elective back or neck surgery for chronic pain: what are...

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KVI022705/1203/AS/jf © 2005 Patient Power, LLC All Rights Reserved

Elective Back Or Neck Surgery For Chronic Pain: What Are Reasonable

Expectations? AM 570 KVI

February 27, 2005 Jens H. Chapman, M.D. Jodie Kent, R.N.

Please remember the opinions expressed on Patient Power are not necessarily the views of KVI, our sponsors,

partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your

own doctor. Please have this discussion you’re your own doctor, that’s how you’ll get care that’s most

appropriate for you.

Introduction Andrew Schorr: Good morning. Welcome to Andrew Schorr's Patient Power. I'm Andrew Schorr. This is

the program that for one hour every Sunday morning we put you the patient back in control of your healthcare. And I'm delighted that every week we have just phenomenal

guests, and this week we have two good friends of mine, one a woman who has gone through two neck surgeries over the last year and a half or so, good friend, but who is a nurse, and we'll talk about what she's been through, how she has considered whether to

have surgery or not, how her recovery is going and lessons she's learned for anyone who may be considering surgery, particularly back and neck surgery, which often is sort of the

road you come to if you can't get relief other ways. But also we have a leading medical authority, and that is a top professor from the

University of Washington, and that is Dr. Jens Chapman, and he'll introduce himself further. He's one of these--I call him a rock star surgeon. He's one of these folks at

Harborview Medical Center here at Seattle where you get to him and you put yourself in his hands and you hope that that will bring you relief and good health for the future.

We're going to talk about that, but we need your calls. We've got a top orthopedic and neurosurgeon here and a woman who is a nurse who's been through it herself quite a bit.

But let's begin our discussion while we're waiting for your calls. I have plenty of questions.

First I want you to meet Jodie Kent. Jodie, welcome to Patient Power.

Jodie: Thank you, Andrew. It's good to be here.

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Andrew Schorr: Jodie, just a little bit of your story. So you've been a nurse for how many years?

Jodie:

I have been a nurse for about 22 years. Andrew Schorr:

Okay. And you've done all kinds of nursing during that time.

Jodie: All kinds of nursing. I've done trauma. I've worked in the O.R. I've done home infusions.

Andrew Schorr:

And a lot of standing and a lot of lifting. Jodie:

Right. Well, nursing tends to be hard on your body.

Andrew Schorr: Okay. And there you are and I think you told me that when you were younger you were a

cheerleader. Jodie:

Yes.

Andrew Schorr: And you were a gymnast.

Jodie: Right.

Andrew Schorr: So jumping, tumbling, all those kinds of things.

Jodie:

Yes. Andrew Schorr:

So then you get further on in your life and you have pain in your back.

Jodie: Right. Well, actually my neck injury happened in one day, in one instant.

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Andrew Schorr: I think you told me you were in a CPR class and you felt sharp pain in your scapula, and

that is sort of the wing in your back there.

Jodie: Right.

Andrew Schorr: And then eventually after a long road that you'll tell us more about you ended up in

surgery. Jodie:

Right. Actually I was in pretty bad shape and had surgery within a couple of weeks which I guess is unusual following that kind of symptoms. Sometimes they wait to see if you

actually get better, but I was in such severe pain that they went ahead and scheduled surgery for me.

Andrew Schorr: Okay. And then you had that surgery. There were some other issues that came out of

that so then after about a year, year and a half of relief then you had a second surgery which was just a little over two weeks ago.

Jodie: Exactly.

Andrew Schorr:

So we're really delighted that Jodie could come down here, and you know if you need to move around a little to feel more comfortable you're welcome to. Well, sitting next to her is a top surgeon who does surgeries like that, and it's Dr. Jens Chapman. Dr. Chapman is

a professor at the University of Washington. Dr. Chapman, tell me some of your other titles so people understand the area that you're in.

Dr. Chapman: First of all, good morning, Andrew.

Andrew Schorr:

Good morning. Dr. Chapman:

Good morning, Jodie, and good morning to the listeners. My official title is that of a professor of orthopedic surgery and sports medicine. I'm adjunct professor in the

department of neurological surgery at the University of Washington.

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Andrew Schorr: Great. And we should say right off the back two things. One is none of the things that

we'll speak about today are really substitutes for your own dialogue with your own doctor or doctors, healthcare team that you see because there is no way we would know what

your own situation is. So we can't practice medicine over the radio, but we can try to give you some guidance on things to think about, things to ask. Also in Dr. Chapman's case he's here as an individual and not as a spokesperson for the University of Washington or

Harborview or University of Washington Medical School. But with that said, let's go on.

