Kerry: 0:29

All right. Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Jesna Sublett. Welcome to the podcast.

Jesna: 0:39

Thank you. Thanks for having me.

Kerry: 0:42

Yes. We're so excited to have you. And why don't you tell us a little about who you are and what you do.

Jesna: 0:48

Of course. So I am as Dr. Reller mentioned, I am Jesna Sublett. I'm a neurosurgeon here in deland, Florida. I am fellowship trained in minimally invasive spine surgery. And I love what I do and that's why I'm here.

Kerry: 1:03

Wow, that is probably a lot of training. So if, for people who don't know, I think neurosurgery training is like nine years or something. What is it? Tell us.

Jesna: 1:11

Seven years of residency and then one or two years of fellowship depending on what you go into. So for me, yes. It ended up being nine years,

Kerry: 1:19

Nine years. That is a lot of training. So you are an expert in what you do, no doubt, right? Yeah. So how did you get into neurosurgery in the first place?

Jesna: 1:30

There's a short answer and there's a long answer.

Kerry: 1:32

All right.

Jesna: 1:33

short answer is you have to be just a little crazy to wanna do this for a living. But the long answer being, neurosurgery is such a, such an interesting and complex specialty that of all the specialties that were open to me at the end of, med school, this is the one that drew me the most.'Cause you have one specialty that has the range of something as minor as like a carpal tunnel syndrome. All the way to intensive, several hour long skull-based tumor surgeries or aneurysm clippings. So it had this whole wide spectrum of things that we do that really called to me.'cause I was like, I'm not somebody that's gonna be happy doing the same thing day in and day out every single day. I like to have that variation and I like to have the choice of what direction I wanna go based on what season of my life I'm in. For example, right now my focus mostly is minimally invasive spine surgery, which one of my mentors used to say there is no emergency degenerative back pain. I'll see patients in clinic every day and, treat diagnose their problems, help find the best solution. But at the end of the day, I get to go home and hang out with my two children. and the surgeries that I do, minimally invasive spine surgeries, they're outpatient surgeries for the most part. So people coming in, getting surgery done, going home the same day it did significantly reduced how much rounding I need to do in the hospital. So that's a big within the realm of neurosurgery that's a big lifestyle positive. All of those things were were their draw. But as they say, like a lot of students, when we start to go med students. Thinking about neurosurgery, the first thing that attracts you is when you sit there in the, or watch a super like amazing surgeon do like an aneurysm clipping, which is the best of the best type surgery. Oh, everyone comes in, wants to be an aneurysm surgeon. And then you go through the seven years of residency and then you realize everything else that comes along with that. And so people start to go off to different specialties. But yeah. Spine really called, to me, 80% of people that come to a doctor have some sort of back pain, neck pain, things like that. And a lot of times they get this fragmented care where they see a doctor, they send them to someone else, they send'em to someone else, they get imaging done, they get, and they're just not getting like the. Answers of what they need to do. And then a lot of times, we'll, some of them will get, go to a surgeon and the surgeon's focus is, yes, you need surgery, or No, you don't need surgery. And that's it. And the patient's still left with questions, okay, if I don't need surgery, then what do I need? How do I get better? So those are the gaps I saw that I felt like I could help fill in and direct patients to answering the question that they come in. Patient doesn't come to see me as a spine surgeon to say, do I need surgery or do I not need surgery? They come and say, I'm in pain. What do I need to do to get better? And that's the disconnect a lot of times between the patient and the physicians that I try to approach from a different angle.

Kerry: 4:49

Yeah, totally important. And you mentioned something that I didn't even know about neurosurgery was I didn't, like you mentioned you do carpal tunnel. I had no idea. I certainly have never referred to a neurosurgeon for carpal tunnel surgery. It's good to know that as well. And then I should say you're mentioning minimal invasive surgery. What does that even mean? So we can tell our listeners what that is.

