):
Hey, I appreciate the honesty.
Yeah, that's good, I got nopride left, okay.
Speaker 1 (01:35):
Do you have a?
Speaker 3 (01:35):
max a PB.
So I'm gauging it off of ourprevious PT test, right, Because
I'm still in the military.
We have a two minute drill partof the PT test where you do
pushups for two minutes.
In two minutes I can accomplish85 pushups.
Speaker 1 (01:52):
Okay, in two minutes that's pretty good.
So like one and a half a second.
Speaker 3 (01:55):
About that's pretty good.
Speaker 1 (01:56):
Yeah, it is, and thank you very much for your
service.
Speaker 3 (01:59):
Thank you.
Thank you for your support andall those who support.
Speaker 1 (02:03):
And are you?
You're a major.
Speaker 3 (02:06):
Major, yes, promotable major.
Speaker 1 (02:09):
Do I need to call you major?
Speaker 3 (02:11):
You just call me Mark .
Speaker 1 (02:13):
Can I say hey, bro.
Speaker 3 (02:14):
You can do that too.
Speaker 1 (02:16):
Do I have to salute?
Speaker 3 (02:16):
you, you do not, you do not.
Speaker 1 (02:18):
Okay, that's only for other officers, right.
Speaker 3 (02:26):
Actually, it's not even for the officers.
It's for officers that are umsubordinate to me, and the
enlisted, all enlisted, okay,and that's out of respect, not a
something that I earned I grewup on uh wilford hall and
lackland, lackland.
Yeah, it's good that's.
Speaker 1 (02:37):
That was a air force.
Speaker 3 (02:38):
Uh, major there oh for like 25 years so I grew up
in in Fort Bliss, el Paso, texas.
That's a birthplace and that'skind of I guess that's
motivation of the Army.
I always grew up around that,surrounded by it.
Surrounded by it, inevitablyjoined it, even though I didn't
think I was going to, did itanyways, did it anyways, and now
(03:00):
you're on part-time.
Part-time, that's right.
I serve primarily the state, somy direct boss, if you will, is
the governor.
Governor Abbott, we respond tolocal well, we respond
nationally too, but mostlystatewide interventions border,
(03:20):
which is probably going to bevery big within this next couple
of years.
Speaker 1 (03:26):
So yeah, things like that.
Well, thank you for yourservice.
Speaker 3 (03:29):
Appreciate it.
Speaker 1 (03:30):
And you are a UTSA graduate.
Speaker 3 (03:32):
I am.
I am UTSA alumni go runners.
You know part of the inauguralfootball team, so still always
go runners, that's right Forever.
Speaker 1 (03:42):
That's right.
What was your degree inKinesiology, kinesiology, and
what position did you play?
Center?
Speaker 3 (03:47):
Safety Center, safety Number 25.
Speaker 1 (03:50):
Yeah, google it it shrunk a little bit Now.
I thought safeties were fastand athletic.
Speaker 3 (03:57):
How did?
Speaker 1 (03:57):
you get that place.
Speaker 3 (03:58):
See, time passes, oh, and that goes away.
Oh, okay, right, some of itstays, but most of it goes away,
okay, I understand Very goodand, reed, you are an A&M
graduate.
Speaker 2 (04:09):
I'm an Aggie yep Gig'em.
Gig'em.
Speaker 1 (04:12):
Did you guys notice what I did for your school alma
maters?
Speaker 3 (04:15):
Which one, I don't know.
I'm representing both you dohave.
There's no orange, but thatdoesn't count, but there's blue.
Speaker 1 (04:23):
Orange.
I don't have orange scrubs.
Orange is just so repulsive.
Speaker 2 (04:27):
I thought I did pretty good.
I'm going to find a compromise.
Speaker 1 (04:29):
I thought I did pretty good just matching this
with Giggum maroon and blue.
Speaker 2 (04:33):
That was good.
Speaker 1 (04:34):
Come on, I'm not really good at matching colors,
that's pretty good, so A&M now.
Speaker 2 (04:43):
I know, are they doing biomedical?
No, no, they're smart.
Speaker 3 (04:51):
They are finding their own way, so that's good.
Speaker 1 (04:53):
We're really proud of them.
That's good, okay.
And two young kids.
Speaker 2 (04:59):
Two older kids, two older kids.
I have a daughter who's aboutto start driving this coming
summer, and my son is 12.
Speaker 1 (05:05):
Okay, so that's good.
Speaker 2 (05:07):
You have younger kids .
Speaker 3 (05:08):
I have three younger kids.
Oh my gosh, I got a whole possehere.
Speaker 1 (05:12):
Okay.
Speaker 3 (05:13):
Ten seven six, so prayers are always welcome.