Starting a Conversation with your Doctor So first of all, Dr. Chapman, people wait maybe a long time before they get to see you the

surgeon because they've been on this journey of trying to get relief for in this case back pain, shoulder pain, neck pain, disabilities that may have come with it, and even for any

surgeon it may not be immediate unless it's some kind of trauma. In Jodie's case she did get there pretty quickly. But when people come they're often a little daunted. What would you say to people to guide them so that they can sort of talk turkey with their

doctor and really have a successful partnership?

Dr. Chapman: I think you raise some he very good issues. I was holding my breath initially when you

said wait because I thought that was reflective of time spent in the waiting room of a physician's office.

Andrew Schorr: No.

Dr. Chapman: No. The wait towards a surgeon in preparation of seeing your physician is one way you

can gather information. I think that's a very critical element obviously and made so much easier with the internet nowadays, with all its pros and cons. But it's relatively

straightforward nowadays to gather some information and try to filter it by selecting your sites very carefully. And I think that's probably the best thing to do. I actually suggest starting a little notebook with questions and with events, and you have your question

page right up front, and as questions come up you basically write them down from one through 12 or 20, and then when you actually have to wait in a surgeon's office--which I

know never happens, right, Jodie--then you can basically go through the order of those questions again and be well prepared.

Andrew Schorr: So here's somebody who is in pain, though, and it's a little daunting. They have a lot on

their mind and they're not feeling well. Is it a good idea to bring somebody with you to help make sure those questions get answered and to hear the answer?

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Dr. Chapman: I always actually appreciate having a close family member or two with patients along,

especially in an elective type or nonemergent situation, because it just basically opens up a very different communication pathway. And there have been actually studies made on

this. The numbers of facts that patients retain from an informational visit are probably about less than 20 percent of the overall volume, so having two sets of ears is actually much better in that regard.

Andrew Schorr:

Sure. Well, we're going to be back with much more as we continue our discussion with Dr. Jens Chapman from Harborview and Jodie Kent, a neck surgery patient. This is KVI Talk Radio 570. Call us up.

Listener Questions

Andrew Schorr: And we're back with more of Patient Power. I'm Andrew Schorr. Thanks for being with us

on a foggy morning here in Seattle. It's starting to lift, and maybe we'll see the Space Needle shortly, but we want your calls now as you wake up on a Sunday morning. We're

talking about surgery, and as an example we're talking about back and neck surgery and spinal problems because we're blessed with having one of Western Washington's top

spinal surgeons here in the room with us, Dr. Jens Chapman from Harborview, and a friend of mine, a nurse, who has been through two neck surgeries, Jodie Kent. So we'll be taking your calls, and I want to take one now. Sandy is joining us from Bremerton.

Sandy, welcome to Patient Power. Do you have a question for us?

Caller: Hello. Yes, I do. I've been diagnosed with spinal stenosis of the lower back and of the cervical spine, and I want to know if there is anything to do besides surgery.

Andrew Schorr:

Good point. Well, Dr. Chapman is the guy to ask. And I'm sure you try to do lots of things before surgery, right, Jens? Maybe you could help Sandy.

Dr. Chapman: Good morning, Sandy, first of all.

Caller: Morning.

Dr. Chapman:

Again, I can only give very generic answers in terms of spinal stenosis in general, so not specific to you.

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Andrew Schorr: And what is stenosis, by the way?

Dr. Chapman:

That's a good point, Andrew. Stenosis meaning narrowing of the tube, the bony tube through which our nerve elements flow, and basically at some point in time the stricture becomes so significant that the nerves don't get enough blood supply as we exercise or

are active, and that pinching can be a very painful condition and limit our aerobic capacities and functional abilities. The main aspect is we very much try to treat this

condition nonoperatively for the longest part by looking at the patient as a whole, by looking at their health, by looking at their weight, by looking at what activities they do that provoke these issues, by making sure we understand what the spinal column does in

general. So basically the first step is a very thorough assessment for spinal stenosis. The second step is then to take some immediate corrective action in terms of activities and

strengthening and basically working out and-- Andrew Schorr:

So would this be maybe going to see a physical therapist for a while?

Dr. Chapman: Absolutely. A therapist is a first very reasonable option, and basically changing your

lifestyle on a daily basis like brushing your teeth and combing your hair and doing something for your spine.

Andrew Schorr: One of the things that you do, and I know I've have had some back problems over the

years and tingling down my leg and all that, was are you doing something that you can change. Like for me I was a runner, and so when I was running a bazillion miles a week training for marathons then I got numbness in my leg. Well, some of it was to do a lot of

stretching and then also not run so much, too, in my case. So you look at how is somebody living, I guess, as well.