Jesna: 5:10

Absolutely. So minimally invasive spine surgery is a subspecialty of spine surgery where all of the surgeries we do are through tiny incisions. To put it in context the traditional way of doing spine surgery is where you have huge like this big incisions all down the back of, down the middle of your back for lumbar surgery, for example, where you would have to go down, take off all the muscles of the bone, take off the lamina which is the back part of the spine to uncover the nerves that are being pinched. And then you get to the problem, which is maybe there's a disc herniation, maybe there's foraminal stenosis where the nerves are getting pinched. And so you have to do a lot of what we call collateral damage before you get to where the problem actually is. Then fix the problem. The way minimally invasive spine surgery works is instead of doing all of that, we make a tiny incision, and through that incision, whether it's a small tubular retractor, or whether it's now more and more people are doing endoscopic spine surgery, so a camera that goes into a tiny incision. And you go right down to the area where the problem is, you're not destroying the muscles on your way in, you're not taking off all of that extra bone that you know you don't need to take off. And you're right down to where you need to be to relieve the pressure off the nerve, whether taking the disc off or opening up the stenosis. And so in doing that because we avoid a lot of collateral damage one of the kind of, I guess analogies that's used is instead of using a bazooka, we're using a sniper. Like we're just going down to the problem, fixing it, and then leaving everything else intact, which allows patients to have shorter recovery times, less post-op pain. They're able to get outta the hospital. They don't have to be admitted. Most these days mo surgeons that are doing minimal spine surgery, most, a lot of them are doing them in surgery centers. You don't even have to be seen, like you don't even have to enter the hospital. And if you do, you're just in and out which it translates into better patient outcomes. In general, post-op care patients tend to do better in their own home setting rather than in a hospital. Of course, you get all the other risks factors that come in with that, with other, sources of infection or a lot of times mobility is reduced when you're inpatient in the hospital. No. You can't get out until physical therapy sees you or no, we need a doctor's order before you get out. But you're going home, you know what the surgeon told you to do, you're free to do that, right? So you're gonna get up to get into your car to drive, to have someone take you home. Things like that. So there's a lot of positive sides to doing that minimal invasive. And once you start doing this enough, you just don't know that there's a ne, there's any need for that collateral damage anymore. So that's the draw for minimal invasive spine surgery.

Kerry: 8:03

Yeah, I think that's an excellent description. I love the bazooka sniper analogy. That really narrows it down, if you will. Yeah. So you mentioned patients are coming to you, they're in pain, they just want answers. They wanna know what to do. What do you think are the most common reasons that some people develop like chronic back pain or spine pain?

Jesna: 8:21

Oh yeah, that's a big one. So most of the patients that come to me with these problems, chronic back pain, chronic neck pain, are older populations, right? So degenerative back pain a lot of times it, it can be aggravated by several years of excessive or overuse of your spine. So things like heavy work, construction type work or for the neck. For neck cervical issues, a lot of like sedentary workers that sit at a computer for long hours. You're looking down, at your monitor or in today's day and age, the texting neck, right? So everyone's looking down at their um, phone. And so posture is a big one. How much activity or overuse in terms of heavy work. And then of course there's always the the underlying, the non modifiable risk factors. So age age, we already talked about the genetics. So a lot of times these things do tend to run in families. Patient will come and say, yeah, I have, I've had back pain for a while. My dad had really bad back issues for several years, or my mom has had several surgeries for her spine, things like that. So a lot of times this will have a genetic component to it. And then the modifiable things, which is a big one. Smoking is a huge risk factor. It's funny, I, a lot of times I mention, I tell people, so I'll pull up their MRIs and I'll say, if I was to go out, say to a Walmart or a local grocery store and just get MRIs of every person that's in there and I compare the people that smoke to the people that don't smoke. On average, the MRI pictures of the people that do smoke look about 20 years older than the people that don't. In the same kind of age group comparison. And a lot of people express surprise when they hear that because we all talk about how smoking affects your lungs, right? We all talk about how it causes lung cancer and things like that. We never, we don't talk enough about how much it affects your body's ability to heal. It's your normal degenerative processes that occur over the years and your body has inbuilt mechanisms to deal with that smoking really, affects that. And so you do have faster deterioration, worse degeneration over the years. So

Kerry: 10:39

So you see that on the inside then because we talk about smoking in the, like with the skin, right? It really ages the skin and like you said, impairs the healing. And we obviously talk about it with the lungs and cardiovascular disease, but I haven't thought about it in this way either.

