Practice News

Police Officer Len Guida had 30 years’ experience on the job, but like almost everyone in New Jersey, he had never experienced anything quite like Hurricane Sandy.

The 53-year-old Bradley Beach Chief of Police and native, who is also part of the Office of Emergency Management (OEM), put in 80-hour workweeks during the storm,  lifting cement benches and heavy sand bags, among other duties,.

Shortly thereafter, Guida said, “My right knee started locking up.” He couldn’t do much about his knee injury during the many weeks of storm-related work, he said. “It got progressively worse; I put it off for weeks.”

Finally, it got so bad he contacted Workers’ Compensation, which referred him to a doctor. From there he went to an orthopedist, who thought Guida might have suffered nerve damage. That’s when Guida was further referred to an expert, this time to Dr. Andrew Elkwood of The Institute for Advanced Reconstruction. Dr. Elkwood, an expert in the diagnosis and treatment of peripheral nerve damage, is also the founder and Director of the Center for Treatment of Paralysis and Reconstructive Nerve Surgery at Jersey Shore University Medical Center.

Following a number of tests to verify the diagnosis of nerve damage, Guida underwent surgery in January 2013 at Jersey Shore University Medical Center. Three months later, he reports that he is feeling much better. He praises the medical help he received from both his orthopedist and Dr. Elkwood.

“I am extremely pleased with the care and attention I received from Dr. Elkwood and his staff,” he said.

As Dr. Elkwood elaborates, “Len had surgery to the nerves around the knee. We interrupted the ‘sensory nerves’ to his knee. The result is that he has no feeling to the knee joint. No feeling means no pain. This surgery is a very useful, but an under-utilized technique when other options, such as orthopedic means, have not been able to control chronic knee pain. This technique can also be used for other joints (i.e. wrist, shoulder, elbow, and ankle.)”

After two to three months of rehabilitation following his surgery, Guida is off of restricted duty and back to full-time work.

Guida, who faced a similar problem 10 to 15 years ago with his left knee, which at that time included a torn lateral meniscus, may also have nerve damage in that knee. As a result, he explained, he plans on surgery for his left knee “as soon as possible. And I’m absolutely going to use Dr. Elkwood.”

Local doctor offers treatment option for painful neuropathy

Written by
Susan Bloom
For the Asbury Park Press

[original article]

For Gale Krywinski, 65, contracting diabetes 12 years ago was bad enough, but the subsequent tingling sensation she felt in her legs was more than she could bear.

“I could never get my legs comfortable and it was hard to sit in one place for a while,” she said of the throbbing pain that “made it difficult to go to a show or sit in a car or on an airplane” and which would often wake her at night.

Though the Brick resident and retired healthcare worker tried treating it with medication for a while, “I didn’t like the side effects and didn’t want to live on medication for the rest of my life,” she said. “Most doctors told me they really didn’t have much to offer for my neuropathy and that I would just have to live with it.”

Happily for Krywinski, another option was in store.

“In simple terms, neuropathy occurs when a nerve isn’t working properly, a condition which can result in numbness and tingling in the hands and feet,” said Dr. Michael Rose, cosmetic, plastic and reconstructive surgeon at The Plastic Surgery Center in Shrewsbury.

Typically associated with diabetes or of “idiopathic” origin with no known cause, neuropathy also can be triggered by alcoholism, lead poisoning, certain medications and chemotherapy “and can cause crippling pain that makes it difficult for patients to walk, sleep, hold things or work,” Rose said.

“Patients with severe cases often have to go on long-term disability,” Rose added. “It definitely impairs their lives.”

Nerves travel through tunnels, and can swell and choke within their housing if the nerves are not healthy, almost like someone’s neck when it’s restricted by a tight shirt collar, Rose said.

“This compression of the nerves causes a tingling or throbbing sensation in the extremities,” he said. “Many doctors consider neuropathy progressive and irreversible, but the truth is that a subset of patients will respond positively to a special technique that releases pressure on the nerves.”

About half of the patients who have the 45-minute, minimally-invasive outpatient procedure show improvement, Rose said.

To determine a patient’s potential for the procedure, Rose conducts an evaluation to assess their overall health and status of circulation to their limbs, and will then perform a test to determine if the nerve is alive enough to respond.

If the results are promising, he will proceed with the technique.

Krywinski took the chance in July 2012 when she elected to have the procedure performed on her left leg.

“It’s much better than it was before,” she said. “My toes can bend much more easily and I can put my leg up on the couch and cross my legs for longer.”

She is about halfway through the expected 18-month recovery period for her leg.

“I continue to get more and more sensation back as time goes by,” she said, adding that she returned to have the technique performed on her right leg in January. “My legs aren’t tingling or throbbing anything like what they were before and I’m so happy for this bit of relief.”

