1. Who is Dr.Benoy Benny?
Dr.Benny is an Interventional Physiatrist which is a Physical Medicine and Rehabilitation Specialist who specializes in Spine and Sports care. A physician who completes his training in Physical Medicine and Rehabilitation is referred to as a physiatrist. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system. Following Residency he completed a Spine and Sports Medicine Fellowship to further his education in Spine and Sports Medicine Care. On your visit, Dr.Benny will do a complete history and physical exam and look at any pertinent imaging to diagnose your situation. He will then determine the best treatment plan for your complaints.
2. What are some of the different treatment options Dr.Benny utilizes?
Depending on your situation, you may find him utilizing several different options
•Using specific physical therapists to work on the biomechanics (movement) and training for the spine and joints (shoulders, knees, hips).
• Using imaging and electrodiagnostic testing to help specifically diagnosis your situation.
•Using alternative medications (non-addicting medications) to help with your discomfort. He may use short term pain medications.
•Using minimally invasive therapeutic and diagnostic surgical procedures (that can include injections) into the spine or joints to help with your spine or sports complaints.
• Uses specific spine or sports surgeons that he works along with if it is decided that you will indeed need to see someone for surgery. The good news is that most of the time, surgery can be avoided, but if needed, Dr.Benny will work with the surgeon to come up with the best plan and success for surgery.
3. Is Dr.Benny a chronic pain doctor?
Dr.Benny is not a chronic pain physician. He does see some patients who have had pain issues for a while, but in the hopes that he can get them functionally better and their pain relieved with alternatives. A lot of this is due to diagnosing the correct cause and treating that appropriately. He may prescribe short term pain medications, if he thinks that will help for the short term, but he will not be prescribing strong pain medications (narcotics) long term.
4. What are the Main Conditions that Dr.Benny treat
• Spinal Conditions (Back and Neck)
•Shoulders, Hip and Knee Conditions
•Other Musculoskeletal Conditions
5. What should I expect during my outpatient procedure?
You will be evaluated by Dr.Benny and then will be asked to sign consent for this procedure. You will be placed on an X-Ray table and the area of interest will be sterilely prepared with betadine solution and a blue sterile drape. Several images will be taken in order to localize the site of needle entry. The needle entry site will be anesthetized with lidocaine, then the needle will be carefully but swiftly moved into position under X-Ray guidance. A non-ionic contrast dye will be used to confirm proper positioning of the needle, and then the medication mixture (commonly a steroid/ lidocaine mixture) will be injected in the specific area of interest. You will have vitals taken during the procedure and will then be discharged back to your recovery room. You will be monitored for 10-30 minutes and then sent home with specific discharge instructions.
6. Will the procedure hurt?
This is a relatively variable answer, as different people tolerate pain and injections differently. I always use a local anesthetic to numb up the injection site prior to the needle entry and I always talk you through the procedure as it goes along. The whole procedure usually takes about 10 minutes. You will then remain in recovery for up to 20 minutes just to make sure things are well before you leave. In my experience, most patients have left reporting “It really wasn’t bad at all”.
7. Why do I need a driver?
This is simply a safety precaution. Most patients are given anesthesia administered by an anesthesiologist. This is not deep sedation but something called “conscious sedation” or “twilight” or “MAC”. This is similar to what is given before a colonoscopy. This is to make sure you are comfortable and do not feel the procedure too much but you are kept awake to maintain the safety of the procedure. Sometimes patients may feel warmth, or numbing sensation in their legs after the injection for up to 6 hours due to the local anesthetic used, which may impede driving.
8. When can I resume normal activities after the procedure?
After the injection, you should not operate a motor vehicle or heavy machinery for the remainder of the day of the procedure. You can ambulate as tolerated on the day of the procedure (you may be quite sore) and can resume all normal activity by the next day.
9. How will I know if the procedure worked?
This depends on what procedure is being done and what is injected. Some procedures are purely diagnostic and only last a short time but done to confirm a diagnosis. Some are therapeutic and can show result anywhere from immediately to up to 5 days after the procedure.
If you are having an epidural steroid injection: On the day of the procedure you may have about 4-6 hours of numbness in the lower legs (or arms) due to the local anesthetic effect. Even the feeling of “numbness, warm feeling, and difficulty moving my legs” is normal for the first 4-6 hours after an epidural steroid injection due to the local anesthetic component. If it is lasting past that time to where you are having it that night (more than 8 hours later) with no improvement and definitely the next day, please give us a call. Once this wears off, you will have quite a bit of soreness at the injection site for about 24 hours. Make sure to ice the injection site for 15 minutes at a time 2-4x that first day after the procedure, this will significantly decrease the soreness. You may need to take over the counter Tylenol or Ibuprofen as well the evening after the procedure to help with post-procedure soreness. You may also need to take over the counter Benadryl (tablet or lotion) to help with minor itchiness at the injection site (Most likely from the betadine sterile preparation used)
*if steroids are used
The steroid medication on average will begin working in 48-72 hours, and its effects often last up to 2-6 months, but this also varies and there is no set timeframe.
It is essential that you monitor and record the extent and duration of relief (a pain diary) you have received especially for the next 2 weeks after the procedure. You should have a follow up with us 2 weeks after the procedure, and depending on the extent and duration of steroid effect we will discuss if another injection is warranted.
*If you are having a Radiofrequency Ablation, Percutaneous Discectomy, Procedure with PRP or Bone Marrow Concentrate or any other procedure, please discuss this with your physician
10. What should I expect immediately after the procedure?
Again this depends on what procedure you had done
Even though very rare, short term side effects of the steroid include nausea, dizziness, fatigue, irritability, difficulty sleeping, high blood sugar, and fluid retention. If diabetic, you will need to monitor your blood sugars more closely for 48 hours. If you have renal dz. or heart disease you will need to contact your primary doctor prior to the procedure to monitor your fluid retention more closely after the procedure.
The steroids will take effect in 48-72 hours.
Warmth and numbness in the legs (or arms), and paresthesia in the legs (lack of feeling or movement in the leg) may last up to 4-6 hours after the injection due to the local anesthetic mixed with the steroid injection.
You may have significant tenderness and pain at the needle entry site after the numbing medication wears off in 3-4 hours. Make sure to ice the area for 20 minutes every hour for 3-4 hours which should take care of any swelling.
You may have minor itching and redness around the needle entry site due to the betadine sterile preparation we had used. Please wash this area off thoroughly and take an over the counter antihistamine (Benadryl ointment or tablet) to help with the itching.
For Radiofrequency Ablation, Percutaneous Discectomy, Procedure with PRP or Bone Marrow Concentrate you may be sore for 1-2 days but this should be manageable with Over the Counter medications. If you are concerned your physician may give you short term pain medication to help with this.
11. How often can these injections be done?
This depends if the procedure is done for therapeutic effect or diagnostic purposes (without steroid). In regards to steroid injections, if this is done for therapeutic effect, with steroid, on average we do no more than 3 to maximum 4 injections within a 12 month period. Other factors include age, amount of steroid used, site of injection, and diagnosis. There is research to support doing a second ESI if you have no relief or short term or incomplete relief from the first injection; rarely would a third be done. The number of injections done will be determined on an individual basis. For diagnostic purposes, using local anesthetic, there is no such restriction in number of times these can be done.
12. Why do I have to stop my anti-clotting agents before the procedure?
Medications such as Coumadin, Plavix, Heparin, Aspirin, and Aspirin like products prevent clotting of blood at the procedure site as well as within the spine itself which could lead to unnecessary complications. Please check with your primary doctor before stopping these medications. Keep in mind your injection procedure is only elective and may take second priority to your cardiac disposition. If your doctor does allow you to be off Coumadin for the necessary 5-7 days, you will need an INR of 1. 5 or less on the day of the procedure. (We can phone prescriptions to your local blood draw lab if needed, let us know. ) For all Lumbar procedures, knee, shoulder or hip joint procedures, you can continue taking your aspirin or non-steroidal anti-inflammatory (like ibuprofen, Motrin, alleve, naproxen, Celebrex, Mobic). These will have to be stopped for cervical and thoracic spine procedures.
13. What Medications can I continue to take?
You do not need to stop any other medications outside of anti-clotting agents mentioned above for the procedure including muscle relaxants, anti-depressants, blood pressure meds, insulin, or Tylenol, Vicodin, Darvocet, Tramadol or other narcotics. We ask that you do not take NSAIDS (Ibuprofen, Alleve, Excedrin) for 3 days prior to CERVICAL or THORACIC procedures, but you can take it immediately afterwards. It is ok to take NSAIDS for LUMBAR procedures.
14. When can I begin my medications after the procedure?
You can begin all medications except for blood thinners right after the injection. This includes any pain medications or NSAIDS. You can begin taking your blood thinners (Coumadin, Plavix, or Aspirin like products) four hours after the injection.
15. When should I call the clinic or the Emergency room after the procedure?
If you have any symptoms of bowel/bladder incontinence (Cannot feel when you are having bowel movements or urination), high fever, chills, severe pain, weakness that is persistent the next day, or headache within 48 hours of the injection, please call us at the clinic so we may assist you.
16. What are the contra-indications to this procedure?
Please cancel the procedure if you are PREGNANT, or have an active INFECTION and are on ANTIBIOTICS. We can wait or discuss alternatives to the injection. Please let your doctor know if you are diabetic (Your BLOOD SUGAR WILL BE HIGH FOR 48 HRS), have cardiac or renal disease (You will have FLUID RETENTION). These are not contraindications for the procedures but you should know about this. Please let us know if you have betadine allergies, iodine contrast dye allergies, or latex allergies so we may take the necessary precautions for your safety.
