October 1, 2025 • 29 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. It's another weekend here in the heart of
the dusty Chuahuan Desert in West Texas. You're listening to
the Medical Hackers. However, you may be tuned in this week,
and I'm your host, Doctor Sandy Brow. I'm here to
bring the latest information in healthcare, medicine, and technology to
the borderland on the show. I consider myself a bit
of a hacker. A hacker any positive sense, a hacker
(00:28):
breaks down some of the barriers to accessing new medical
technologies and current health care information. So I got Juni
here with me.
Speaker 2 (00:37):
Hey, Doug, good afternoon. Good to be with you is.
Speaker 1 (00:40):
Always absolutely one of the things I wanted to highlight
just to start off the show. I want to go
into in depth on some other areas related to pain later.
So in the second third part, we're probably going to
go into shoulder pain because that's some very interesting patients
who came in with shoulder pain. But I want to
kind of start off with a few news items that
(01:01):
really caught my interest. One of the things that really
caught my interest was actually this this interesting study that
came out of the New Journal of Medicine, and it's
related specifically to my field, which is radiology and imaging.
And so what they said was medical imaging that is
specifically CTEs and X rays, the type of imaging that
(01:25):
involves radiation. It's actually been linked and we've always known
it's been linked to cancers to a certain degree. Okay,
but they specifically looked at kids, and they did this
amazing study where they followed up children all the way
from their birth all the way to twenty years of age,
so this is a really long term study, and they
looked at kids who'd gotten more imaging and less imaging,
(01:47):
and what they found is overall that up to ten percent,
so one in ten kids who had developed a blood
cancer like a leukemia, was attributable specifically to radiation exposure,
which I find really fascinating because when we think about
all the studies that we talk about, we talk about
(02:09):
radiation linked cancers, when we talk about the effects of
cts of X rays, we all know that has some
radiation effects and theoretically it can affect your DNA can
that radiation can cause mutations. But a lot of that
data is actually they extrapolated it from data from survivors
(02:34):
of the atomic bomb blast. They hear Shumma Nagasaki, those
blomb bomb blasts, and so the way those studies were
done way back is that they saw that these patients,
these people in Japan were exposed to these atom bombs,
and they saw over time that they had more cancers.
But it's not a very precise type of thing like
(02:59):
this study. And that's what I found sound really interesting
about the study because overall we're trying to do this
thing which is called image wisely. You know, there's a
lot of people who when they come into the emergency room,
they just want to get every single study done, especially
parents who might be worried about their kids. You come in,
you had a kid, maybe they fell, and all of
(03:20):
a sudden, you're really worried. Oh do I want to
get a head CT. Well, you know what, you can
actually probably try to avoid that just by looking at
the clinical science. Obviously it's a super traumatic event. Then
you definitely want to get the imaging, but you don't
want to go overboard. And that's exactly what the study highlights.
So one in every ten blood cancers and children has
been attributable to imaging, and.
Speaker 2 (03:41):
So o' wrong. I've got a question for you, and
this is going back a little bit here when you
said that children who did end up with a blood
cancer type, were those children more exposed and more imaging
than the others? Are kind of the same.
Speaker 1 (03:58):
No, exactly, So exact we got more imaging ductle lifetime.
So they looked at between nineteen ninety six and twenty sixteen,
three point seven million kids they were in health systems
in the United States and in Canada. And what they
did is they followed them all the way till twenty seventeen.
So that's about the end of their healthcare coverage as
(04:20):
a child, Okay, And so they looked at how many
of these kids got a CT scan, how many of
them got an X ray? How about a just a
forest copic study? So what do I mean by fuorest
copics study? Have you heard of a barium swallow? Have
you heard of a upper gi Sometimes what we'll do
is imagine if you have difficulties swallowing, if you have
(04:41):
some pieces come in and they say you want, I
feel a lump in my chest sometimes when I drink,
I doesn't feel like it's going down. Now, what could
be going on there? There could be a lot of
things going on there, but one of the first studies
that a lot of gastro neurologists GI doctors order is
called a upper GI or a barium swallow. What we
do is we have you drink this chalky liquid, and
(05:05):
this chalky liquid actually shows up on X ray. So
as you drink it, I see as this liquid flows
down your esophagus, down your throat into your stomach, and
make sure that it flows all the way down. Now,
we frequently do that for kids because we have a
lot of kids who for whatever reason, they're nauseous. They're
growing up, and so we have to do these studies.
(05:27):
But my point is that this is a type of
a study that involves radiation. So I'm there's definitely gonna
be studies that you have to get done. I don't
want people to freak out and say, you know what,
I don't want to get anything done because of this.
But it's very important though. If you just had if
they compared to a child who had one seat scan
versus someone who had two or three seat scans over
(05:49):
that same period of time, the one the child who
had two or three seat scans actually is a fifty
percent high risk of having a blood cancer like a leukemia.
So I think that's really important to know because the
really really important reason is the United States overall, when
you compare to every other country in the world, actually
(06:09):
is the highest per capita rate of diagnostic imaging. That
means more people get scans done in the US than
any other place in the world. Maybe it's due to
the wide availability. People think that, you know, it's a
very easy study to do, but it's just very important
to know that there's a risk and when you follow
(06:29):
people over time, these risks manifest as a cancer.
Speaker 2 (06:35):
I've got a two part question for you, Doc. You
said you mentioned mutation earlier. Was that mutation for the
young ladies who were exposed to imaging? And the other
part you just mentioned right now about the the imaging overall.
Do you think we're being a bit irresponsible with it?