Jesna: 10:54

Yeah. It affects your spine, it affects everything.

Kerry: 10:57

That's so interesting. Yeah. Okay. So what are you actually seeing on an MRI in a comparing a non-smoker and a smoker?

Jesna: 11:05

So it is not that there's specific separate findings in smokers, it's just all of the degenerative changes that we'll see are much more magnified or happen quicker. So for example, a 50 year old's. MRI might look like a 70-year-old non-smokers mRI. And it's funny because I've also, I have specifically anecdotally had patients come back. We had the initial conversation about back pain and this and that, and all the things you can do to help your pain, and then they'll stop smoking and then a year or two later they'll come back, Hey doctor, I don't really feel that pain anymore. I really don't. Oh, we were gonna do surgery. I don't think we need to do that anymore. I, I'm fine. And so it's it's very beneficial. Even that quickly after having smoked for decades, even like a few months or a year later, it will help your symptoms. So that's the, one of the things I tell my patients is that's the single best thing you can do for yourself and to help your pain is to stop smoking.

Kerry: 12:10

That's interesting. So for lungs, do we think that, no further damage is going to be done, but it's hard to reverse any damage. For the lungs from smoking so they can actually get better, is what you're saying

Jesna: 12:21

so it's not going to necessarily take away the damage or on the imaging. So the stenosis, the bone We're seeing is not gonna go away, but symptoms can get better even with the same imaging findings persisting because your nerves are still constantly trying to I guess reduce the irritation around them. Or your body's constantly trying to reduce the inflammation on the nerves and things like that. And so when it's not actively fighting, the not being able to heal for some reason, yeah, symptoms do get better.

Kerry: 12:55

That's really cool. So what other modifiable risk factors were you gonna

Jesna: 13:01

Oh yeah. So I think I mentioned, so age and genetics would be the non-modifiable smoking posture. And it's gonna come to me there, there's a third one that I always talk about. But yeah it'll come to me.

Kerry: 13:16

Okay. That's okay. you mentioned posture. I think that's probably one of the most important things as well, you were talking about texting on the phone and things like that, and sometimes, I don't know if you've heard the phrase, tech neck, basically people are like this and we know that can definitely affect posture and things like that. And I would agree. I actually just finished reading this book called The Back Mechanic by PhD. I forget, he's outta Canada, I think, or maybe the uk. But he, it's an excellent book and it obviously is focusing on, these you modifiable things, doesn't mention smoking but learning how to move in your daily life. A safe and healthy way, and it talks a lot about keeping the spine neutral. Can you speak toward that at all? What does that mean and why is that helpful and important?

Jesna: 14:05

Yeah so keeping the spine neutral, so when you look at your spine from the side, it has three natural curves. You've got a cervical, what we call lordosis, so curve towards the front and then or thoracic kyphosis. So an opposite curve along your midback. And then a lumbar lordosis, it's all supposed to balance out, so your head's perfectly above your pelvis. A lot of times as we go about our day, as we get caught up in the things that we're thinking about as we're walking, for example you have this natural tendency to just kinda lean forward or bent walk, walk, bend forward in a stooped posture. And that can because it affects the alignment of your spine, it pet puts additional stresses on the other parts of your muscles, for example, are overworking to try to keep you upright so you don't fall over, right? And over time, that constant pull of gravity when you're walking bend forward can start to cause degeneration in the intervertebral discs. And then it becomes a bit of a cycle because once you get to a certain level of degeneration and you got stenosis, you got tightness around your nerves coming out the, on the on, on the sides. At that point, bending forward actually relieves the pain because bending forward will open up those spaces and so it becomes a little bit of a cycle where you're bending forward because it hurts, and then that more worse the degeneration and that worsens the pain. So trying to be, get in the habit of being upright, making those muscles in your back work like they're supposed to, so they stay strong and they keep you upright and your spine remains in its normal alignment allows to hopefully slow down, nothing you do is gonna make the wear and tear of the degeneration stop. The older you get, you're gonna have wear and tear, but at least it could slow it down enough where you're not ending up in spine surgery after spine surgery. So yeah, that's a big one. And yeah, I remember the third

Kerry: 16:06

I knew

Jesna: 16:07

modifiable one that's it's weight loss. And it's, obviously it's not surprising when someone mentions that the more weight we carry on our spine. The more wear and tear you're gonna have. So that's another big one that does show up as worsen higher risks of worsened degenerative problems.