The Institute for Advanced Reconstruction (www.advancedreconstruction.com) at The Plastic Surgery Center is at 535 Sycamore Ave. in Shrewsbury and can be reached at 732-741-0970 or by visiting www.looknatural.com.

As clinicians, we all encounter patients with pain. Most of the time, our procedures relieve pain. However, a small subset of patients don’t get relief and it can be very frustrating to deal with this scenario. We may second-guess our judgment about having done an initial procedure. As a next step, our instinct is to typically suggest a more aggressive and more invasive procedure. When this fails as well, we may begin to question both ourselves and/or the motivation and psyche of the patient.

Facing the dilemma of chronic joint pain is common. In one national survey, about one-third of adults reported having joint pain within the past 30 days.* A prototypical scenario is a person with knee pain. First, we take the most conservative approach, and offer physical therapy and anti-inflammatory medications. The next step is cortisone shots. If that doesn’t help, we move on to arthroscopy and possible endoscopic repair of damaged joint elements, if any exist. Finally, the end-game is total joint arthroplasty. Despite this final measure, in some patients, there is still pain. Yet how can there be pain in the complete absence of the native joint?

The answer to this quandary is that not all pain is structural. We in the medical profession have all been indoctrinated to think structurally. The first step we take to make or confirm a diagnosis is to order an imaging study and evaluate how the structures look. And that is STILL the correct first step. However, when all of the structural causes of pain have been excluded, it’s time to start thinking about neural origins of pain. Nerve dysfunction or damage is possibly causing joint pain.

Years of use, repeated injuries (minor and major), and surgeries can lead to injury to the nerves that innervate the capsule around the joint. When these nerves are damaged or injured, no amount of structural repair can alleviate the pain. The nerves must be addressed.

Nerve denervation for the wrist, knee, elbow, shoulder and ankle has been well documented, and has actually been in practice since the 1950’s. The outcomes for long-standing, chronic pain are not as predictable as those in which the pain is relatively recent in onset. But dramatic, life-changing outcomes have been achieved by our techniques for both groups of patients.

Dr. Michael Rose, who has performed hundreds of nerve decompression and denervation procedures in the past ten years, has a particular interest and expertise in joint denervation procedures for acute and chronic pain that is not relieved by standard structural based methods. He is one of only a handful of plastic surgeons specifically trained in this technique. He is a member of the team of surgeons at The Institute for Advanced Reconstruction, where the main focus is on neural-based solutions to difficult surgical problems. Further information can be found on advancedreconstruction.com

Source: *http://www.webmd.com/pain-management/guide/joint-pain

February, 2013

Dear Dr. Kaufman,

Over the past several months, I’ve thought about and tried writing this on numerous occasions. It seemed nothing ever justified the gratitude I feel, or how deeply indebted I am to you for saving my life. I say that because I was at a crossroads in life, and if we had never crossed paths, I know I wouldn’t be here today.

I was in a car accident on March 3, 2007, exactly six months before my wedding, and everything changed. I was rear-ended at a red light on Route 6 in Dickson City, PA. I went to Mercy Hospital in Scranton after the accident, where they checked me out, pushed some pills, and sent me on my way with scheduled follow-ups.

I slowly started getting better everywhere, except my head. The left side of my head had a hyper-sensitivity that would bring me to tears instantaneously, and included a pain much like fireworks going off in my head. That created a build-up of pressure, leaving me with the desire to drill holes in my head.

I came to appreciate the small things in life I previously took for granted. I realized for the first time you really can’t judge a book by its cover, because as normal as I looked on the outside, no one knew the damage that my nerve sustained, or the amount of pain I was in and how it would impact my life and daily activities. Everything became a struggle, but through it all, I tried masking my injuries as much as I could, and tried to lead as much of a normal life without anyone knowing. My doctors and husband were the only people who really understood my daily struggles (maybe not fully, but they watched it firsthand) over the course of five years of treatments, whether oral or injectable. Certain treatment options helped, but nothing was ever long-term. After a time it became very evident I was not improving in the least.

I truly hid my pain from the entire world, except my doctors and husband. I watched as my OB-GYN dropped me as a patient after the accident because I would be a high-risk pregnancy. I located a new one, and even he referred me out of the area for a one-time consult, only to be told that with my medications, pregnancy was not in my near future. Now, after five years of marriage and my surgery, things seem to be looking a little more optimistic.

Last year, I was let go from my job as the employer began to outsource many positions in an effort to save money during this economic downturn. This finally gave me the opportunity to seek out the help I needed while looking for a new job. In addition, my health was rapidly declining, and I was only hanging on by a string.

My occipital neuralgia* was taking over my life. The pain was consuming me, so much so that I can honestly say I debated at times if I actually wanted to live. I was losing perspective. I tried so hard to fight the hypersensitivity and be a normal 23-year-old when the accident occurred, but as the years progressed, being in chronic pain took a toll on my body. I simply felt like I couldn’t possibly handle one more day, or vomit one more time. I wanted my bedridden days to be a pastime, but they were very real and becoming more frequent as I was losing ground at holding onto my health. I researched occipital neuralgia and new treatments daily, and things to try. One day, I happened upon your website.