Speaker 1 (06:57):
So overall, let's start with the second part first, which
is are we being irresponsible? So there's definitely people who
are trying to shine more light on imaging. There's definitely
debates back and forth when you talk about women who
need imaging. So one of the biggest things Amber, I
don't know if anybody here out there listening has had
a mammogram because you need to start getting those in
(07:19):
your forties. People say you need to start getting your
first mammogram in your forties. So there's this thought out
there from some people who say we are over imaging
women with mammograms because there's a lot of negative mammograms
that are coming back. Meaning you go in, you get
your mammogram, and it's normal. So are we unnecessarily imaging
(07:40):
these people? Because what is a mammogram involve? Obviously, you know,
you go in, you sit in that little chamber, they
squeeze the breast tissue, and then you're hit with radiation
with X rays to develop this image of your breast
looking for a cancer. Now people are suggesting they are
people napstairs. I'm not on that side. I do think
(08:02):
it is important to start your imaging at least have
a baseline mammogram starting in your forties. But because you're
hitting this tissue, some people say, you know what, you
might be unnecessarily exposing people to assess radiation. Now, what
larger studies have found when you look at women and imaging,
is that the overall benefit that you get from identifying
(08:24):
these cancers outweighs the risk from a radiation related cancer.
And the reason for that is because see, when you're
a child and you're getting imaged, you have so many
more years of having that cancer developed. So if you're
somebody who's four years old and getting unnecessarily imaged with
X ray cts, that's much different from a woman in
(08:48):
their forties who's getting imaged for the first time, or
maybe maybe not the first time, but it's just attack
on radiation you're getting at your forties because your lifespan
is now, we're looking at someone from the fourties to
maybe their eighties or nineties, so that's about a forty
year window. Whereas you're looking at someone who's a child
who's getting imaged, we're talking about their entire last pane
of developing that cancer. And so that's really why it's
(09:10):
important too, as we say image wisely, to think about it,
especially when you come to the pediatric population, because you
have one is, you have organs that are just growing
and developing and you're hitting them with radiation. Two is,
you have this entire lifetime of possible exposure because that
may not be the first time they get imaged, that
(09:32):
may be the only time they get a X ray
and all that accumulates over time. So I'm gonna take
a quick break you on the Hackers and go a
little bit different direction.
Speaker 3 (09:43):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Rao, call nine five five hundred four to three
seven zero or by emailing Row at medical hackers dot com.
Speaker 1 (10:10):
Backing on the Hackers, I'm doctor out here with Junie,
and one of the things I wanted to discuss was
two interesting patients who came in to see me this week,
and there were actually two different clinics. So I have
one clinic, actually I'm obviously i'll live here in the borderline,
live here in o'past, so, but I also have a
clinic in Phoenix, and I also have one in San Antonio.
And I had patients presenting with shoulder pain, chronic shoulder pain.
(10:34):
It wasn't pain that just woke them up at night,
but it was also difficulty from a range of motion standpoint.
So these patients both had difficulty abducting their arms. That
means imagine, if you take your arm and you try
to sort of imagine you're trying to flap your your
wings like if you're a bird, right, So they're having
difficulty doing that motion. They're having difficulty combing their hair.
(10:56):
So they had overall decreased range of motion in addition
to having shoulder pain not just with motion but also
at night. So that was kind of interesting because I
took two different approaches to treating both these patients. So
let me tell you about the first one. The first
guide first gentleman, he actually had pain in both shoulders
(11:18):
and he had when you looked at his X ray,
I found severe arthritis. Okay, just severe severe arthritis. Now
that severe arthritis was due to just a lifetime of wear,
but he had also had a prior history of having
rotator cuff disease rotator cuff tears.
Speaker 2 (11:38):
How old was your patient, doc?
Speaker 1 (11:40):
This patient was actually in his fifties, in mid fifties,
fifty five years old, and so a lot of pain.
These patients coming to see me because they might have
been told, you know what, you might have need to
get a shoulder replacement potentially, but sometimes that may or
may not help. And also, as we know, it's an
invasive procedure, a lot of recovery, especially if you have
both shoulders. You know, there's a that's a long period
(12:02):
of recovery if you have to do replacements for both
of them. So this particular gentleman came in. He wanted
to see what I could offer him because he's trying
to do a last ditch effort to see what he
can do to avoid any short of big surgery. So
in this one particular case, after looking at everything and
seeing what his insurance and everything paid for what covered,
(12:23):
I determined that what might actually work for him is
what's called an arterial embolization of the shoulder. So what
I did was two weeks ago, actually did his first shoulder,
his left shoulder. I went in through a little ivy
in the wrist, the radio artery. I went in with
a tiny little wire and I looked at his blood
(12:45):
vessels of his shoulder under X ray, and what I
found was abnormal inflammation, abnormal what we call hypervascularity. That
just means there's a lot of new blood vessels that
had developed in the area where there's the arthritis in
his shoulder.
Speaker 2 (13:01):
Is that what your doctors call angiogenesis.
Speaker 1 (13:03):
Exactly exactly angiogenesis. And so what I did is I
went into those blood vessels and I put in medication
designed to block the blood flow, which is kind of
weird to think. You might think you might need more
blood flow, But what I'm doing is I'm actually depriving.
I'm starving the inflammation of blood flow. So the thought
(13:27):
process behind this whole technique because I actually apply this
the exact same technique for patients who have risk pain.
So there are patients who have not carpal tunnel wrist pain.
That's a totally different solution that does not have my
does not respond to what I do. But if you
have what we call arthritis of the hands, some people
have severe arthritis hands, some people have it of the
knees most commonly ankles, and other patients I've seen recently
(13:51):
for this. But the thought is that there's two theories. Okay,
So the first theory is that with the continue inflammation
that you have in any joint, so you have the
underlying arthritis, and that causes ongoing inflammation and chronic inflammation
that causes the development of new abnormal blood vessels, hypervascularity
(14:15):
or what you said, the angiogenesis. And so what that
does is that new blood vessel formation in the inflammation,
what it does is it leads to all these abnormal cells.
So when you have an inflammatory response in your body,
there are cells that get pushed into that area, inflammatory cells, cytokines,
and what they do is they're designed to take care
(14:37):
of the inflammation. So what's happening is there's this cyclical
process of there's inflammation going on, new blood vessels are formed,
and now it's causing more and more inflammation. So we're
helping breaking down that cycle and reducing the inflammatory process. Now,
the second part of that is the second theory is
that we think that this hypervascularization that we see, this
(14:59):
app normal new blood vessel formation, is actually stimulating There
are the sensory nerves that are in that area, so
there are these unmilinated So unmilinated just means so when
you think of a nerve, think of a cover on
a nerve, Okay, almost like a I don't know how
(15:20):
to describe, almost like it's laminated. But we use the
word myelinated. Okay, So myelin is a thin sheath, a
thin cover around a nerve. But when we start looking
at the nerve endings, it starts to be uncovered, unmilinated.
