Posts Tagged ‘epidural steroid’

Lumbar Epidural Steroid Injections + Fish Oil

January 9, 2009


As a doctor who treats patients with back pain and sciatica all day, lumbar epidural injections + fish oil is a great and powerful combination that I use on my own intermittent left S1 disc/nerve problem.  Why do I use this combination on my own problem?  First, epidural injections can be a great way to calm down an inflamed spinal nerve when the fire just gets too much to manage.  I consider this like putting allot of water on a really big nerve fire.  In addition, we stay away from very high dose steroids in our epidurals and have replaced the milligrams with nano-grams of steroid.  This is because this is closer to the dose range that the body uses naturally.  In addition, since we have our own stem cell culture lab, we add in platelet lysate or a VEGF rich supernatant from cultured platelets.  What’s all that mean?  These natural preparations made from the patient’s own blood platelets bring natural growth factors to bear to help the disc bulges heal themselves.  Fish oil is a natural management tool for the day to day inflamed spinal nerves (sciatica) many of us get form sitting too long or just chronic bulges.  Our friend Joe Maroon (a Neurosurgeon at the University of Pittsburgh) conducted a study where he was able to get about 60% of his patients off of NSAID’s like Motrin by substituting a high quality fish oil loaded with Omega 3 fatty acids.  We personally use the same brand he uses, which is Nordic Naturals.  Too often fish oil is made from oxidized and cheap junk fish, while these guys do the processing right.  What to do when the epidurals and fish oil no longer work well?  We use the patient’s own stem cells injected into the disc tears that are causing the bulges (to help heal the tears and reduce the size of the disc bulges).  This method usually helps our patients avoid low back surgeries (where the disc is too often weakened by cutting off the disc bulge).  Repair is better than cutting out-at least that’s what we believe at The Centeno-Schultz Clinic.

Adverse Effects from Epidural Steroid Injections

January 9, 2009

Epidural steroid injections have become a mainstay of treating herniated discs (sciatica).  As a interventional pain specialist I’ve seen them work well to avoid surgery hundreds of times. However, there can be adverse effects from epidural steroid injections.  These side effects are generally much less than surgery.  The side effects from epidural steroid injections can be: increased pain or numbness, an increase in epidural fat causing pressure on the nerve, immune and repair function suppression, just to name a few.  In our clinic, we consider that the most concerning of these side effects of epidural spinal shots for pain are caused by the extremely high doses of steroids commonly used.  Steroids are a two edged sword (like cortisone). They do bring down swelling around the nerve.  However, for an unknown reason (likely due to medical tradition and certainly not medical science), most physicians use about a million times more steroid than your body uses on a day to day basis.  We’ve found that lowering the dose of steroids from the milligram range to the nano-gram range doesn’t diminish the anti-inflammatory effect, just the side effects.  This is because your body naturally produces it’s own steroids in nano-grams (one billionth of a gram) and not milligrams (one thousandth of a gram).  We also commonly add in platelet lysate (growth factors isolated from the patients blood and processed in a our cell culture lab).  These growth factors (especially VEGF) can help bring in much needed extra blood supply to the poorly vascularized and nutritionally challenged disc, helping the disc heal itself.  We can also create a VEGF rich supernatant (we call it super VEG) by culturing the patient’s blood platelets.  What if the disc/nerve (sciatica) problem still persists?  We then turn to using the patient’s own stem cells to heal the tears in the disc and get rid of the bulge.  For more information, click the link in the last sentence or check out the video below: