[ RadSafe ] Fluoroscopy exposure question

[Howard Long]

Susan,
Ask your mother to ask her doctor
(as he/ahe likely does with shoulder bursitis) to
palpate (poke) deeply for tender spots, especially every 3 cm of the sacroiliac ligaments 
and sciatic notches. 
Hundreds of my patients have had pain go from 8-10 to 0 in 20 minutes, 
never to recur at that place or where pain was referred (like sciatic nerve distribtion),
after infiltration of every 3 mm of the tender areas to 2" deep.
Warning: it is abnormally painful when the needle touches the calcific grating of
inflammation, the wince (seen in the mirror when patient is standing with elbows
on the examining table) guides the physician to where the anesthetic is needed.
3 cc lidocaine 2% plain with dexamethasone 6-12 mg is infiltrated throughout
usually taking half an hour with exam and treatment and costing $100-$200
(Obamacare and insurance czars don't approve this cure because it bypasses 
the dependency bureaucracy that takes most "health care" costs).
I give doxepin 50mg antihistamine and naproxen 500mg antiinflammatory and 
put the patient to bed for a day with a hot pack on the site to speed the dissipation of the inflammation.

Radiation alternative I saw given in 1949 by a rural doctor who had given the first ECG at UCSF, was a high dose (10 x usual shoulder diagnostic dose?) from a diagnostic 
x ray machine to a workman's very tender shoulder. 
He said others had been greatly improved. 
Jerry Cuttler, who will be speaking to our DDP meeting in NYC Saturday 
( ddponline.org ) has much on low dose radiation treatment.

Howard Long, family doctor and epidemiologist


On Jul 26, 2012, at 7:33 AM, "Perle, Sandy" <sperle at mirion.com> wrote:

> Agree. See an Orthopedic or Neuro surgeon for another opinion 
> 
> Regards,
> 
> Sandy Perle
> Sent from my iPhone
> 
> On Jul 26, 2012, at 10:05 AM, "JPreisig at aol.com" <JPreisig at aol.com> wrote:
> 
>> Hi,
>> 
>>    I would get my Mother to go see a real Back  surgeon.  Soon.
>> 
>>    Joe Preisig
>> 
>> 
>> 
>> 
>> In a message dated 7/26/2012 12:46:46 A.M. Eastern Daylight Time,  
>> slgawarecki at gmail.com writes:
>> 
>> Hi  All,
>> 
>> I have an actual technical radiation safety question.  My  mother has had
>> two facet joint injection procedures to treat her chronic  back pain.  Facet
>> joints are the small joints located between each  vertebra, and a painful
>> syndrome can develop when one or more becomes  inflamed or irritated from
>> arthritis or other causes.  The injection  of a local anesthetic and a
>> corticosteroid anti-inflammatory medicine is  guided by fluoroscopy.  This
>> can be repeated every two months.   She is contemplating another procedure
>> called radiofrequency neurotomy,  which interrupts the nerves to the facet
>> joint by thermal denervation using  a radiofrequency probe, again guided
>> using a fluoroscope.  This  procedure has a longer-lasting effect.  Both
>> procedures are performed  on an outpatient basis.  The facet joint
>> injections take 20 to 30  minutes, and the radiofrequency neurotomy takes 30
>> to 60 minutes.  The  patient is then observed for 45 minutes of initial
>> recovery.
>> 
>> Does  anyone know the typical radiation exposures associated with  these
>> procedures?  What questions should she be asking about the use  of the
>> fluoroscope?
>> 
>> Thanks in advance for any  information.
>> 
>> Susan  Gawarecki
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