And so we think that this hypervascularization, this new blood
vessels that are in this areas of inflammation is actually
(15:42):
hitting these nerve endings of in that era. And so
by going in, by embolizing, by blocking off these blood vessels,
by me doing my procedure, by shutting down the blood
float to this area, I am now reducing the stimulation
that you're having that's causing you pain. So two theories
(16:03):
behind why this entire thing works. But the interesting thing
is at work. So this particular guy who came in normally,
just so you know, whenever I have a patient was
two shoulders or two knees that have pain. I tell him,
you know what, why don't you wait a month or two.
I want to see how you do, because I don't
want to just offer you an unnecessary procedure to the
other side. I want to see how you do. I
(16:24):
want to make sure you recover. But two weeks ago
this guy came in got his shoulder done and this
was a big surprise to me. So he actually within
an hour of the procedure. He told me he had
significantly reduced pain and he was actually had increased mobility
in his shoulder, and so he was like he was
now chopping at the bit. He was like, how quickly
can we do the other shoulder? So I actually went
(16:45):
in yesterday and I wish it went in did his
other shoulder, and I was able to go in on
the other right arm, go in through the blood vessel,
put medication in to help decrease the overall inflammation in
that shoulder. Again, this is an outpatient procedure, takes about
an hour or so. He goes home with just a little,
(17:09):
you know, a little you know, band aid on his wrist,
so it's not a significant recovery time. You just kind
of walk out of there with that. So really, I mean,
this guy actually is probably my star case. Because I've
had different cases. I can tell you there have definitely
been some patients who have not improved. But if you
ask me the overall improvement with this symbolization procedure, I
would say it's about none out of ten patients get
(17:31):
improvement in their shoulder pain. So but I have I
saw one patient who actually didn't improve and maybe after
this break. What I'll do is I'll go into what
are the other options I do for shoulder pain because
there's so many different approaches we can do. And that's
the beauty of being in an outpatient minimally invasive office
is that we can go go approach it from an
arterial standpoint, which is what I just discussed, but I
(17:54):
can also go after it by targeting specifically the nerves.
There's ways to stimulate these nerves, and I'm going to
kind of go into a different top of patient who
might not have benefited the first go round, but I'm
going to go and throw something else at them and
see how that might work to really, at the end
of the day, we're trying to get patients to really
(18:16):
be able to sleep better at night, no pain, a
little bit improved mobility. Now you're probably not going to
be able to go out there and start, you know,
throwing baseballs, you know, throwing them at you know, at
a fast pace. But my point is most people are
just looking for functional recovery. They want to be able
to you know, maybe comb their hair, maybe you reach
for something on the shelf, you know, just get through
(18:37):
their normal activities.
Speaker 2 (18:39):
Is your patients able to go do the chicken dance.
Speaker 1 (18:41):
Now exactly they might be able to do it, maybe
not do a significant flapping of the wings. Yeah, but
exactly that's all they want though, right, That's that's all
you really need, because you just need a certain amount
of motion to be able to get you back on
your road to recovery quick breaking all the Hackers.
Speaker 3 (18:58):
You're listening to the Medical Hackers with doctor Sande Brow,
board certified vascular interventionalist bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(19:22):
dot com.
Speaker 1 (19:26):
Back here on the Hackers talking about shoulder pain, chronic
shoulder pain and different approaches. So, Junior, I just told
you about a patient who had responded well to embolization,
But I've had other patients who I don't really offer
embolization because I personally don't think you should offer one
treatment to every single person who walks in the door.
If you offer the same treatment to everybody who walks
(19:48):
in the door, I don't know if you're doing it right.
I think you're probably just trying to sell a procedure.
Speaker 2 (19:54):
You agreed, you.
Speaker 1 (19:55):
Know, I've I heard somebody want say this about there's
some docs who have single medication practices that happens a
lot in the pain space. They run ketamine only clinics.
Have you heard of these?
Speaker 2 (20:11):
I've seen it.
Speaker 1 (20:13):
So I heard someone say this. What they said was,
if you're a doctor is only offering just a specific
type of medication for every single patient who comes in.
You're not a doctor, You're just a drug dealer. You're
just pushing that. So when I look at it from
a pain standpoint, when a patient comes in, some patients
get medication if needed. Some patients I have to apply
(20:36):
a certain type of procedure, and then other patients I
look at evaluate them and as go, you know what,
maybe you're not the best candidate for this procedure, but
you're a good candidate for a different top of procedure,
and that's where this other procedure comes in. So at
my San Antonio clinic, one of the things that I
offered to a patient. A patient came in, a woman.
(20:56):
She was a little bit older, I would say she
was closer maybe to her late sixties. But she only
had pain in one shoulder, okay, And when you start
looking at her imaging, she actually didn't have much in
the realm of arthritis. But she just had this pain
that she does not know what is the cause of, Okay,
(21:18):
just chronic pain, just in one shoulder. And this pain
was actually almost a neuropathic pain. What do I mean
by neuropathic pain? It was like a burning and numbness
were also part of the tops of pain. So she
had pain in her shoulder, going down into her forearm
and going into her fingers. So she said she experienced
(21:40):
a lot of numbness and tingling in her fingers as well.
And also she just had this burning sensation throughout her
throughout her hand, throughout her forearm. And so a few
things come to mind when I think about that. So
when I'm thinking about it from that standpoint, I don't
know if it's necessarily due to the same type of
(22:02):
patient that we just talked about, the patient who came
in with arthritis in the shoulder. This is in my mind,
a pain related to nerves. So that's where I have
now decided to offer something called nerve stimulation Now, this
is an interesting type of treatment because it's very unique.
(22:24):
You actually get to try it the treatment for seven
days before he decide to commit to it.
Speaker 2 (22:29):
Doctor Row, how do you determine that that pain? Are
are you doing an ultrasound or what are you doing there?