Dr. Chapman: Yes. I mean definitely looking at the patient and their activities and doing activity

modifications within reason. We now know that we have to do and we have to pursue cardiopulmonary exercise on a daily basis. Our federal government even recommends

that, and so we should really pursue that kind of a strategy over time. Andrew Schorr:

Now, stretching. A lot of us don't stretch or are not very flexible at all. What's that doing to our spine related to problems that could come up later?

Dr. Chapman: Basically we have to imagine that we pound, and I'll use your word there, we pound on

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our spinal column and our disks specifically incessantly as the day goes on and even as we sit we actually squeeze our disks. So stretching is actually one of the very simple

things that can relieve some of the pressure in our disks and fluid can come back into the disks.

Andrew Schorr: So for Sandy, though, wondering, though, if surgery part of her future, how do you as a

surgeon work with the patient to determine is it then appropriate?

Dr. Chapman: In general fortunately a routine stenosis is an elective condition, meaning we don't have to just barge in and do surgery. We need to do, as I said before, a thorough assessment

of the patient, establish a relationship with the patient, make a number of recommendations and then follow together with the patient, how the patient is responding

to those measures. Andrew Schorr:

So it's not a for-sure thing that you do not pass go and go to surgery at all?

Dr. Chapman: Unless there is a clear-cut neurologic deterioration where the patient has done all these

various intervention measures and things are not getting better, surgery is not a necessity.

Andrew Schorr: Okay. Sandy, does that give you some guidance to discuss with your own doctor?

Caller: It does. Thank you so much.

Andrew Schorr:

Thank you for being with us on Andrew Schorr's Patient Power. Keep listening. Tell your friends.

Caller: I will. Thank you.

Andrew Schorr: Thank you. Let's take another call from Auburn. Tom is joining us. Tom, welcome to

Patient Power. You have a question for us or a comment?

Caller: I have a comment. Let me tell you something I ran across. I was coming to the point where I couldn't use my left side. I couldn't put my pants on. Couldn't use a chalk board

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and I'm a school teacher. It was getting so serious that I thought for sure maybe I'd torn out my rotator cuff or something. So I scheduled in to see an orthopedic surgeon and he

looked me over carefully and he said, you know I think I know what this is. We'll send you down to x-ray. Came back and within a few moments of time he explained that I

needed a left cromial decompression. So they go in and just shave away some of that cromial bone.

Andrew Schorr: So this was a surgery you're talking about?

Caller: Yes. So he sat down and explained it very carefully what would happen. And also he

went through the history of what that kind of surgery entailed, and today by doing it laparoscopically, by going in with very small incisions at two different locations the

amount of trauma and rehab would be very minimal. Well, I was pretty apprehensive about it anyway because I kept hearing all these horror stories about going into any kind of joint or bones coming close together and carving the tissue away. But I have to tell

you that that was about Christmas time. Today I don't even know I had the surgery.

Andrew Schorr: And we have to say I'm a big baseball fan and we hear these guys have various surgeries

all the time. Now, often it's not on their spine but it's on other joints, but fortunately we get to see them play again often, so we know that there can be tremendous success.

Tom, thanks for your comment.

Caller: Okay. I just want to encourage people, let them know that the procedures that they are doing today are just so much easier to rehab from, and it just--I wish I had done it earlier

because I suffered with that thing for over a year.

Andrew Schorr: We're going to talk about that. Keep listening, Tom. Thank you for being with us.

Caller: Okay. You take care.

Andrew Schorr: Thank you. Dr. Chapman, did you have a comment on that?

Caller:

Yes, I think Tom is an ideal patient just by the two-minute interaction there. I think he's just what we all hope for. He's a very motivated person, and although it's very nice to

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hear that he gives credits to his surgeon, who undoubtedly did an excellent job. This is the kind of a patient who can help himself dramatically by just taking an active role in the

whole disease process and the recuperation after surgery.

Andrew Schorr: Right. Jodie, let's go to you now. It's been a tougher road for you. Jodie’s Story Jodie:

Well, I can relate to what Sandy was talking about because I had--my second surgery was due to some stenosis and they had to go ahead and go in and open that area to allow

blood flow to my arm. And, you know, listening here today it's so easy to tell people to get out of bed and to exercise, but I have to say that I'm a very active person and with the pain that I had the last six months it was very hard for me to get out of bed to even

go walk my dog. And activities that people would do daily were monumental to me, you know, doing laundry. So you really have to push yourself to get better. It's not an easy

task. Andrew Schorr:

Right. And you're in a recovery period from your second surgery.

Jodie: Right.

Andrew Schorr: And you had your first and you had relief pretty quickly from that, but that lead to some

other issues in your neck that then needed to be corrected with the second surgery and we hope they are, but we don't know yet, do we?