Speaker 1 (05:16):
So you don't really want to go home that fast, you
want to drag this out.
Speaker 3 (05:20):
You know what I do?
Because I still get thatdaddy's home.
I still get that they come andI have to throw them up in there
, regardless of how tired I am.
They run and I've got to throwthem up in there.
Speaker 2 (05:32):
Did they?
Did you tell them you weredoing a podcast?
Did they just start up and tellthem you were doing?
Speaker 3 (05:35):
this today?
Absolutely not.
Speaker 1 (05:37):
They're going to think you're a star.
Speaker 3 (05:40):
I'm the GOAT Dad.
I'm the GOAT dad.
My kids are too old to thinkI'm a star.
Speaker 1 (05:43):
They know this, they still want to know They'll think
you're a star.
Say yeah, I did a podcast today, Just another day Going to get
tons of followers.
Speaker 3 (05:50):
I told them I'm going to talk to Dr Moran and we're
going to talk on a video.
They watch.
Youtube.
I told them you're going to seethat on YouTube too, there you
go Well.
Speaker 1 (06:00):
Thank you guys very much for being here.
I appreciate that, and BostonScientific is a great company.
There's lots of great companies, but specifically Boston
Scientific.
You guys are vital to the careof our patients and I'm honored
to have you guys helping me outwith that.
Thank you, let's talk a littlebit about Boston Scientific
spinal cord stimulation.
Okay, I don't know anythingabout that.
Speaker 2 (06:38):
So what is spinal cord stimulation?
The idea there is your nerves,you have motor nerves and you
have sensory nerves.
And the sensory nerves take allthe sensations to the brain and
if you've got chronic pain,those nerves are taking a pain
(07:00):
signal to the brain for no goodreason typically, and they do
that via electrical impulse.
So they communicate viaelectrical impulse and they do
that via electrical impulse.
So they communicate viaelectrical impulse and this is
just a way that some reallysmart doctor back in the day
figured out to basically kind ofinterrupt or intercept that
signal and either deliver alittle like a light, soothing,
like tingling sensation, or, asresearch has gone on, we found
(07:21):
that we don't even have todeliver any sensation to the
patient for them to get really,really significant pain relief.
Speaker 1 (07:27):
Okay, let me clarify.
So you're saying we can putelectricity or use electricity
into the spinal area andstimulate nerves like an on-off
switch to make the pain not befelt?
Speaker 2 (07:38):
Basically, is that a good summary.
Yes, a great summary.
Speaker 1 (07:41):
Very good.
And how long has thistechnology been around?
A long time.
Speaker 2 (07:46):
So I tell patients, if I can go a little beyond that
the first stimulator was put ina patient like in the 60s and
people are always like that'scrazy, but I think it wasn't
commercially available to likethe 80s and then even then I bet
most doctors didn't even knowwhat it was until like the early
2000s.
That's when it really reallytook off.
The technology kind of tooksome like leaps and bounds.
(08:11):
The technology became muchbetter, it started gaining more
acceptance and I the bestanalogy I have is like it's like
cell phones.
So there were probably cellphones in the 60s.
I know there were in the 80s.
My dad had one and it was abrick, you know, like car one,
two yeah, and so it wasn't untillike the early 2000s, cell
(08:32):
phones kind of became small anduseful and everybody had one
affordable, and I thinkstimulators have really kind of
almost paralleled that, likearound 2010, 2015,.
You see these big like leaps inthe technology and now, like,
what we have compared to just 15years ago is pretty crazy.
(08:52):
So from a hardware perspectiveto a software perspective, so
yeah, it's been around a whilebut it hadn't really been
popular and common until maybethe last 20 years.
Speaker 1 (09:05):
Perfect, I agree with that.
It's been around since I everstarted practicing.
And how many patients aroundthe country?
Speaker 2 (09:12):
Is that in the 60s?
Is it in the 60s?
67, 68-ish I started practicing40-ish.
Speaker 1 (09:17):
How many people in the country would qualify for
something like spinal cordstimulation for low back pain?
Just roughly Within two?
Speaker 3 (09:27):
Within two.
Speaker 1 (09:28):
Yeah, plus or minus two, I'm not sure I have.
Speaker 2 (09:29):
Bad odds.
Tens of thousands, oh yeah.
Speaker 3 (09:32):
Tens of thousands, easily Hundreds of thousands.
Speaker 2 (09:35):
I would say so yeah.
Speaker 3 (09:36):
I'd be confident, as you know you talk about it in
your video series.
Speaker 2 (09:44):
The most common reason people go to the doctor
as an adult anyways is back pain, specifically back pain.
There's a lot of reasons whypeople have that pain.
Some of them are notappropriate for spinal cord
stimulation, but a lot of themare, or a lot of those diagnoses
are.