Speaker 1 (22:34):
Sure, so, as part of every work up, I always
like to have at initial obviously he gets a symptoms, right,
you ask them the symptoms. So if you look at
the symptoms from this patient, it's very different from the
symptom from the earlier gentleman. This woman who came in
is just one side. She had not had much trauma
on her shoulders, but she just had this burning neuropathy pain.
(22:56):
But she actually has full range of motions, so she's
able to move her hand in all directions, but she
just has this burning pain in her shoulder, as opposed
to this earlier gentleman who had decreased range of motion,
inability to reach for things, or significant pain with that
and significant pain at not as well. And when you
look at his X ray that's a little bit more confirmatory.
(23:17):
You can also see this arthritic change. Now the ideal
test to do also when you look at these shoulders
is also to get an MRI if you can get
one done. But actually neither of these patients want their
insurance would pay for the MRIs, so I act was
actually able to proceed without that. But the reason why
it's good to have an MRIs you can actually sometimes
see the inflammation on the MRI scan. You can see
(23:39):
areas where we call you know, like you can sometimes
see adhesive capsule lightest. So there's this capsule that surrounds
your shoulder joint that you can actually see if there's
inflammation going on in that that shoulder joint. You can
see underlying changes in the bone. You can see if
there's we call a edema or what we call fluid
within the within the bone. So there's a lot of
different things we can see with the MRI more than
(24:00):
an X ray, and it's an ideal test if you
can get it done, if you can have your insurance
pay for it, or if you're willing to pay for
it here on your own. But a lot of patients,
for whatever reason, they don't want to get it done.
Maybe they're claustrophobic, they don't want to sit in a scanner.
But in any event, I use a different A lot
of different things to generate a treatment opti form. So
in this particular woman's case, I'm offering her nerve stimulation. Now,
(24:24):
when it comes to nerve stimulation, there's different nerves you
can tackle, Okay, So it depends on where the pain is.
So when I asked her where her pain was, you know,
her pain seems to be mostly in her arm forearm
in hand. And so my goal is to go after
and there's a nerve bundle called your brachial plexus that
sits in your accela, in your armpit, and so there's
(24:46):
a way for me to put this little nerve stimulator device.
All I'm doing is I'm putting a little wire adjacent
to the nerves. That's all. Now, the key part is
you obviously want to avoid hitting any critical a Sure,
there's there's blood vessels that are there. But using ultrasound,
using extra I can sometimes try to see exactly where
I am in terms of leaving this this wire in place.
(25:09):
But you know, if this patient had told me she
was having more pain like where you know, the deltoid
muscles mostly involving her you know, a little bit more
like in her shoulder, like not just her shoulder but
even her going extending a little bit to her upper back,
that's a different there's a totally different top of treatment.
There's a different top of nerve I can try to target.
(25:30):
But really what we're doing is we're going after the
specific type of nerve that we think might cause you
your pain. Now, sometimes patients have a mixed bag of symptoms.
Sometimes they have some shoulder pain and some upper back pain.
In that case, what I do is I might put
two little nerve stimulators at the same time, or I
can even do them in sequence. You know, if you
(25:50):
say you know what I want to just let's first
go after one nerve. Let's put the wire there. You
can trial it out for one week. If you get
benefit after one week, we can make that a permanent device.
Now let's say it didn't work the first go round,
I can put another little wire in in in your
soft tissues or your back and we can see if
(26:13):
that helped. Maybe that's the one that's implicated as causing
your pain. Now you might wonder what is this wire
that I'm talking about. So basically what I'm doing is
I'm putting a tiny little wire. It just kind of goes.
Maybe I would say an inch or two underneath your skin,
sitting right next to your nerve, and then the rest
of that little wire actually I taped to the outside
of your skin just for this trial period of time.
(26:35):
So for the first five to seven days, it's taped
to your skin. So I don't want you to go
swimming when you have this on. I don't want you
to go do any significant movements because that wire could move.
But it's really designed just for the trial. I want
to see how this little wire that's temporarily in place,
how it affects your function. Can we take care of
your pain? And so that's basically what we're doing. We're
(26:58):
going to go after a couple of nerves, see if
we can take care of this woman's symptoms. And that's
exactly what I'm gonna be hopefully seeing in the future. Here.
Speaker 2 (27:07):
When does she return down?
Speaker 1 (27:09):
Yeah, so I'm actually doing this trial tomorrow and then
she comes back in a week.
Speaker 2 (27:15):
Oh wow.
Speaker 1 (27:16):
But as I said, the beauty of this is there's
so many different areas that we can target. So I'm
gonna go first offer her one nerve stimulation target, see
how she does. It's a mini million invasive procedure. You'll
probably take about ten fifteen minutes. She goes home the
same day. We'll follow up with her every single day.
We're gonna be asking her questions, asking her, how's your
pain one out of ten? How was your sleep one
out of ten? How's your numbness? You're tingling one out
(27:38):
of ten? And if she tells me she got at
least fifty percent of more improvement, we can proceed with
making it a permanent part. Now we're running out of time,
but making it a permanent part of your life just
involves me taking that little wire and putting it underneath
your skin surface. So it's not really a super invasive procedure,
but it's certainly something that can work. So that wire,
(27:59):
just for tho are listening, It receives a little signal
from a little battery pack. This battery pack is something
that you can kind of implant on your shoulder. Sometimes
they can put a little you can put a little
sort of a band on your thing. You can wear
it whenever you have pain. But it's a little battery
pack that's rechargeable and it's constantly sending little impulses to
stimulate that nerve and bump the pain signal off and
(28:21):
instead have a different signal traveling on your nerves, causing
you not to recognize pain. So, as I said, unfortunate time.
The Saturday is up. If you're interesting more information on
any of you mentioned minimally invasive techniques and treatments, you
can always call to get more information at nine to
one five five hundred forty three seventy that's five zero
zero four through seven zero. You can also reach me
(28:43):
by email at raw that's RAO at Medicalactors dot com.
I hope these healthcare hacks have helped you navigate a
complex medical system. If you've been tuned into this whole time,
bless your heart, change your health. I'm doctor Sandy Brown.
You've been listening to the Medical.