Jodie: Well, I just had another x-ray last week because they put a bone graft in there to open up

that area, and they took a film, the graft is in place, everything looks good, but still lots of swelling, and this just takes a long time to heal. And also nerve pain takes, the recovery

of nerves takes months. Andrew Schorr:

Let's talk to Dr. Chapman about it. So when you actually do do surgery on somebody's spine, on the neck all the way down through the bottom of their back and it's all these

nerves are there and bones pushing on things and the way you normally carry yourself trying to be upright and walk and walk the dog like Jodie had wanted to do, there can be complications and it often can be not a perfect solution, right? I mean, how does

somebody enter into that having reasonable expectations? What should reasonable expectations be?

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Dr. Chapman:

I think that's a very important point that you raised. And first of all, Jodie, for the listening audience, you should see her next to me. For two weeks out from surgery she

looks fabulous. There's no swelling or anything like that. So like our previous caller, she's one of those ideal patients.

Setting Reasonable Expectations

The main thing is we have to have a realistic set of expectations, and so knowledge is I think the first step towards that. The knowledge that the patient has helps greatly. Obviously as the patient interacts with the physician, the specific surgeon, they are

counting upon three factors in that surgeon. One is obviously the medical knowledge or wisdom. Secondly, it's the surgical skill. And thirdly, and this is where we come down to

it, communication. And that's a two-way street. It has to basically go both ways. We as surgeons to address complications specifically have to by law prior to engaging in a

surgical procedure in patients inform patients of the most prevalent, that means of most common complications, and even if they're very rare the most catastrophic kind of a case

scenario. And we have to try to do that as our healthcare industry mandates nowadays in a very compressed time frame but as effectively as possible.

Andrew Schorr: Okay. And, Jodie, you were aware that you had what's become a serious condition, and

while it's not life threatening you were aware that it may work out great and you may have tremendous relief or it could be somewhere along the continuum. And you went into

that with your eyes open. Jodie:

Well, as my surgeon told me, he said the first surgery you always have, you know, higher expectation of what--you're going to get better, which I instantly did. And he said any

time you go in for the second surgery, you know, the percentage changes, 60/40 of recovery. I went into the second surgery because my first one I had such instant relief, and I haven't had it this time as quickly as I'd hoped.

Andrew Schorr:

Well, we wish that for you. We're going to be coming back and hearing more from you Jodie, the kinds of tips that you've learned that you would recommend to other people, other patients as they navigate the healthcare system. But we're delighted to be talking

about helping you, the listener, navigate the healthcare system and being back in control. This is Andrew Schorr's Patient Power on KVI Talk Radio 570. We'll be right back.

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Andrew Schorr: Welcome back to Andrew Schorr's Patient Power, and I am Andrew Schorr. This is the

program that puts you back in control of your healthcare, lets you ask questions of leading experts and sound off if you want on the healthcare system. We're on every

Sunday from 8:00 to 9:00 a.m., and this is a new program, just our third week. Why are we doing this? Why am I doing it? Well, I'm an eight-year leukemia survivor. I was blessed with founding a company that's doing well called HealthTalk or healthtalk.com,

and I recommend you take a look at that website. My wife and I founded that company more than 20 years ago, and now it's a tremendous resource for people with chronic

conditions. But I really wanted to reach out to people on the radio, those of you driving in your car or

getting ready for Sunday school or church or gardening or whatever you may be doing today and help you be a smarter patient. And so today we have a pretty smart patient

with us in the studio, Jodie Kent, who has gone through two neck surgeries over the last year and a half, and then Dr. Jens Chapman, who is a leading surgeon at Harborview Medical Center and the University of Washington here in Seattle. So we're taking your

calls and, Jeff in Edmonds, we'll hear from you in just a second.

Tips from Jodie on Navigating the Healthcare System

But I wanted to hear from Jodie for a minute. Jodie, you've been on this journey and the journey has been serious pain in your neck and back and ultimately getting the surgery. And I should mention that Jodie's husband is a general surgeon so she's familiar with this,

and you've been a nurse many years. So, Jodie, how does someone advocate for themselves in the healthcare system to try to get to the right providers, the right

treatment and ultimately relief? Any tips you would offer people? Jodie:

Well, this is a problem that all patients face, having a good primary physician is so important who can get you the referrals you need to get into these specialists is very

difficult these days. Specialists are in high demand, and that's the first thing. And what was the other part of your question?

Andrew Schorr: Well, I just want to go to that point you just made for a second.

Jodie: Right.

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Andrew Schorr: So is it fair to ask your primary care doctor, now, many women sometimes just have a

gynecologist, but an internist, whoever it may be, say, look, I need you to go to bat for me. This is really serious, and I don't want to be just shuttled around. I need you to help

advocate for me. Is that a fair request to make of your primary care doctor? Jodie:

Oh, it shouldn't be a request, it should be a demand. I mean, your primary should be looking out for you. This primary physician is going to be possibly taking care of you for

years. Your specialist you're going to see--you might never see him again, but this primary doctor will be with you your whole life and be responsible for your healthcare in the long term, so it's very important that you get taken care of because this problem is

not going to go away.