So I don't.
I never thought about what thenumber is, but it's huge.
Speaker 1 (10:05):
do you know a percentage of people that have
back pain that could be treatedJust rough Back?
Pain that could be treated Withspinal cord stimulators.
Is it 5% of the population?
Is it 10% of the population?
What do you think?
I would guess it's somewhere inthere.
5% to 10%.
Let's be conservative and say5%, and there's about 330
million people in America rightnow.
So let's make it easy and say300 million people.
(10:26):
5% of that is I need acalculator Well, 10% is going to
be 30 million, so it's going tobe 15 million.
So 15 million people roughlyjust guessing off the top of my
head that might or could be agood candidate for spinal cord
stimulation.
The point is there's plenty ofpatients out there that could be
(10:46):
candidates to benefit fromspinal cord stimulation out
there that could be candidatesto benefit from spinal cord
stimulation, and the reason Ilike spinal cord stimulation is
because it's exactly like a cartest drive.
Do you know the analogy I'mtalking about?
I do.
Do you want to explain it toour follower.
Speaker 2 (11:02):
Yeah, so what Dr Moran is saying, I think I agree
, is one of the coolest thingsabout what we do with spinal
cord stimulators.
They're very effective.
Dr Moran has a very highsuccess rate.
He created identifying patientsbut for some reason, some
unknown reason, they don't workfor everybody.
Even patients that kind of fitthe profile.
But they work for the vastmajority.
(11:23):
So before we go and put anactual implant into a patient,
just assuming hey, you fit allthe criteria, before we just
stick an implant in them, eachpatient gets to do their own
little seven-day test drive.
We call it a trial, but it'stypically seven days.
Some doctors do shorter.
Very rarely do they do longerthan that.
(11:43):
But like Dr Moran does those inhis office, it's a very safe
procedure.
It's kind of like getting anepidural steroid injection.
A lot of patients have had that.
Basically it's kind of a way forthe patient to have the actual
stimulator in and the actualeffect.
But some of the components areexternal and they get to go home
(12:07):
with it for a week and theytake the week-long test drive if
you will.
And what's important about thatis we don't just want to, we
could test it right there in theoffice and say, hey, does this
feel good?
Does it help your pain?
But a patient really needs,they need to go home and live
with it.
They need to see if it improvestheir functionality.
That's how does it affect yourlife.
And so it's more than justgoing to the auto dealership and
(12:29):
saying, hey, I like the car, itlooks great, it's going home
and kind of live with it for afew days.
Speaker 3 (12:36):
And if I could chime in, I like to tell most of my
patients it's one of the veryfew things in medicine that you
get to try before you actuallyproceed with the.
We call it a permanent implant,but the actual implant right an
implant, but the actual implantright when you go into surgery.
The intent for surgery is foryou to get better when you walk
out of there, assuming that youhave some time to heal.
(12:57):
Well, there are some cases, aswe all know in medicine, that
you may go into a surgery andmay not come out as great as you
want it to.
Our stimulator, the deviceitself, gives you an opportunity
to try and determine whether ornot you want to proceed.
I tell my patients all the timevery few things that you get to
try before you say I like it, Iwant it, I want to move forward
(13:19):
.
And so that's very importantfor patients to really
understand is we aren't the oneswho determine whether or not
you move forward.
It is you.
It is always a patient.
Speaker 1 (13:29):
The patient's always in control, regardless of what a
doctor says or a rep says oranything else, the patient's
always in control.
I agree with you guys.
You guys are right.
The reason I like thesestimulators is because you get
to test drive it before you haveanything implanted in you.
It's like the car.
You go to the car dealership,you say I want to try this one.
Speaker 3 (13:46):
You test drive it if you don't like it, you turn it
back in and nothing has changed.
Speaker 1 (13:51):
It's the same thing with the stim trials you come in
, we put the wires in.
It takes 20 or 30 minutes, andthen you go home and live with
it for a week because we don'twant to just see how much it
benefits you that day.
We want to see how much itbenefits you not just with pain,
but with activity and energyand sleeping and smiling and
everything with your overallquality of life.
And we that only comes if youwear it for five to seven days.
(14:13):
Correct?
You'll come back after five toseven days.
We pull it out.
It's very easy.
You just take the tape off andpull it out and then we ask you
these questions and then thepatient will give us this
overall quality of lifeimprovement.
The insurance requires you tohave at least 50 improvement to
to qualify for the implant.
But if you do qualify, it'sstill 100% up to the patient if
(14:33):
they want to have it implantedor not.
Speaker 3 (14:34):
So it's a test drive If you like it.
Speaker 1 (14:36):
You decide if you want it implanted.
If you don't like it, we moveon to other options.