Speaker 3 (28:58):
Actors release the page stated and representing
Speaker 2 (29:07):
Him to repress the PA
Good afternoon. It's another weekend here in the heart of
the dusty Chuahuan Desert in West Texas. You're listening to
the Medical Hackers. However, you may be tuned in this week,
and I'm your host, Doctor Sandy Brow. I'm here to
bring the latest information in healthcare, medicine, and technology to
the borderland on the show. I consider myself a bit
of a hacker. A hacker any positive sense, a hacker
(00:28):
breaks down some of the barriers to accessing new medical
technologies and current health care information. So I got Juni
here with me.
Speaker 2 (00:37):
Hey, Doug, good afternoon. Good to be with you is.
Speaker 1 (00:40):
Always absolutely one of the things I wanted to highlight
just to start off the show. I want to go
into in depth on some other areas related to pain later.
So in the second third part, we're probably going to
go into shoulder pain because that's some very interesting patients
who came in with shoulder pain. But I want to
kind of start off with a few news items that
(01:01):
really caught my interest. One of the things that really
caught my interest was actually this this interesting study that
came out of the New Journal of Medicine, and it's
related specifically to my field, which is radiology and imaging.
And so what they said was medical imaging that is
specifically CTEs and X rays, the type of imaging that
(01:25):
involves radiation. It's actually been linked and we've always known
it's been linked to cancers to a certain degree. Okay,
but they specifically looked at kids, and they did this
amazing study where they followed up children all the way
from their birth all the way to twenty years of age,
so this is a really long term study, and they
looked at kids who'd gotten more imaging and less imaging,
(01:47):
and what they found is overall that up to ten percent,
so one in ten kids who had developed a blood
cancer like a leukemia, was attributable specifically to radiation exposure,
which I find really fascinating because when we think about
all the studies that we talk about, we talk about
(02:09):
radiation linked cancers, when we talk about the effects of
cts of X rays, we all know that has some
radiation effects and theoretically it can affect your DNA can
that radiation can cause mutations. But a lot of that
data is actually they extrapolated it from data from survivors
(02:34):
of the atomic bomb blast. They hear Shumma Nagasaki, those
blomb bomb blasts, and so the way those studies were
done way back is that they saw that these patients,
these people in Japan were exposed to these atom bombs,
and they saw over time that they had more cancers.
But it's not a very precise type of thing like
(02:59):
this study. And that's what I found sound really interesting
about the study because overall we're trying to do this
thing which is called image wisely. You know, there's a
lot of people who when they come into the emergency room,
they just want to get every single study done, especially
parents who might be worried about their kids. You come in,
you had a kid, maybe they fell, and all of
(03:20):
a sudden, you're really worried. Oh do I want to
get a head CT. Well, you know what, you can
actually probably try to avoid that just by looking at
the clinical science. Obviously it's a super traumatic event. Then
you definitely want to get the imaging, but you don't
want to go overboard. And that's exactly what the study highlights.
So one in every ten blood cancers and children has
been attributable to imaging, and.
Speaker 2 (03:41):
So o' wrong. I've got a question for you, and
this is going back a little bit here when you
said that children who did end up with a blood
cancer type, were those children more exposed and more imaging
than the others? Are kind of the same.
Speaker 1 (03:58):
No, exactly, So exact we got more imaging ductle lifetime.
So they looked at between nineteen ninety six and twenty sixteen,
three point seven million kids they were in health systems
in the United States and in Canada. And what they
did is they followed them all the way till twenty seventeen.
So that's about the end of their healthcare coverage as
(04:20):
a child, Okay, And so they looked at how many
of these kids got a CT scan, how many of
them got an X ray? How about a just a
forest copic study? So what do I mean by fuorest
copics study? Have you heard of a barium swallow? Have
you heard of a upper gi Sometimes what we'll do
is imagine if you have difficulties swallowing, if you have
(04:41):
some pieces come in and they say you want, I
feel a lump in my chest sometimes when I drink,
I doesn't feel like it's going down. Now, what could
be going on there? There could be a lot of
things going on there, but one of the first studies
that a lot of gastro neurologists GI doctors order is
called a upper GI or a barium swallow. What we
do is we have you drink this chalky liquid, and
(05:05):
this chalky liquid actually shows up on X ray. So
as you drink it, I see as this liquid flows
down your esophagus, down your throat into your stomach, and
make sure that it flows all the way down. Now,
we frequently do that for kids because we have a
lot of kids who for whatever reason, they're nauseous. They're
growing up, and so we have to do these studies.
(05:27):
But my point is that this is a type of
a study that involves radiation. So I'm there's definitely gonna
be studies that you have to get done. I don't
want people to freak out and say, you know what,
I don't want to get anything done because of this.
But it's very important though. If you just had if
they compared to a child who had one seat scan
versus someone who had two or three seat scans over
(05:49):
that same period of time, the one the child who
had two or three seat scans actually is a fifty
percent high risk of having a blood cancer like a leukemia.
So I think that's really important to know because the
really really important reason is the United States overall, when
you compare to every other country in the world, actually
(06:09):
is the highest per capita rate of diagnostic imaging. That
means more people get scans done in the US than
any other place in the world. Maybe it's due to
the wide availability. People think that, you know, it's a
very easy study to do, but it's just very important
to know that there's a risk and when you follow
(06:29):
people over time, these risks manifest as a cancer.
Speaker 2 (06:35):
I've got a two part question for you, Doc. You
said you mentioned mutation earlier. Was that mutation for the
young ladies who were exposed to imaging? And the other
part you just mentioned right now about the the imaging overall.
Do you think we're being a bit irresponsible with it?
Speaker 1 (06:57):
So overall, let's start with the second part first, which
is are we being irresponsible? So there's definitely people who
are trying to shine more light on imaging. There's definitely
debates back and forth when you talk about women who
need imaging. So one of the biggest things Amber, I
don't know if anybody here out there listening has had
a mammogram because you need to start getting those in
(07:19):
your forties. People say you need to start getting your
first mammogram in your forties. So there's this thought out
there from some people who say we are over imaging
women with mammograms because there's a lot of negative mammograms
that are coming back. Meaning you go in, you get
your mammogram, and it's normal. So are we unnecessarily imaging
(07:40):
these people? Because what is a mammogram involve? Obviously, you know,
you go in, you sit in that little chamber, they
squeeze the breast tissue, and then you're hit with radiation
with X rays to develop this image of your breast
looking for a cancer. Now people are suggesting they are
people napstairs. I'm not on that side. I do think
(08:02):
it is important to start your imaging at least have
a baseline mammogram starting in your forties. But because you're
hitting this tissue, some people say, you know what, you
might be unnecessarily exposing people to assess radiation. Now, what
larger studies have found when you look at women and imaging,
is that the overall benefit that you get from identifying
(08:24):
these cancers outweighs the risk from a radiation related cancer.