Kerry: 16:27

And we notice that for any joint and things like that, and the spine, has its own little joints, right? So I think that really makes a lot of sense as well. It's super important as well. So if someone's coming in with like back and neck pain, how do you know they can improve with conservative care versus something that really needs further intervention?

Jesna: 16:44

So there are some big red flag symptoms that tell me or a spine surgeon, no, this is not something we should be waiting around for. So those would be things like. New onset motor deficit. So a foot drop, for example. Or really new sudden incontinence. Not the type where, you know older ladies or people that have kids the little bits of sneeze I sneeze and I pee a little bit. Not that type of incontinence. But specifically just, you and I are talking and we looked down and I wet myself. I didn't even realize that. So those kinds of things, those are big red flags. That's not something where you wanna wait to wait for your next appointment with the neurosurgeon, however long out that might be, you wanna go into the er. Because in those situations, if that's coming from spinal or nerve compression or what we call cauda equina syndrome, that it has as a 24 to 48 hour window in which we have to act, or the symptoms do become permanent. So there's, at that point, even after you do the surgery, it may not be reversible. But other than that, the symptoms that most people come to a spine surgeon with pain along the back, radiates down the legs, numbness, tingling, so radicular pain, and there's correlating symptoms on imaging. Most of the time, even with that, so the symptoms correlate with the imaging and it makes sense. Even with that, 80% of people will still respond to some kind of non-operative treatment, whether it's physical therapy alone, whether it's combination of injections and things like that. And just, addressing some of those modifiable risk factors we talked about. So it's a very small portion of people that do end up necessarily requiring neurosurgical interventions, the surgical intervention, even with positive findings on imaging. And that's when we, I would recommend proceeding with surgery. But, you wouldn't know which bucket you are in until you talk to the expert. So seeing the spine surgeon should not wait until, oh, I'm ready to get surgery. It can be your initial consult of this is what I have, this is what was found on the imaging. Where do I go from here? And then the surgeon can direct people to, okay, you can go this way, or you can go that way. And then we'll follow up and see how you do. And then decide if you do need surgery.

Kerry: 19:09

I'm not sure how to a ask my next question, but how often, because you mentioned if the symptoms clinically correlate with the findings on the imaging, and I think that's a really important comment, right? Because I think a lot of patients may get imaging for another reason and then, oh, surprise, this was seen on their back and now all of a sudden they're having maybe pain or something like that. But how often are the images important to address, or I guess, what is your experience with this kind of situation where there's just imaging findings, but maybe things aren't matching up?

Jesna: 19:43

Oh, we see that a lot. A lot. And that's a great question. The way I approach that is, and this is what I tell the patients I'm in the business of treating patients. Not fixing pictures so you can have issues on your imaging that doesn't correlate to symptoms real life. And that just means, yeah, you've got some evidence of wear and tear. There's nothing to do about it. It's only when the two things match up. So you can have symptoms and no imaging findings, and that's a whole different like path down the decision tree. You can have imaging findings with no symptoms. Yeah, no surgery. Definitely the two have to correlate for me to say, okay, you have, so it imaging findings symptoms and you've tried the non-operative treatment. Yeah, modalities that will work for most people. All of those have to line up before I say, okay, you now meet criteria to get surgery. And I'm confident that the surgery I do will help with your pain. Even with that it's interesting to note. So as a spine surgeon if you come to me for back pain, back surgery is not likely to help you. Back surgery helps with leg pain. So radicular The stenosis around the nerves, right? So it takes off the pressure, off the nerves. That'll help with the radiating pain going down your legs. Pain right in the middle of your back, what we call axial back pain. Most of the time that's related to multiple other things that are not necessarily, just the nerve part, the nerve stenosis part, which is what we work on. So things like your posture, your muscles, your fascia. Your disc related back pain or facet joint related back pain. Those are all types of axial back pain that don't necessarily respond to surgical interventions. Those are actually better suited to be to respond to things like physical therapy and certain types of injections. So when we talk about spine injections, there's two different types of injections that they'll do. The pain doctor might do steroid injections that are in the epidural space. Which is geared towards the nerve pain going down the legs. And then there's injections that go in the facet joint that's geared towards axial back pain. So it's two different types of injections. But yeah, there are certain things that can help with axial back pain, but the answer for that is not always surgery. Leg pain I can more confidently say, yes, you've got leg pain, you got nerve stenosis. I can unpinch that nerve, I can help that pain.