So I like that technology.
We've done dozens of patientswith them over the years.
Are we in the hundreds?
Speaker 2 (14:47):
yet oh, we're in the hundreds.
I must be busier than I think.
I am.
There you go.
Speaker 1 (14:52):
And we have very good success rate.
I usually tell my patientsroughly 75 to 85% of them will
get roughly 75 to 85% of benefit.
Some of them it doesn't work,it's not meant for everyone, but
the vast majority of peoplewill get some benefit.
And this is only for back pain,or can you use it for other
types of pain too?
Speaker 2 (15:11):
It does have a few indications.
Back pain is the most common.
The most common is a patientwho's had a back surgery and
they're still in pain.
But it can be used for patientsthat haven't had back surgery.
It can also be but have crackedback pain.
Also things like radicular legpain.
That's usually pain that'scoming from the back.
(15:31):
But also some of the newerindications are complex regional
pain syndrome, which is you'vehad several patients that have
done really well with that.
Speaker 1 (15:44):
Usually they respond very well to stimulation.
Speaker 2 (15:46):
Yeah, they do, they do well.
I won't get into the nature ofthat condition because I don't
really fully understand it, butit's usually of the extremities,
sometimes it's of the arms orthe foot, so you can use
stimulation for arm pain too.
Yes.
Speaker 1 (16:02):
Okay, so you can do it in the low back and or the
neck.
Speaker 2 (16:06):
Correct.
Well, it's not on label for theneck, but it is on label for
the CRPS.
Speaker 1 (16:12):
I understand you have to be careful because the
lawyers, we love lawyers.
We're not doing anythingillegal, but we are trying to
help the patients as much as wecan and in the end it's up to
the insurance company.
Absolutely If the insurancecompany is going to approve it,
then we're going to go ahead anddo what the insurance will
approve, and certainly it's verycommon for doctors to do spinal
cord stimulator trials for neckand arm pain.
Speaker 3 (16:33):
Correct.
Yes, In addition to that, I'vegot to add DPN diabetic
peripheral neuropathy right, andthat mostly stems from patients
who have diabetes a lot of painin their feet.
We have acquired thatindication for spinal cord
stimulation too, so that's veryimportant.
Speaker 2 (16:48):
Yeah, that's the newest indication.
Speaker 1 (16:50):
It's very exciting and that was just acquired a
couple months ago.
Speaker 2 (16:53):
Six months ago.
Speaker 3 (16:53):
About a year ago.
About a year ago, yeah, okay.
Speaker 1 (16:55):
Which is great, because diabetic patients with
peripheral neuropathy usuallyit's just medicines that they
can take to treat their pain.
Now, this is a very powerful,effective way to treat their
diabetic pain, because this typeof pain really helps a lot with
nerve pain, and dpn, ordiabetic peripheral neuropathy,
is nerve pain that can betreated with these stimulators I
(17:16):
agree with that.
Uh, lots of benefits for dpnpatients or diabetic peripheral
nerve patients.
Good, all right, um which oneyou guys is funnier?
Speaker 2 (17:26):
oh, it's definitely that's free he keeps yeah, it's
free
Speaker 3 (17:30):
it's free I think, I have, uh, I have humor in my
mind.
Speaker 1 (17:37):
That only works in my mind, but you know he has more
experience as a dad, so he hasmore dad jokes.
Speaker 3 (17:42):
That's right, that's right.
Right, I'm gonna catch up.
Maybe use that one maybe that'swhat's going on here I don't
know if they'll get it, and acouple more things with
stimulation westerns.
Speaker 1 (17:51):
Is this something that you'd go to right away when
you have back pain, or do youusually want to try other things
first?
Speaker 2 (17:56):
I mean I'm up for it.
Yeah, let's do it, but but no,truthfully, no, we it's.
This is kind of at the end of,uh, at the end of the algorithm.
It might be moving up.
I think it is moving up.
Um, some of that is dictated, alot of that is dictated by
insurance.
But obviously you want to startas a doctor, right?
(18:16):
you want to start with what'sone most easy obtainable, you
know, like the insides over thecounter stuff.
So you're gonna start withwhat's easiest, and of course
safety is considered there.
But patients are pretty muchgoing to have to go through a
series of other treatments thatyou would try, and you know a
(18:37):
lot of those can be veryeffective for a long time and
then maybe over time they don'tget the same effect, and so as
that efficacy wears off, theymight become a candidate.
As that, as efficacy wears off,they might become a candidate.
Um, but also, you know, I dothink it is moving up in the
algorithm.
Oh, you're that we're seeingthat?
Speaker 1 (18:58):
yeah, I see that.
Yeah, so reed is correct.