Andrew Schorr: Okay. And then you ultimately got to surgery. Surgery is a big deal.

Jodie: Big deal.

Andrew Schorr:

Okay. What about your feeling as a patient on second opinions. We're going to go to Dr. Chapman. He's an eminent guy and there are many people who go to you, Jens, I'm sure, and say I've gone to the guy, but should they also go to the other guy or gal to

really see what makes sense?

Jodie: Well, second opinions are good and bad. They can be confusing in that every surgeon has their own opinion about how things are done. They're going to do it differently. They'll

have their own ideas. I did seek a second opinion, and I was glad that I did. It reinforced my thought that I did need surgery. But I also think you can get too many referrals, and

then you can get confused. Andrew Schorr:

How did you ultimately make a decision?

Jodie: Mine was based on pain and my level of function.

Andrew Schorr: So it was just got to do it.

Jodie: Got to do it.

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The Importance of Patient/Doctor Communication

Andrew Schorr:

Okay. Now, Dr. Chapman, you have people coming through your office day after day and then the O.R., and I'm sure there have been things you wanted to say to them. I wish we could interact this way. I wish our process of communication was this way. Now, you

mentioned earlier about writing down your questions, bringing a family member or a friend, but what about a point of view? Do you welcome patients being strong advocates

for themselves, being healthcare consumers? What's your point of view on this? If you could say to patients, I wish you guys would get it and think this way, what would you say?

Dr. Chapman:

This is a great point. The more informed a patient is the more to the point the whole conversation becomes and it's actually a very pleasant situation. But personally speaking I don't care whether a patient comes with zero knowledge or a whole book of knowledge

points. I think somewhere there's a healthy medium of being informed and asking critical questions but basically then establishing a communication platform. I always come back

to that C word. I think that's what it always boils down. I think what I heard in Jodie's very apropos comment about seeking second opinions, it's based upon communication,

having a situation of a platform of trust. Andrew Schorr:

Now, when someone says to you, well, thank you very much, Dr. Chapman, you're recommending surgery X or Y at this point in time, but, you know, that's scary to me. I'm

going to get a second opinion to just see if that's confirmed. Do you resent that at all? Dr. Chapman:

No. I never perceive that as a threat. I mean Jodie has actually raised a point that has been studied. There are several publications out on that. Surgeons, especially in spine

surgery, have this divergence of opinions and I'm sure for patients it's crazy. One study said something to the effect of four surgeons, three will have different opinions, and I think that reflects difference of opinions, difference of training backgrounds, difference of

comfort levels, etc. But it's something that in the end we all try to do what's best for the patient, and the patient will then hopefully out of this platform of trust that they hopefully

develop with one individual make their selection. Andrew Schorr:

But, Jodie, ultimately it's your body so you have to take the heat, if you will, for the decision. You have to take responsibility that you the patient are making the decision

with as much good information as you have, right?

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Jodie: Which is somewhat frightening because when you go to your specialist, you know, they

are kind of the expert. You look at them for their guidance and what they would do. And the question I always ask my specialist, if I was your wife what would you do?

Andrew Schorr: And what do you say, Dr. Chapman?

Dr. Chapman:

I consider every patient as a relative because from my personal perception any patient who I've ever operated on becomes my patient for eternity. So not a one patient. My door is always open. My nurses know that if I have operated on that patient, if that

patient has a question down the line, if it's ten years from now or whatever, the door is open. So they become my extended family in a way, so I automatically personally

speaking always include every patient into that particular group. Andrew Schorr:

We're taking your calls on this program for Dr. Jens Chapman, an eminent spinal surgeon from Harborview Medical Center, and Jodie Kent who has gone through you two neck

surgeries, one just a little over two weeks ago.

Artificial Disks We got a call from Edmonds. Jeff is joining us. Jeff, welcome to Patient Power. How are

you doing today?

Caller: Really good. I have a question for Dr. Chapman on his thoughts on the new artificial disk that they've been coming out with in Europe and recently been approved in the US.

Andrew Schorr:

Okay. Let's find out, Dr. Chapman. Dr. Chapman:

Good morning, Jeff. We're all extremely excited about artificial disks, yet we have to say that this is one of those newer technologists that we have to approach with a great deal of

caution. We have done these artificial disks at the University of Washington. This is a great example of a situation where there are huge expectations on the part of the patient population and where if we really look at the data the enthusiasm for that is actually by

far not that warranted, number one. And, number two, the results aren't that great, and the indications for these particular procedures are very, very narrow. In my own practice

probably out of ten patients who come to me with a request for a disk replacement or an inquiry, nine are absolutely not indicated. And the patients are frequently disappointed by that, but it basically just reflects what we as a medical profession know.