Kerry: 22:16

Let me clarify. Are you referring to all neurosurgery or the minimally invasive

Jesna: 22:20

No any, all surgical interventions in the spine are geared towards opening up stenosis around the nerves. Stenosis around the nerves causes radicular pain. There are some that, as a side effect, can help with some of the axial back pain. So for example, if we do fusion surgery in the lumbar spine by taking away the motion at the facet joint, it can affect only the facet related axial back pain. But again, axial back pain tends to have multiple etiologies all combined together. So if someone recommends a lumbar fusion Only for axial back pain. You have no radicular pain. That's something you wanna think a, a second time about because axial back pain it's a little bit of a coin toss If I do surgery for axial back pain, you may get better, you may not get better. If I do surgery for radicular back pain, yeah, I know I'm targeting a targetable problem so I can get it better. And that's a little bit of that difference that plays a role when you'll hear a lot of patients say, I had back surgery, it didn't change anything. I still have the same pain. And because if you have a hammer and you use the world as a nail. Sometimes it works and sometimes it doesn't. But if you use the hammer to put a nail on the wall for to hang a picture, it'll work So.

Kerry: 23:51

is a very important point that you're making here and I'm, I guess I never really thought about it this way. So would you say that we already answered the question of what types of spine conditions are especially well-suited for minimally invasive approaches then?

Jesna: 24:07

Actually no. The what, so what we're talking about right now was spine surgery in general and what types of symptoms it addresses minimally misses spine surgery. Can address, can do all of the same things that traditional open spine surgery does with small exceptions. For example there are things like, so thoracic disc herniations, for example. That's a big kind of up and coming topic, especially in the world of minimally invasive and endoscopic spine surgery because. Excuse me. Traditionally, when you do open surgery for the thoracic spine you have to of course, take off the lamina in the back, but then you also have to take some of the bones off the side the parts of the rib that attach to the spine so that you can get a little bit more of a lateral approach to the spinal cord because the thoracic area. Spinal cord it, the spinal cord extends to about L one, L two level in most people. So that's an area where you have this, the entire, the bulk of the spinal cord, and you can't really pull the cord over to the side to get down to where the disc herniation is because it can lead to sometimes permanent new deficits. Where in the lumbar spine, a lot of times the surgeries we're doing are lower lumbar L three four, L four five, things like that. So the spinal cord's already stopped. It's nerve roots. You can easily move the nerve roots over to one side to get around to the front, and they it doesn't affect them. In the same way. So with open spine surgery, you have to get that lateral approach. With endoscopic surgery or minimally necess surgery, you can get more of that lateral approach without necessarily taking all those extra bones off. Prevents needing to have a fusion or hardware. But it is a very high level skill technique. So even all endoscopic surgeons are not comfortable with doing thoracic disc level. That's one of those, you have to, you have done a lot of these to be comfortable with that level of skill. So there's that. Whereas with open surgery, yeah, you can do it, you're gonna have all the collateral damage, but most spine surgeons. Or all spine surgeons are trained to do that type of surgery. So there's those differences in terms of how advanced the technology for endoscopic and minimally invasive has gotten and what parts of the spine you can apply it in a safe, risk-free way.