Uh, usually most doctors aregoing to try conservative things
first, because we know the vastmajority of patients are going
to get benefit from conservativeoptions like chiropractor,
physical therapy, acupuncture,these type of stretches.
The next option would bemedicines, whether non-narcotic
or over-the-counter medicines,and then prescription medicines.
Then after that, you start toconsider interventions like
(19:20):
injections.
Then after that you start toconsider spinal cord stimulator
and or surgical options fortreating pain correct.
Speaker 3 (19:26):
So that's sort of a rough algae analogy or algorithm
.
Speaker 1 (19:30):
patients need to go through, so you're right, it's
not initially.
But I have had patients thathave come to me and they've
tried those other things, andthen we do go initially to right
spinal cord stimulation.
Speaker 3 (19:39):
And we always tell patients right is when you've
come to us, there have beenprocedures and interventions
done, like you already statedright, and they have this
success and they're like whydidn't it start here?
It is a procedure, right.
Once you proceed to the actualimplant, there's surgery
involved, and so the doctor doestheir due diligence to make
(20:06):
sure that they can try to treatas with little intervention as
possible, or it's not the wordthat I'm waiting for Minimally
invasive.
Speaker 2 (20:11):
Minimally invasive.
Speaker 3 (20:12):
Thank you, reed.
Thank you.
So they get to us kind of atthe middle or the end of the
road of pain and hopefully wecan help that.
But the doctor is doing theirdue diligence, like Dr Moran
does, to see if other thingswork before we have to move to
that route.
Speaker 1 (20:29):
Okay, Okay, so we have tens of people listening.
Okay, who knows how viral thisis going to go.
What is like the top three bestpieces of advice you guys can
give to people consideringspinal cord stimulation?
Speaker 2 (20:47):
As a patient.
Speaker 1 (20:49):
As anyone, as a rep or a patient or a friend.
Speaker 3 (20:51):
Very first one I'd say is don't be afraid of it.
I think that we come acrossmore fear than anything and I
think that comes from lack ofeducation, where we try to
intervene in that part and makesure patients understand what to
expect, and that's why I'm verycareful.
I said earlier, we have animplant.
(21:12):
We typically refer to it as apermanent implant and most
patients kind of are weary ofthat and it's not permanent
whatsoever.
It can always come out ifmedically necessity.
But I think the number one,biggest advice is don't be
scared of this.
Speaker 1 (21:29):
I agree with that.
I think a lot of times peopleget caught up by the name spinal
cord stimulation and they'relike I don't want to mess with
my spinal cord.
So technically it's not goinginto the spinal cord, it's
resting on top of the spinalcord Correct.
So that's why it's a stimulatingthing.
I agree with that.
Also, and I tell patientsfrequently don't confuse
possibility with probability.
Certainly, possibility withprobability.
Certainly.
It's possible right now that weget hit by a meteor, but that's
(21:54):
not going to happen.
None of us are worried aboutthat because the probability is
so low we don't worry about that.
It's the same thing with anymedical procedure.
Don't confuse possibility withprobability.
Certainly it's possible.
There's complications, but theprobability of it, especially
with this technology, is verylow, correct.
Speaker 2 (22:06):
Correct, so that's a good one.
Do you have anything?
Well, I have a couple of things, but I also kind of want to add
on to that.
Like we were lucky enough inyour office to get to educate
some patients, sometimes earlyon.
You know, maybe they're they'rejust they're asking about, they
see stuff in your office andthey want to know, like, what is
this all about?
Maybe they're not even close tobeing ready for it, but
educating those patients earlyon I think goes a long way,
(22:29):
because I always encourage themlike hey, go do your homework.
Obviously you always want to becareful when you're looking at
reviews and stuff online.
You're going to get someextremes on both ends, but I
think every patient should dotheir homework.
But, like Mark said, you knowit's natural to be kind of a
little apprehensive, like, ohman, you're going to do what.
But you know, do your homework.
(22:51):
And also reach out to theoffice and ask if there's.
I know we've got a lot ofpatients that you've treated
that are have told me expressedthey're willing to talk to other
patients.
In other words, patients thathave gone through the trial,
they've gone through the implant.
They're so happy with what theydid that they want to talk to
other patients and because theyknow that they had those same
fears.
So you know, ask if you're.
(23:11):
If you're, don't just dismissit If those same fears.
So you know, ask if you're.
If you're, don't just dismissit.
If you're nervous about it,don't dismiss it.
Talk to the office.
If you've already been incontact with a rep, you know,
let them know.
Beyond that, I would say partof it is setting expectations.
So you know, have goodexpectations.
Ask the reps, ask the doctor,like you know what.
(23:32):
What does successful look like?
You know you mentioned at least50% improvement.
It's all subjective, it's up toyou, the patient.