And the reason for that is because see, when you're
a child and you're getting imaged, you have so many
more years of having that cancer developed. So if you're
somebody who's four years old and getting unnecessarily imaged with
X ray cts, that's much different from a woman in
(08:48):
their forties who's getting imaged for the first time, or
maybe maybe not the first time, but it's just attack
on radiation you're getting at your forties because your lifespan
is now, we're looking at someone from the fourties to
maybe their eighties or nineties, so that's about a forty
year window. Whereas you're looking at someone who's a child
who's getting imaged, we're talking about their entire last pane
of developing that cancer. And so that's really why it's
(09:10):
important too, as we say image wisely, to think about it,
especially when you come to the pediatric population, because you
have one is, you have organs that are just growing
and developing and you're hitting them with radiation. Two is,
you have this entire lifetime of possible exposure because that
may not be the first time they get imaged, that
(09:32):
may be the only time they get a X ray
and all that accumulates over time. So I'm gonna take
a quick break you on the Hackers and go a
little bit different direction.
Speaker 3 (09:43):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Rao, call nine five five hundred four to three
seven zero or by emailing Row at medical hackers dot com.
Speaker 1 (10:10):
Backing on the Hackers, I'm doctor out here with Junie,
and one of the things I wanted to discuss was
two interesting patients who came in to see me this week,
and there were actually two different clinics. So I have
one clinic, actually I'm obviously i'll live here in the borderline,
live here in o'past, so, but I also have a
clinic in Phoenix, and I also have one in San Antonio.
And I had patients presenting with shoulder pain, chronic shoulder pain.
(10:34):
It wasn't pain that just woke them up at night,
but it was also difficulty from a range of motion standpoint.
So these patients both had difficulty abducting their arms. That
means imagine, if you take your arm and you try
to sort of imagine you're trying to flap your your
wings like if you're a bird, right, So they're having
difficulty doing that motion. They're having difficulty combing their hair.
(10:56):
So they had overall decreased range of motion in addition
to having shoulder pain not just with motion but also
at night. So that was kind of interesting because I
took two different approaches to treating both these patients. So
let me tell you about the first one. The first
guide first gentleman, he actually had pain in both shoulders
(11:18):
and he had when you looked at his X ray,
I found severe arthritis. Okay, just severe severe arthritis. Now
that severe arthritis was due to just a lifetime of wear,
but he had also had a prior history of having
rotator cuff disease rotator cuff tears.
Speaker 2 (11:38):
How old was your patient, doc?
Speaker 1 (11:40):
This patient was actually in his fifties, in mid fifties,
fifty five years old, and so a lot of pain.
These patients coming to see me because they might have
been told, you know what, you might have need to
get a shoulder replacement potentially, but sometimes that may or
may not help. And also, as we know, it's an
invasive procedure, a lot of recovery, especially if you have
both shoulders. You know, there's a that's a long period
(12:02):
of recovery if you have to do replacements for both
of them. So this particular gentleman came in. He wanted
to see what I could offer him because he's trying
to do a last ditch effort to see what he
can do to avoid any short of big surgery. So
in this one particular case, after looking at everything and
seeing what his insurance and everything paid for what covered,
(12:23):
I determined that what might actually work for him is
what's called an arterial embolization of the shoulder. So what
I did was two weeks ago, actually did his first shoulder,
his left shoulder. I went in through a little ivy
in the wrist, the radio artery. I went in with
a tiny little wire and I looked at his blood
(12:45):
vessels of his shoulder under X ray, and what I
found was abnormal inflammation, abnormal what we call hypervascularity. That
just means there's a lot of new blood vessels that
had developed in the area where there's the arthritis in
his shoulder.
Speaker 2 (13:01):
Is that what your doctors call angiogenesis.
Speaker 1 (13:03):
Exactly exactly angiogenesis. And so what I did is I
went into those blood vessels and I put in medication
designed to block the blood flow, which is kind of
weird to think. You might think you might need more
blood flow, But what I'm doing is I'm actually depriving.
I'm starving the inflammation of blood flow. So the thought
(13:27):
process behind this whole technique because I actually apply this
the exact same technique for patients who have risk pain.
So there are patients who have not carpal tunnel wrist pain.
That's a totally different solution that does not have my
does not respond to what I do. But if you
have what we call arthritis of the hands, some people
have severe arthritis hands, some people have it of the
knees most commonly ankles, and other patients I've seen recently
(13:51):
for this. But the thought is that there's two theories. Okay,
So the first theory is that with the continue inflammation
that you have in any joint, so you have the
underlying arthritis, and that causes ongoing inflammation and chronic inflammation
that causes the development of new abnormal blood vessels, hypervascularity
(14:15):
or what you said, the angiogenesis. And so what that
does is that new blood vessel formation in the inflammation,
what it does is it leads to all these abnormal cells.
So when you have an inflammatory response in your body,
there are cells that get pushed into that area, inflammatory cells, cytokines,
and what they do is they're designed to take care
(14:37):
of the inflammation. So what's happening is there's this cyclical
process of there's inflammation going on, new blood vessels are formed,
and now it's causing more and more inflammation. So we're
helping breaking down that cycle and reducing the inflammatory process. Now,
the second part of that is the second theory is
that we think that this hypervascularization that we see, this
(14:59):
app normal new blood vessel formation, is actually stimulating There
are the sensory nerves that are in that area, so
there are these unmilinated So unmilinated just means so when
you think of a nerve, think of a cover on
a nerve, Okay, almost like a I don't know how
(15:20):
to describe, almost like it's laminated. But we use the
word myelinated. Okay, So myelin is a thin sheath, a
thin cover around a nerve. But when we start looking
at the nerve endings, it starts to be uncovered, unmilinated.