Kerry: 26:29

So location, obviously in the spine really matters too then. Okay.

Jesna: 26:32

Yeah.

Kerry: 26:32

So we're trying to, avoid surgery. How can a patient, what can they do to avoid getting to the point where they need surgery and it's the only option

Jesna: 26:42

yeah so you have, if you have pain we, typically recommend all of the, so essentially the way I say it is there's a buffet option of options of what all you can do to help with your pain. You always wanna start with the lower risk, least invasive things first. That doesn't work. Work our way up, work our way up. So of course the lowest risk would be things that you can do on your own, right? Get some over the counter medication and then try start to do those, modifying your risk factors, right? See what you can do about weight loss, see what you can do about stopping the smoking, adjusting your posture, things like that. And in the meantime, of course, if it's hurting, you can't do the exercises, you're not gonna wanna do'em salon pass, lidocaine patches, those kinds of things. And then, once it gets to a point where anything that you can do on your own is not helpful, then you can go to professionals that can offer that next level of therapy. So massage therapy, acupuncture, chiropractor, those are all reasonable options. Now with chiropractic treatments, I always use the disclaimer of as a neurosurgeon. I'm comfortable with a chiropractor working on your back for anything shoulders and below, shoulders and above. I have seen too many complications as a neurosurgeon from over enthusiastic neck adjustments. So for the neck, I do put that little bit of a disclaimer in. Now this is not to knock out the entire specialty. Of course there are several chiropractors I know personally in several that are out there that really understand their limits. They know when it's appropriate to do, what level of aggressive measures and all that, but just shoulders and above I just always have that hesitation. But yeah, all of these other treatment modalities that can act on the pain from different angles and then could potentially get you to a point where your pain is reasonably under control, where you can do the things that will get you that longer lasting relief. In terms of the, risk mitigation. And then if that's not helping, then you scale it up to physical therapy, for example, six to eight weeks where they're working on building your core strength, getting your muscles stronger, takes a load off your spine, allows your spine to do the healing. It's designed to do. And if it's too painful to do that, you can get a pain doctor to get some injections. One thing that I hear over and over is, oh, I went to a pain doctor. I got injections that didn't help my pain. The injections are not designed to reverse the degeneration that you already have is designed to take the edge of the pain off. So the way that works is steroid medications right around where the nerves are irritated. When the nerves are irritated, they swell. And so if the room around them is small, their stenosis right, and this nerve is swollen, it's gonna hurt, but the injections can reduce the swelling doesn't change the stenosis doesn't make the room any bigger, but it can reduce the pain because the nerve. Has more room around it now. And so temporarily it can help with the symptoms enough where you can do the physical therapy exercises because that really is your long-term fix, the long-term building, your core stabilization and maintaining your flexibility, things like that. That's the way to really reduce or slow down the wear and tear. And then if none of that works, then yeah, that's when we talk about surgery.

Kerry: 29:51

What happens if they ignore their pain and push through certain activities or their job requirements or things like that. What, without addressing the root cause?

Jesna: 30:01

Yeah, that's when it'll work for a little bit. And then at some point your body's compensator, compensatory mechanisms will stop and you fall off the edge. So yeah, it's important when you start to feel symptoms. It's important to remember that's your body's way of telling you there's something wrong. So you wanna do something to address it. It may not mean that you need to go get surgery at the drop of a hat, like as soon as you get the first symptom of pain, but you need to do something differently. And so what that differently is depends on your specific situation but ignoring pain, short term at work, long term, it just tends to backfire.

Kerry: 30:45

Are there any specific like movements or like mistakes that people tend to overdo or do often, or any fear-based things that can make the spine worse over time?

Jesna: 30:56

So specific types of movements that question makes me think of like exercises at the gym that a lot of people will ask about. So when you're working out at the gym, which absolutely recommend going to the gym. Absolutely recommend doing exercises. There are certain specific ones that I recommend or caution against. And those would be ones that ha like you axially load your spine where you're lifting weight over your head and doing that. If you're in otherwise healthy, good shape, your back doesn't have issues, that's not a big deal. But if you already have ongoing degenerative spine issues, you've had back pain for a while, or in some people, for example, if you have scoliosis that you know about or been told about when you do the axial load bearing, it does tend to affect worsen that degenerative wear and tear.