Was this successful for you, um, but I always do preface with
patients.
I'm not looking for a hundredpercent success.
It's just not realistic.
Um one, you've probably gotother little ailments that this
isn't going to help.
(23:52):
It's not going to help withyour arthritic knee, it's not
going to help with your stufflike that.
But in my opinion it should bevery significant improvement
that you've experienced with thetrial before you move on.
But you have that expectation.
It's not going to help with theaches and pains that we all
deal with, but it should reallyknock out most of that
(24:15):
neuropathic pain, that's, that'sthe, the big source of pain.
And then I have something elseneuropathic pain, meaning nerve
pain and I agree that knowledgeis power.
Speaker 1 (24:26):
I advocate that to my patients all the time.
Knowledge is power, and be anactive participant, not a
passive recipient, in yourhealth.
If you are considering this,then do your research.
There's lots of information outthere and you can go to my
website it's markmoranemdcom tolearn all kinds of things about
options for back pain, includingspinal cord stimulator.
Another thing is you can alwaysgo to onemonthmdcom, which is
(24:50):
my website, to help peopleeducate them about all types of
treatments and options andcauses for low back pain, and
one of the options I give isspinal cord stimulation because
of the success we've had withyou guys.
So I agree with that Knowledgeis power.
Encourage the patients tobecome active participants, not
passive recipients, in theirhealth.
They come to me and say whatare you going to do for me?
(25:11):
I say nope, we're a team.
You're going to beparticipating with this
treatment problem.
So go learn as much as you canand always bring us questions.
Right, correct, good, did youguys have like one thing that
patients that have stimulatorsdo that you wish?
You could just say all tens ofpeople that are watching what
would be one piece ofrecommendation.
Speaker 3 (25:34):
My very first one that I go to is as far as Boston
Scientific is concerned.
Our ability to navigate andcreate customized therapy is
again.
This is a bias, but it's beyondeverybody else.
So what I tell patients is thatas you start to utilize the
(25:54):
spinal cord stimulation therapy,be willing to change right,
just like you would when youcome into this office, if
something is not working or youwant to make adjustments.
We purposefully, intentionallyplace different modes of therapy
so you don't just get one typeof therapy.
So try the different therapiesthat we initiate for the
(26:17):
patients.
Don't just stick to one.
Don't be afraid of the remoteright, it looks a little wonky.
Change the channel.
That's what I tell the patients.
Speaker 1 (26:24):
And you mean you give patients different options with
their stimulator during thetrial?
So they can see which one worksbest and they like better or
not as much.
Absolutely so they have optionsduring the trial to see which
one works.
Speaker 3 (26:34):
They have options during the trial that have even
more options when they actuallyhave the device right.
We have a limited timeframe.
Our intent during the trial isjust to see if that actually
works right.
We want to see if spinal cordstimulation works for your
patients.
The limited amount of time iswhere we try to make sure that
we have the right parameters setand that's kind of the entirety
(26:55):
of the trial.
Once we find out what the rightparameter is, then we know
where to gauge and where to aimwhen you have the actual implant
.
And so when you have the actualimplant, just like everything
else, you kind of habituate tothe type that you like or a
level and we tell patientschange it, change the channel a
little while, like change thechannel every now and then,
(27:16):
change up your routine every nowand then.
Uh, that's the very first thingthat I typically tell my
patients.
Speaker 1 (27:21):
Good, so good, very good.
Do you guys have anything else?
Speaker 2 (27:25):
yeah, I was gonna say , uh, kind of along those lines.
Like some people also getintimidated by they're just from
the off, the right off the bat.
They're like they don't want totouch the remote.
They're like I don't dotechnology and we can with
boston scientific.
We can make it as simple andset it as and forget it as, as
you like, um, or we can, likemark said, we can create crazy
(27:50):
customizations for you that youcan.
If you're somebody that youlike to mess with stuff and you
want to change things all thetime, we can do it however you
want.
So, um, and if, if you are alittle intimidated and you think
you might want to try thosethings, we can teach you and get
you there.
But we can set it however youlike.
We have automated um.
We have an automated version ofour fast, that's the fast
(28:12):
acting sub perception Therapy.
So you're not feeling thistherapy, but it's unique in that
it works quick and you don'tfeel it.
A lot of the old programs thatpatients wouldn't feel it would
take a couple of days for thetherapy to wash in.
So with this we can turn it onand you'll get almost instant
relief.
Speaker 1 (28:30):
So this is like young Mark's safety as compared to
current Mark's safety, correct?
Speaker 2 (28:35):
It's much faster, very fast.
Speaker 3 (28:38):
Very fast.
Speaker 1 (28:39):
Very fast back then.
Very fast Did you beat me in arace?