And so we think that this hypervascularization, this new blood
vessels that are in this areas of inflammation is actually
(15:42):
hitting these nerve endings of in that era. And so
by going in, by embolizing, by blocking off these blood vessels,
by me doing my procedure, by shutting down the blood
float to this area, I am now reducing the stimulation
that you're having that's causing you pain. So two theories
(16:03):
behind why this entire thing works. But the interesting thing
is at work. So this particular guy who came in normally,
just so you know, whenever I have a patient was
two shoulders or two knees that have pain. I tell him,
you know what, why don't you wait a month or two.
I want to see how you do, because I don't
want to just offer you an unnecessary procedure to the
other side. I want to see how you do. I
(16:24):
want to make sure you recover. But two weeks ago
this guy came in got his shoulder done and this
was a big surprise to me. So he actually within
an hour of the procedure. He told me he had
significantly reduced pain and he was actually had increased mobility
in his shoulder, and so he was like he was
now chopping at the bit. He was like, how quickly
can we do the other shoulder? So I actually went
(16:45):
in yesterday and I wish it went in did his
other shoulder, and I was able to go in on
the other right arm, go in through the blood vessel,
put medication in to help decrease the overall inflammation in
that shoulder. Again, this is an outpatient procedure, takes about
an hour or so. He goes home with just a little,
(17:09):
you know, a little you know, band aid on his wrist,
so it's not a significant recovery time. You just kind
of walk out of there with that. So really, I mean,
this guy actually is probably my star case. Because I've
had different cases. I can tell you there have definitely
been some patients who have not improved. But if you
ask me the overall improvement with this symbolization procedure, I
would say it's about none out of ten patients get
(17:31):
improvement in their shoulder pain. So but I have I
saw one patient who actually didn't improve and maybe after
this break. What I'll do is I'll go into what
are the other options I do for shoulder pain because
there's so many different approaches we can do. And that's
the beauty of being in an outpatient minimally invasive office
is that we can go go approach it from an
arterial standpoint, which is what I just discussed, but I
(17:54):
can also go after it by targeting specifically the nerves.
There's ways to stimulate these nerves, and I'm going to
kind of go into a different top of patient who
might not have benefited the first go round, but I'm
going to go and throw something else at them and
see how that might work to really, at the end
of the day, we're trying to get patients to really
(18:16):
be able to sleep better at night, no pain, a
little bit improved mobility. Now you're probably not going to
be able to go out there and start, you know,
throwing baseballs, you know, throwing them at you know, at
a fast pace. But my point is most people are
just looking for functional recovery. They want to be able
to you know, maybe comb their hair, maybe you reach
for something on the shelf, you know, just get through
(18:37):
their normal activities.
Speaker 2 (18:39):
Is your patients able to go do the chicken dance.
Speaker 1 (18:41):
Now exactly they might be able to do it, maybe
not do a significant flapping of the wings. Yeah, but
exactly that's all they want though, right, That's that's all
you really need, because you just need a certain amount
of motion to be able to get you back on
your road to recovery quick breaking all the Hackers.
Speaker 3 (18:58):
You're listening to the Medical Hackers with doctor Sande Brow,
board certified vascular interventionalist bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(19:22):
dot com.
Speaker 1 (19:26):
Back here on the Hackers talking about shoulder pain, chronic
shoulder pain and different approaches. So, Junior, I just told
you about a patient who had responded well to embolization,
But I've had other patients who I don't really offer
embolization because I personally don't think you should offer one
treatment to every single person who walks in the door.
If you offer the same treatment to everybody who walks
(19:48):
in the door, I don't know if you're doing it right.
I think you're probably just trying to sell a procedure.
Speaker 2 (19:54):
You agreed, you.
Speaker 1 (19:55):
Know, I've I heard somebody want say this about there's
some docs who have single medication practices that happens a
lot in the pain space. They run ketamine only clinics.
Have you heard of these?
Speaker 2 (20:11):
I've seen it.
Speaker 1 (20:13):
So I heard someone say this. What they said was,
if you're a doctor is only offering just a specific
type of medication for every single patient who comes in.
You're not a doctor, You're just a drug dealer. You're
just pushing that. So when I look at it from
a pain standpoint, when a patient comes in, some patients
get medication if needed. Some patients I have to apply
(20:36):
a certain type of procedure, and then other patients I
look at evaluate them and as go, you know what,
maybe you're not the best candidate for this procedure, but
you're a good candidate for a different top of procedure,
and that's where this other procedure comes in. So at
my San Antonio clinic, one of the things that I
offered to a patient. A patient came in, a woman.
(20:56):
She was a little bit older, I would say she
was closer maybe to her late sixties. But she only
had pain in one shoulder, okay, And when you start
looking at her imaging, she actually didn't have much in
the realm of arthritis. But she just had this pain
that she does not know what is the cause of, Okay,
(21:18):
just chronic pain, just in one shoulder. And this pain
was actually almost a neuropathic pain. What do I mean
by neuropathic pain? It was like a burning and numbness
were also part of the tops of pain. So she
had pain in her shoulder, going down into her forearm
and going into her fingers. So she said she experienced
(21:40):
a lot of numbness and tingling in her fingers as well.
And also she just had this burning sensation throughout her
throughout her hand, throughout her forearm. And so a few
things come to mind when I think about that. So
when I'm thinking about it from that standpoint, I don't
know if it's necessarily due to the same type of
(22:02):
patient that we just talked about, the patient who came
in with arthritis in the shoulder. This is in my mind,
a pain related to nerves. So that's where I have
now decided to offer something called nerve stimulation Now, this
is an interesting type of treatment because it's very unique.
(22:24):
You actually get to try it the treatment for seven
days before he decide to commit to it.
Speaker 2 (22:29):
Doctor Row, how do you determine that that pain? Are
are you doing an ultrasound or what are you doing there?