Kerry: 31:48

Are there any maneuvers that you would actually recommend to help with patients who already have back pain?

Jesna: 31:54

For example, for exercises at the gym if you already have back issues trying to do the exercises that involve keeping your back straight, so things like on the bike or on the treadmill. Or things where you're, if you're lifting weights you're doing one of these, right? Biceps and triceps type work where you're not really necessarily stressing your spine those would be good. Ones to, to pick over the other type.

Kerry: 32:17

What about like strengthening the core to protect the spine? Yeah. Does.

Jesna: 32:21

Oh yeah, the strengthening the core, definitely that is the number one type of exercise you should do to help with healing from your degenerative Keeping your core strong allows your spine to offload some of that work onto the muscles and so allows with healing from degener.

Kerry: 32:39

Yeah, and I was, reading like most things that obviously keeping the back in the neutral position are the helpful. So I don't know if you've heard of the bird dog. Do you know what that is? Yeah. So basically you're on your hands and knees and one arm and opposite leg are lifting and going out straight. And that can strengthen, the back and the core as the same time. And then, doing that every day. And then as well, the side plank can be very helpful in strengthening those muscles that need to support the spine. Those are some big ones that I was

Jesna: 33:09

All of the variations of the plank type exercises are very helpful for the spine. Now of course, it also depends on where your baseline is, right? Not everyone can do a plank or hold a plank, but yeah, those are good ones to engage your core and get it stabilized.

Kerry: 33:25

What else would you like to tell us about minimally invasive spine surgery? And then, obviously I'll ask you like where people can find you, but what else would you like to tell us about that? Did we miss anything?

Jesna: 33:36

No, I I'll say minimally invasive spine surgery, in and of itself is a huge field. With multiple different variations. So the style that I was trained in during fellowship is a tubular surgery where there's a small, maybe a centimeter or centimeter and a half diameter tube that goes down an incision about that size versus the three or four or five centimeter incision that used to be done. But now a, as I mentioned earlier, we're even progressing to smaller and smaller. So endoscopic spine surgery is five millimeters. Or sometimes yes, sometimes a little bit less, where through that tiny incision you can still do all of the work you used to do with open surgery, but you're significantly reducing the trauma, the surgeon trauma to the tissues. Yeah, there's so much exciting progress going on in this field that we're doing. We're doing things better and helping our patients, in ways that we weren't able to do before. So there's so much even coming down the pipe that I'm excited about.

Kerry: 34:45

Very cool. Yeah. So tell us about your practice and why it is different.

Jesna: 34:51

Okay I recently a few months ago, left my employed job and decided to go on this entrepreneurship journey as a s. Solo private practice neurosurgeon. What's different about my practice versus Mo The most common type of setup out there is that I do not do a solely in network based services. We have a bit of a hybrid practice where I'm. In network with a handful of insurances, but most of it we are out of network or cash pay based. I think that is a good, a different way of doing it. It's very helpful because it cuts down a lot of the layers of bureaucracy that typical, traditional in-network practices get wound up in. And so it allows me access or allows my patients. Quicker access to me. I am able to provide same day or next day appointments. And that is the goal to, to stay that way for forever. A lot of people will ask, is that just right now?'cause you just started. No. This is how it's gonna be. If you call me, you say you need to see me. We're gonna try to try our best to offer you same day or next day appointments where possible. It also allows you to be able to say, Hey, I have a quick question for my neurosurgeon, and not have to go through three other layers of messages going back and forth, and I don't know if the doctor even got the message or not. Convenience, flexibility. I have the ability with the way my practice is set up. To have multiple different location facility locations as options for patients to get their surgeries done. And I try to pick based on whichever one is closest to the patient or is more convenient to them and of course with their preferences and things like that. So this has allowed me a lot of leeway into being able to do medicine in the way that I think it needs to be, which is. Patient physician relationship without all the intermediaries. So I'm very proud of what we're building here and I have a lot of, I'm very excited for where we're gonna be going.