Speaker 3 (28:41):
Absolutely 100%.
Speaker 1 (28:43):
Sound a little confident there.
Speaker 3 (28:45):
There are very few people that can beat me.
Speaker 1 (28:47):
I don't know, is there a Chick-fil-A at the end
line?
I might be pushing your limits,right there, those Chipotle
guys.
Speaker 3 (28:54):
No, no, very good.
What's your 40 speed?
Like my top 40 speed.
No, your lowest Top top.
I ran officially in a combine440.
So that's my fastest time,that's my official time.
I ran faster than that, butthat's.
Speaker 1 (29:10):
I got 4.5 on one leg hopping.
I'm just saying.
Speaker 3 (29:16):
With a Boston Scientific Stimulator.
Speaker 1 (29:17):
4.4 ever okay, remember, we are trying to teach
people some stuff here.
I agree with that.
Spinal cord stimulator verygood technology.
What you're saying is you canpersonalize individual options
for each patient when they comein with stimulation.
Absolutely, it's not a cut block, cookie cutter type thing.
(29:39):
Everyone gets the same.
Every patient getsindividualized treatment.
Absolutely Got it.
Good, it should be that way.
Next thing we want to talkabout a little bit because we're
starting to run out of time.
I know our watchers andlisteners really want us to keep
going, but I do want to quicklymention do you?
want to say hi to your mom, heymom, okay, reed, yeah, hey,
(30:01):
mark's mom, we want to talk alittle bit about something
that's relatively new for BostonScientific called Intercept,
and you're kind of in charge ofthis for the VA, right.
Speaker 3 (30:15):
No.
So I'd say that I wouldn't becomfortable talking about
Intercept as much as I'd like.
Okay, we manage the flow, butwe do have a rep, beth Irwin,
who is completely in charge ofeducating.
Beyond that, then I wouldn'tfeel as comfortable.
I wouldn't feel as comfortable.
(30:35):
Well, do you mind if I take ashot?
No, please.
Speaker 1 (30:37):
I thought we should teach them about stimulators and
Intercept yeah.
So Intercept is a procedure forpeople with back pain where a
lot of people try somethingcalled radiofrequency ablation,
where you put a needle in andyou burn a nerve that's on the
outside of the vertebral body.
This is a procedure where theneedles go inside the vertebral
body.
Now, as we find more resultsfrom research and medicine,
(31:02):
where we used to think that thediscs, the cushions between the
bones, were causes for a lot ofpain, now we realize that it's
not the discs, it's the bonesthat are the cause for a bunch
of back pain.
So instead of treating discproblems for back pain, we now
know that there's a lot ofresearch that shows getting a
needle into the actual bone andburning the nerves inside the
(31:23):
bone can have significantbenefit for back pain absolutely
right, that's what theintercept procedure is correct
rf or radio frequency is burningon the nerves that are outside
the bone.
Intercept is inside thevertebral body and putting a
probe in there and heating it upand burning the nerves that go
to the vertebral body inside thebody.
Speaker 3 (31:41):
Correct, correct.
Speaker 1 (31:42):
That's just a guess.
Is that a good?
Speaker 3 (31:43):
guess?
No, that's.
I mean, we've got to take youto Vegas.
Totally guessed Going to Vegastomorrow.
Speaker 1 (31:49):
And this is an up-and-coming technology.
Speaker 2 (31:55):
How long has?
Speaker 3 (31:55):
that been around.
Speaker 1 (31:56):
Boston.
Speaker 2 (31:56):
Scientific acquired it probably about a year ago,
but I think it was out maybe twoyears before that.
Don't quote me on that, butit's been out a few years.
Speaker 1 (32:04):
I know that the five-year data is just now
recently coming out tosubstantiate it, and I know that
the results are really good.
That's why I'm going to startdoing it.
Yeah, we're excited to startdoing it.
Yes, yeah, so another bullet inmy holster to try and help the
patients out with their backpain.
On top of that, another thingwe can do is knowledge is power,
(32:27):
so learning about the causesand treatments and options for
back pain before they even getstarted is very valuable, which
is why you guys should rememberto check out One Month MD to see
if you can learn anything thatway as well, because we want
patients to be activeparticipants, not passive
recipients, and a lot of timesyou can prevent pain just by
doing yoga.
I've had several people tell merecently, when I finally bugged
(32:50):
them enough, they started tryingto yoga.
They said I did it for thefirst week and my pain in my
hips and knees and shoulders isgone.
Speaker 3 (32:57):
I believe it Absolutely.
Speaker 1 (32:58):
I'm telling you, I know a couple things about pain.
Absolutely, if you're over 40,yoga is very good for your back
pain.
Yeah, I'll have to figure thatout when I get there.