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Andrew Schorr:

I think we hear about this all the time, Jeff. Not just artificial disks but some medical technology that seems to be a better mouse trap, and you get excited as a patient or your

relative clips it out of the newspaper. It often makes front page new, you know, sort of gee-whiz medical technology, but you need to go to an expert like Dr. Chapman and then say, okay, does this apply to me. And in this particular case there is one out of ten that it

does apply, and for them it could be a great thing, but then you're saying nine others where you know it's not right for you. And that's that dialogue you were talking about,

right? Dr. Chapman:

Exactly. Unfortunately the medical industry has become very, very powerful and very smooth in terms of inserting little product tidbits into the newspapers and whatever other

outlets there are, and so for spinal cord injuries, for disk replacement etc., they found these very clever pathways, and so the expectations are huge. And we as medical professionals would like to fulfill them, but we have to be realistic and honest also.

Andrew Schorr:

Do you feel like you're throwing cold water on people? I mean, they come in, they're excited, and you mentioned about the internet or whether it's a newspaper, magazine,

they come in with printouts of things and then you say, you know, Mr. Jones, though, that doesn't really apply to you in my opinion.

Dr. Chapman: Undoubtedly. Nowhere is that more pronounced than especially spinal cord injuries.

These are just people in the primes of their lives who have just been devastated, and they have accumulated a couple of very promising CNN and god knows what, Fox media printouts, and here we tell them, you know what, this was a couple of rats done in a lab in

god knows where, and we're right now trying to duplicate that but this has not been duplicatable so far.

Andrew Schorr: Jeff, thanks for being with us. I hope that puts it in perspective for you.

Caller:

Thank you very much. Andrew Schorr:

Thank you. I wanted to make a comment related to cancer. A number of years ago, front page news, New York Times, worldwide, cancer cured in mice and it would lead to--you

know, this was the idea of antiangiogenesis or that you could take a pill basically and cut off the blood supply to the tumor and then the cancer would sort of wither away. Well, it's been a much tougher road, and there certainly are some drugs that have been

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developed that have not been the be-all and the end-all, but when that initial publicity came out it was a cure for cancer. And so I think one tip we would give everyone is that

it's a long journey, and as Dr. Chapman said, the medical industry that I respect a lot is very good at getting this out in the news media, and the news media is great at bringing

it to you, but you have to have that dialogue with your physician, your specialist, people you trust to see does it apply and what are reasonable expectations.

We're going to talk more with Jodie Kent about her reasonable expectations, what she's thinking now after having gone through two surgeries. We want your calls. Thanks for

being with us now. Stay with us on Andrew Schorr's Patient Power on KVI Talk Radio 570. We'll be right back.

Andrew Schorr: You didn't have to wait long. We're back. Andrew Schorr with Patient Power with

Dr. Jens Chapman from Harborview Medical Center, an eminent spinal surgeon, Jodie Kent, who has gone through two spine surgeries.

I want to mention a couple of things for our listeners. We're on every week Sunday morning, eight to nine. My commitment, our family's commitment, our friends’

commitment to you to be a smarter patient. And I'm an eight-year, almost nine-year it will be in April, knock on wood, leukemia survivor. I think I got great medicine and great

advice as I navigated the healthcare system, and today I'm in molecular remission, which means they can't find the leukemia, and my friend says don't talk about it, and my friend Jodie here is applauding. Let's hope it stays that way. But I want you to have as good

health as you can.

Couple things. I want to announce the Patient Power Awards. What are the Patient Power Awards? Patient Power Awards are you e-mailing us and nominating your provider, nurse, doctor, nurse practitioner, physician's assistant, pharmacist or maybe a mentor

patient and say this person empowered me and helped me be a smarter patient. And I want you to send me an e-mail. Okay? And my name again is Andrew Schorr. So

Patient Power Awards. And then what we'll do is if we get a lot of votes for somebody, we keep seeing Dr. Jones or Nurse Smith, we're going to get them on the program, and they're going to help us all be empowered and navigate the system. Okay. The Patient

Power Awards. And it's not annual. It's whenever we want to do it.

Let's take a call. Jerry is joining us on his cell. Jerry, where are you calling from? Caller:

I'm in Kent. My daughter is having a volleyball tournament.

Andrew Schorr: Oh, great. Okay. What's your question or comment?

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Caller: My question for Dr. Chapman is in a case like Jodie's where there's been nerve root

compression from a herniated disk and a bone spur, she's had decompression now, would it be reasonable to think there will be improvements over the next many, many months,

even up to a year or longer? Andrew Schorr:

What's the expectation? Okay. I'm going to let you listen off the air, Jerry. Thank you so much for calling in.