Speaker 1 (22:34):
Sure, so, as part of every work up, I always
like to have at initial obviously he gets a symptoms, right,
you ask them the symptoms. So if you look at
the symptoms from this patient, it's very different from the
symptom from the earlier gentleman. This woman who came in
is just one side. She had not had much trauma
on her shoulders, but she just had this burning neuropathy pain.
(22:56):
But she actually has full range of motions, so she's
able to move her hand in all directions, but she
just has this burning pain in her shoulder, as opposed
to this earlier gentleman who had decreased range of motion,
inability to reach for things, or significant pain with that
and significant pain at not as well. And when you
look at his X ray that's a little bit more confirmatory.
(23:17):
You can also see this arthritic change. Now the ideal
test to do also when you look at these shoulders
is also to get an MRI if you can get
one done. But actually neither of these patients want their
insurance would pay for the MRIs, so I act was
actually able to proceed without that. But the reason why
it's good to have an MRIs you can actually sometimes
see the inflammation on the MRI scan. You can see
(23:39):
areas where we call you know, like you can sometimes
see adhesive capsule lightest. So there's this capsule that surrounds
your shoulder joint that you can actually see if there's
inflammation going on in that that shoulder joint. You can
see underlying changes in the bone. You can see if
there's we call a edema or what we call fluid
within the within the bone. So there's a lot of
different things we can see with the MRI more than
(24:00):
an X ray, and it's an ideal test if you
can get it done, if you can have your insurance
pay for it, or if you're willing to pay for
it here on your own. But a lot of patients,
for whatever reason, they don't want to get it done.
Maybe they're claustrophobic, they don't want to sit in a scanner.
But in any event, I use a different A lot
of different things to generate a treatment opti form. So
in this particular woman's case, I'm offering her nerve stimulation. Now,
(24:24):
when it comes to nerve stimulation, there's different nerves you
can tackle, Okay, So it depends on where the pain is.
So when I asked her where her pain was, you know,
her pain seems to be mostly in her arm forearm
in hand. And so my goal is to go after
and there's a nerve bundle called your brachial plexus that
sits in your accela, in your armpit, and so there's
(24:46):
a way for me to put this little nerve stimulator device.
All I'm doing is I'm putting a little wire adjacent
to the nerves. That's all. Now, the key part is
you obviously want to avoid hitting any critical a Sure,
there's there's blood vessels that are there. But using ultrasound,
using extra I can sometimes try to see exactly where
I am in terms of leaving this this wire in place.
(25:09):
But you know, if this patient had told me she
was having more pain like where you know, the deltoid
muscles mostly involving her you know, a little bit more
like in her shoulder, like not just her shoulder but
even her going extending a little bit to her upper back,
that's a different there's a totally different top of treatment.
There's a different top of nerve I can try to target.
(25:30):
But really what we're doing is we're going after the
specific type of nerve that we think might cause you
your pain. Now, sometimes patients have a mixed bag of symptoms.
Sometimes they have some shoulder pain and some upper back pain.
In that case, what I do is I might put
two little nerve stimulators at the same time, or I
can even do them in sequence. You know, if you
(25:50):
say you know what I want to just let's first
go after one nerve. Let's put the wire there. You
can trial it out for one week. If you get
benefit after one week, we can make that a permanent device.
Now let's say it didn't work the first go round,
I can put another little wire in in in your
soft tissues or your back and we can see if
(26:13):
that helped. Maybe that's the one that's implicated as causing
your pain. Now you might wonder what is this wire
that I'm talking about. So basically what I'm doing is
I'm putting a tiny little wire. It just kind of goes.
Maybe I would say an inch or two underneath your skin,
sitting right next to your nerve, and then the rest
of that little wire actually I taped to the outside
of your skin just for this trial period of time.
(26:35):
So for the first five to seven days, it's taped
to your skin. So I don't want you to go
swimming when you have this on. I don't want you
to go do any significant movements because that wire could move.
But it's really designed just for the trial. I want
to see how this little wire that's temporarily in place,
how it affects your function. Can we take care of
your pain? And so that's basically what we're doing. We're
(26:58):
going to go after a couple of nerves, see if
we can take care of this woman's symptoms. And that's
exactly what I'm gonna be hopefully seeing in the future. Here.
Speaker 2 (27:07):
When does she return down?
Speaker 1 (27:09):
Yeah, so I'm actually doing this trial tomorrow and then
she comes back in a week.
Speaker 2 (27:15):
Oh wow.
Speaker 1 (27:16):
But as I said, the beauty of this is there's
so many different areas that we can target. So I'm
gonna go first offer her one nerve stimulation target, see
how she does. It's a mini million invasive procedure. You'll
probably take about ten fifteen minutes. She goes home the
same day. We'll follow up with her every single day.
We're gonna be asking her questions, asking her, how's your
pain one out of ten? How was your sleep one
out of ten? How's your numbness? You're tingling one out
(27:38):
of ten? And if she tells me she got at
least fifty percent of more improvement, we can proceed with
making it a permanent part. Now we're running out of time,
but making it a permanent part of your life just
involves me taking that little wire and putting it underneath
your skin surface. So it's not really a super invasive procedure,
but it's certainly something that can work. So that wire,
(27:59):
just for tho are listening, It receives a little signal
from a little battery pack. This battery pack is something
that you can kind of implant on your shoulder. Sometimes
they can put a little you can put a little
sort of a band on your thing. You can wear
it whenever you have pain. But it's a little battery
pack that's rechargeable and it's constantly sending little impulses to
stimulate that nerve and bump the pain signal off and
(28:21):
instead have a different signal traveling on your nerves, causing
you not to recognize pain. So, as I said, unfortunate time.
The Saturday is up. If you're interesting more information on
any of you mentioned minimally invasive techniques and treatments, you
can always call to get more information at nine to
one five five hundred forty three seventy that's five zero
zero four through seven zero. You can also reach me
(28:43):
by email at raw that's RAO at Medicalactors dot com.
I hope these healthcare hacks have helped you navigate a
complex medical system. If you've been tuned into this whole time,
bless your heart, change your health. I'm doctor Sandy Brown.
You've been listening to the Medical.
Speaker 3 (28:58):
Actors release the page stated and representing
Speaker 2 (29:07):
Him to repress the PA
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