Speaker 3 (33:12):
No back pain for Dr Moran.
Speaker 1 (33:14):
When I turn 40.
Speaker 3 (33:15):
Oh that's right.
21 tomorrow.
Speaker 1 (33:18):
Really Happy birthday .
Speaker 3 (33:20):
Thank you.
Speaker 1 (33:21):
You going out for a drink?
Speaker 3 (33:22):
Two, just two.
Speaker 1 (33:25):
Okay, very good, alright, did you guys have
anything else you want to shareor tell or any questions you
want for me?
What else can we do to helpempower the patients with
knowledge?
Speaker 3 (33:38):
No, I think you covered it very well.
I think for your audience it'svery important to know that
spinal cord stimulation is notfor everybody, right?
We try to do our due diligenceto make sure that Dr Moran is in
front of the appropriatepatients for the appropriate
time, but at the same time, doyour due diligence in learning
about spinal cord stimulation.
(33:58):
It may not be now, it may bedown.
The road.
Time is against us all as westart to deteriorate in age and
time.
Speaker 1 (34:07):
I like to say, as people get more life experience.
Speaker 3 (34:10):
Yeah, I like that one .
Speaker 1 (34:11):
No one gets older, they get more life experience.
Yeah, I like that one.
Speaker 3 (34:14):
No one gets older.
They get more life experience.
They get more wise as we wisen.
If that's a word, it's a newword.
Just prepare yourself for theopportunity or the possibility
that spinal cord stimulation maybe down the road for you Maybe
not now, but later on down theline.
So educate yourself a littleearly on.
Reach out to myself or read.
We're always in Dr Moran'soffice willing on down the line.
So educate yourself a littleearly on.
Reach out to myself or Reed.
We're always in Dr Moran'soffice willing to share the
(34:37):
information, even if it's notfor you now.
Maybe you need the informationfor one of your parents or
friends or anything.
Speaker 1 (34:44):
I agree, reed gig him , yeah, gig him.
Speaker 2 (34:48):
I think you know what Mark said is kind of summarizes
everything.
But, you know, ask questions,find out what other options are
there.
Um, I think the earlier you geteducated and start looking into
options, I think the better offyou'll be in the long run.
Um, maybe, maybe it's intercept, maybe it's spinal cord
(35:08):
stimulation, maybe it'ssomething else radiofrequency
ablation, stuff like that thatDr Moran offers, or your pain
doctor.
If you start asking about thosethings and learning about them,
when it does come up and it issomething that the doctor thinks
you're ready to try, I thinkit'll be you set yourself up for
more success because you'llhave kind of prepared yourself,
(35:29):
you'll done your research.
You're not like surprised tohear about it.
So, yeah, knowledge is power.
I think that's a great way toput it.
And definitely you know, onceyou, if you do get to a point
where you have you're doing atrial, you've done a, you've had
an implant rely heavily on yourreps.
You know where that's.
Our job is to make sure you'recomfortable with the device,
(35:51):
make sure the device is workingoptimally for you and so be,
like Dr Moran said, be an activeparticipant.
You know you've got to takepart in your care and you know,
we'll get you there.
Speaker 3 (36:06):
Big shout-out to Dr Moran.
No, no, I think it's importantfor patients to also understand.
You know there are multiplepain doctors locally here in San
Antonio, but not all of themare so interventional, and what
I mean by that is that you mayrun into a doctor that has a
very stringent one way foreverybody.
(36:29):
When patients go into youroffice, they should be very
confident in knowing that you'llbe able to approach them in
different manners.
And we said this earlier.
Spinal cord stimulation may notbe for everybody, but Dr Moran
will have an option for you.
That's appropriate and I thinkit's important for patients to
understand that you want to bein an office where a doctor is
willing to go left and right anddown the middle and maybe a
(36:52):
little off the path a little bitif necessary.
But uh, not everybody's likethat.
Speaker 1 (36:57):
Not everybody has the sound hands minds to be an
interventionist well, Iappreciate that, and I guess you
just want me to buy you a drinkfor your 21st birthday too.
Okay too, but you're right.
I tell my patients the patientsare the boss like I work for
them.
I'm just giving them advice andanswering their questions.
But the patients decide whatthey want to do, and if they
don't want to do something, thenwe find another option.
(37:18):
So you're absolutely right.
Very well, I encourage everyoneto continue to become an active
participant in their health andnot a passive recipient.
If you have anyone that youwould like to be on the show or
know that would want to be onthe show, we're happy to have
anyone, because we're alwayshere trying to educate the
community about options, abouthealth and wellness and taking
(37:38):
care of themselves.
Thank you guys very much, Iappreciate your time and
dedication taking good care ofour patients.
We appreciate that and we'llsee you guys next time.
On back to back.
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