Caller: Thank you.

Andrew Schorr:

Dr. Chapman. Dr. Chapman:

Jerry, great question because this catches us in an almost ethical dilemma. Clearly when patients have an acute disk herniation for instance or an acute nerve compression it's one

of the more brutal pains that we as patients can expect. It's like a tooth gone haywire. It's just nonstop, electrical fire…

Andrew Schorr: Jodie's nodding her head.

Dr. Chapman:

…and we want to do something. The instinct is to do surgery right away. Counter that with the very well-published medical experience that the vast majority of all patients with disk herniations actually get better on their own. Nature actually does a very, very good

job, to the tune of about 85 percent of patients if we as surgeons stay away from it will actually do better by themselves. So here we have this dichotomy. We want to help a

patient right away. The knife can actually help that quite effectively. On the other hand, nature will do a good job between three weeks and three months.

Now, the final problem, the longer we wait, however, the more the chance for a nerve to fully regenerate decreases. So somewhere yet again we have to find the right balance.

Being hyperaggressive will lead to unnecessary surgery, complications, things that we don't want. On the other hand, waiting too long definitely will decrease the chances for a patient to get back to as good of shape as they could have been. So that's a little bit of

our ongoing dilemma.

Andrew Schorr: Yeah, the word is dilemma. So, Jodie, you were familiar with these issues? Had they been explained to you?

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Jodie:

Oh, yes. Having a good surgeon, right away he didn't want to operate. He wanted to wait and see what happens. But you have to see I had two situations. I had one with a

ruptured disk where I really could not function at all. I was basically on bed rest and had surgery within a few weeks. And my second was symptoms that came on about a year later and this was about six months ago trying to get me better and just didn't, so then

again elected to have surgery.

Patient Access to Physicians Andrew Schorr:

Now, Jodie, you are a Group Health patient, right?

Jodie: I am.

Andrew Schorr: Group Health has something really neat where you can e-mail your doc, right?

Jodie: Right.

Andrew Schorr:

So do you do that? Jodie:

All the time. I think it's wonderful. I think that access to physicians is a huge issue for patients. They have questions and, you know, they could be small questions, they could

be large questions, and this is so important to me. I don't think that--I think all healthcare should be like this today, but in speaking here today with the other physician he felt that his time is so valuable it's very hard to answer these e-mails. I talk with my

physicians and they get hundreds of e-mails a day, so I appreciate this extra time that they take to sit down to answer me.

Andrew Schorr: Actually one of the number one questions that patients, particularly patients with chronic

concerns have is easier access to their doctor, not to the office manager, not even sometimes to the nurse. How do they get to the person who they look for most of the

time for their care? And it's something that hasn't been perfected yet. I know there's a lot of work going on. So, Dr. Chapman, you're in the University of Washington medical system and people have questions for you. How do they navigate to get through to you

or to get your question evaluated, to have you weigh in and get an answer back? How do they do that?

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Dr. Chapman:

In an ideal world, I'd have my little cell phone with an ear bud in there and get a phone call from a patient and immediately answer it, right then and there regardless of what's

going on. We're not in an ideal world, and this immediate access, whether it's e-mail or a cell phone call is just not a practicality. Because when you the patient are on the table you probably don't want me to talk to about four or five other patients and to answer

e-mail or something like that. And the same thing goes for office visits. Again personally, just speaking for myself, I'm that tightly scheduled that it's just not possible. It would be

a disrespect to the patient who is undergoing active evaluation or treatment to then be interrupted with incoming calls.

So in a nutshell we have team members. They are physician assistants or nurse practitioners. They are part of the team. The patients will receive those phone numbers,

and they get a direct access virtually immediately to those particular practitioners who then will weigh the question and see whether they can immediately answer it or let me know on a matter of expediency as to what needs to be done.

Andrew Schorr:

Just like if anybody has ever been to the emergency room they're trying immediately to--I think, Jodie, the word is triage. Is it somebody needs to go to the operating room right

away and we need the most prominent surgeon to be called in, or is it something where you're going to have to wait a while. And so triage of the questions is going on in your office all the time from patients I imagine.

Dr. Chapman:

That's exactly the point, and I think that's where triage is appropriate. And the majority of patients actually are very happy to have a knowledgeable soul to talk to them. Yes, it would be nice if the direct physician would be the first point of contact, no question.

Practical reality demands that it's one of those knowledgeable souls, and they're excellent. Fortunately I think most patient are quite happy with the information provided. And if

not, again I consider it my personal first duty to them at the earliest reasonable time to get back in touch with the patient.

Andrew Schorr: And he works long days I can assure you, folks. Now, Jodie, you've been on both sides of

it. You've been a nurse how long? Jodie:

Oh, about 22 years.