Kerry: 36:58

Yeah, it's very cool. I have the problem of, sending a patient to neurosurgery and they won't even see them or talk to them and nothing until there's an MRI done and it's just very frustrating experience from my end. So I can't imagine, from the patient and as well. But what you're doing is amazing and I think that's super important. Obviously giving them better care. So is there any like telemedicine that you do, or is it everything like mostly in person,

Jesna: 37:25

Right now everything is in person at least for the first visit. But if somebody's for example, they're already established the practice and they need a quick follow up. They can't travel the distance. We do try to accommodate. For telephone or tele visits in that situation. But yeah, for the most part, we are in-person practice. And real quick, speaking to your point about the frustration from your side, sending to a specialist, that's another thing. So convenience for patients, but also convenience for my referring docs. Our policy here is you have a patient that needs to come see me, send them to me. I will figure out what workup they need. If you've already done the workup, that's great. We'll look at it. If you haven't done it yet, we will figure it out. So we really try to make it take the burden off. A little bit from the referring physicians and say, I'm here, I can, I know exactly what I need. I can go ahead and get those things ordered.

Kerry: 38:17

So how can patients like overcome the fear that this could be like a out of pocket cash pay costs? When we think neurosurgery, we're probably thinking hundreds of thousands of dollars. So

Jesna: 38:27

Oh, absolutely.

Kerry: 38:29

yeah.

Jesna: 38:30

So one one big, so it's a few different buckets of patients when they have that question, if you have insurance a type of insurance plan that we are in network with, that's completely d set apart, right? So you already have a set way of meeting your deductibles and copays and whatever that your insurance determines. If we are out of network with you and you have out of network benefits. We still work in pretty much exactly the same way we work through your insurance. So it's all it is that I'm not in network with your insurance, but your insurance will still cover out of network provider services. So again, you're not gonna be stuck with the hundreds of the thousands or whatever dollars of surgery. Or surgery fees. And then there's the third bucket, which is the cash pay patients. That's where we have a lot of additional discounts. So we have our set fee schedules, but then we have our self-paid discounts. We have our, what we call easy payment installment options, which is where whatever discounts you qualify for, if you still can't make that amount all in one go. You pick an amount that you can pay on the day of your visit, and then you tell us what amount installment you wanna make over the next, however long every month. And we just send you invoice reminders. There's additional financial hardship discounts, so based on your specific qualifications, your household income and things like that, there's additional tiers of discounts that we offer. So we do try to accommodate as best as we can. Anyone that needs. Neurosurgical services. The goal here is to make it easy, not to make it more complicated.

Kerry: 40:01

So awesome. Yeah, that is an important thing to explain, I think with the I guess the surgical needs of a cash pay type practice or hybrid practice. Let me ask you, what is the one thing you wish patients understood more about their spine?

Jesna: 40:15

The spine. Your spine and your nerves can respond to treatments, but the timeline that they respond to these is what you think in your brain is very different from what your brain or your, what your body will do. So a lot of times this is hard. When you're in pain, it's hard to be patient, but patience is what's required in a lot of situations.

Kerry: 40:42

Ah, that's really good advice. Awesome. What where can people find you if they want to work with you or see you? Or how, what is your information? Are you on social media, that kind of stuff. What do you got?

Jesna: 40:53

Absolutely. My office is located in deland. My website is fl spine surge, F-L-S-P-I-N-E-S-U-R g.com. And I'm on Facebook as Jesna sublet. Find me, text me, send me a message through the website. Call me on my phone. My office number is 3 8 6 2 2 2 2 7 9 2. If you need to be seen, we'd love to see you. We can offer you same day, next day appointments. Give us a call.

Kerry: 41:21

Awesome. Thank you. So much for joining us on the podcast today. This was super educational and I know everybody's going to get a ton out of it, and this was great. Thank you.

Jesna: 41:30

Thank you so much for having me. This was very exciting. It was. It was a great experience.

Kerry: 41:34

Awesome. All right everybody. Stay tuned next week. Okay. Get Healthy Tampa Bay.