I can remember reaching out to The Plastic Surgery Center and speaking to (nurse staff member) Barbara for the first time, and feeling a glimmer of hope when she had me send over my medical history for you to review. Days later, I received a phone call from you. I had never had a doctor call me and give of his time and expertise the way you did. From that phone call, I knew you would change my life forever. I laughed, I cried, I was so excited. You understood the emotional journey I had been on with my occipital neuralgia, and you respected me as a person enough to take the time and listen. You were completely honest with me, explaining that the surgery may or may not work. You never tried to give me false hope.

I can remember waking up from the surgery and instantaneously feeling room in the back of my head for the first time since the accident. It was the most incredible feeling ever!!! My pain was definitely different; it was now what I refer to as surgery pain. Slowly but surely, I hope to be able to get off all my medication. The surgery changed my life. You gave me a reason to live.

I was 23 years old when the accident happened, and I gave up so much of my social life, missing parties, trips, etc. Now, I look forward to transitioning back to the person I was, but at my own speed. I know it sounds silly, but I treasure things the normal person takes for granted– like going to see a movie in a movie theater, working an 8-hour-day and being able to go to the store afterward and cook dinner without wanting to put my head through a wall. For me it’s all baby steps for now, and simply enjoying the life you gave back to me.

People complain about pain every day. I hear it all the time, but I can’t say for sure anyone ever understood mine until I met you. Dr. Kaufman, I will forever treasure the gift you gave me of getting a second chance at life. I was at the lowest point in my life before my surgery. I am so grateful you took a chance on me.

Thank you for helping me when no one else could, and believing me when so many people thought I was imagining things. You gave me reason not to give up hope, and if it weren’t for you, I wouldn’t be here today.

Sincerely,

Kristen Kuczenski

Click to read Kristen’s incredible story: http://www.advancedreconstruction.com/20130205-severe-headache-pain-caused-by-occipital-neuralgia/

*Occipital neuralgia is chronic head pain in areas that correspond to the greater occipital nerves, which extend from the spine to the scalp.

Carpenter Frank Sussina of Bayville, New Jersey, was on the job for 25 years when he suffered his first accident, and it was catastrophic. He was putting up a roof on a building when a negligent piece of loose plywood gave way. He fell 32 feet, shattering both legs, breaking his back and snapping his neck. That was in 1993.

Since that time, the almost 58-year-old had a total of 29 surgeries: among them were those to rebuild his knees, 2 back surgeries, and one for his neck. He has been treated by orthopedists, a neurosurgeon and pain management specialists. In 2001, he had bilateral knee replacement, which led to crippling pain and numbness in his feet.

He went online, and as he tells the story, “I read an article on the website with an interview just like you’re doing with me right now. I said to my wife: let’s go.” The story was on The Institute For Advanced Reconstruction’s website, the practice of which Dr. Rose is a member (www.advancedreconstruction.com).

In September, 2012, Sussina went to see Dr. Rose. “He gave me a 50/50 chance he could help me. I accepted that.” At the time, Sussina was on a daily dose of 400 milligrams of morphine and 90 milligrams of Percocet.

Dr. Rose did the procedure, Sussina’s 30th surgery, on October 14th. “Since then, I haven’t taken any pain medicine at all.” Sussina, who now walks without any foot pain, was finally able to go back to work as a general contractor for more than 2 days a week.

Dr. Rose says, “Frank’s remarkable recovery is a testament to the power of this technique. We can’t help everyone with it, but when it works, it’s truly amazing how we can transform people’s lives in a positive way.”

Painful, tingling feet are a typical symptom of peripheral neuropathy. Nearly 20 million Americans suffer from neuropathy, a chronic condition that results from damage to or compression of the nerves outside the spinal cord and brain. Common causes of neuropathy include diabetes, trauma, chemotherapy and other medications.

Fortunately, in select cases neuropathy can be improved or reversed with nerve decompression surgery. Performed on an outpatient basis and taking less than an hour, the procedure involves relieving the pressure on a nerve by surgically removing the constricting tissue or bone, or widening the canal encasing the nerve. Decompression surgery is successful in relieving the symptoms of neuropathy in up to 90 % of well selected patients. The procedure is minimally invasive, requiring only small incisions over the affected area thus promoting a quicker recovery.

Of Dr. Rose Frank Sussina says, “He was the most polite doctor I’ve ever been to. He explained everything in detail, no big words. He put it all on the table. From the nurses to the technicians, the staff at the Ambulatory Surgery Center was excellent. And I’ve recommended four more people to Dr. Rose.”