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Andrew Schorr: Okay. And the last couple of years you have been a patient a lot. So what would you say

to people so that they could develop that relationship with the nurse or the nurse practitioner or the physician's assistant to help have a respectful relationship there and

help them be an advocate to escalate it to the surgeon in this case if they needed to? Jodie:

Well, I don't think it's the responsibility of the patient. I think it's the responsibility of the nurse and the healthcare people to inform these people. I mean, that's their job. That's

what we're trained to do. Andrew Schorr:

You can call me. So it's the dialogue. So what would you say to healthcare providers, particularly nurses out there to help be an advocate for the patient?

Jodie: Well, I would hope as a nurse and people who want to make people better and help them

that this is just a natural instinct. This is how you treat people. This is how you treat your family and help them get their questions answered because they do have questions.

And if they're not answered they're going to go elsewhere.

Andrew Schorr: Well, this has been quite a program and wonderful advice that you've been giving me.

Now I'll just check, Steven, we're wrapping up now. I'm learning the format here. Steve, so this is our close now that we're doing? No, we have a little more time? Oh, I'm

blessed. We'll come back with more time. So that gives you a chance to call in then. Come back and ask us a question before we go today on Andrew Schorr's Patient Power on KVI 570. We'll be right back.

Andrew Schorr:

And here I am, Andrew Schorr, Andrew Schorr's Patient Power. As we're nearing the end of our hour I need your help, and here's how I need your help. If this program is helpful to you I want you to tell your friends, every Sunday eight to nine in the morning. And I

want you to tell someone else too. The next time you see your doctor, the next time you see your nurse, the next time you go to your pharmacy say have you heard this show, I

want you to tune in, and you know what, I would like your company to help support the program. So let's all try to move this healthcare behemoth in a positive direction. Patients and physicians, pharmacists, nurses, nurse practitioners, physician assistants, all

respecting each other, communicating and the goal of getting great healthcare. Jodie, does that sound like a good goal? You've been in it a long time.

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Jodie: Well, I think healthcare has a long ways to go with this, but I think communication is

something that's new now with access, and it's important for patients' outcome, and in the long run everyone wins.

Andrew Schorr: You got to speak up, though.

Jodie:

You got to speak up. Andrew Schorr:

You as a patient have got to speak up. Jodie Kent, by the way, we wish you all the best with your recovery from your second surgery. Thank you for being with us today.

Jodie: Well, you know, and I'd like to say the questions you don't ask before surgery may cost

you dearly later.

Andrew Schorr: So be informed.

Jodie: Be informed.

Andrew Schorr:

Which is what Dr. Jens Chapman, spinal surgeon from Harborview Medical Center and the university of Washington has been saying. Write those questions down, right, Jens? Speak up.

Dr. Chapman:

As complex as healthcare is nowadays, have your big ring folder there. The first page, as I told you, is the question page, and after that have the inset folders to put all the bills collected, and get this whole complicated situation organized right from the start. And as

I said the first page is the question page.

Andrew Schorr: And, you know, often when you're diagnosed with something serious or you have a serious concern like Jodie has had with her back and neck, people say, what can I do for

you? Well, they can be that friend who goes to the doctor with you. They can be that friend that helps you organize your materials, organize your questions, organize the

answers that you get from the doctor and maybe even help you navigate the system, prevail on your primary care doctor, as Jodie said, to make sure they're helping you navigate. Have an advocate. It's okay to ask a friend or family member to do that.

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Next week we're going to talk about diabetes, and we're going to have Dr. Earl Hirsch

from the University of Washington who is an eminent guy. He'll tell his personal story I'm sure about diabetes as well. It affects about 17 million people so I'm sure that you will

have many questions. So like today next week we'll take other questions as well. Tell your friends this is a chance to talk to Earl Hirsch who is world famous in the world of diabetes and get your questions answered and know how you can be a smarter patient.

It's a joy to do this program. Dr. Chapman, thank you so much for being with us.

Dr. Jens Chapman from Harborview. Dr. Chapman:

My pleasure.

Andrew Schorr: And, Jodie Kent, thank you for telling your story and we wish you all the best, Jodie.

Jodie: Thank you, Andrew.

Andrew Schorr:

It's really a delight to do this program so tell your friends. Next week be ready at eight o'clock. 206-421-5757 will be the number to call, and we'll be taking your questions. And this has been Andrew Schorr's Patient Power on KVI Talk Radio, 570. So be with us

again next week. See you next week. Please remember the opinions expressed on Patient Power are not necessarily the views of KVI, our sponsors,

partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your

own doctor. Please have this discussion you’re your own doctor, that’s how you’ll get care that’s most

appropriate for you.

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