W. T. Guthrie – Spine Surgery

Dr. Carlson is my hero! He has performed two surgeries on me. The first was to repair a bad surgery from another doctor for a herniated discs in my lower back. I could barely walk before the surgery. And I had suffered with back pain for over 20 years. Within two weeks of the surgery (with Dr. Carlson) all pain was gone and I was walking like nothing ever happened! To this day, I don’t have back pain and that was five years ago!

My second surgery was for a disc problem in my neck causing migraines. I had been having severe daily migraines for years. Dr. Carlson ordered an MRI after seeing issues on my x-ray. The insurance company denied the request. Dr. Carlson went to bat on my behalf and did a peer review to get the insurance company to reconsider their decision and they did! How many doctors would do that?!! Dr. Carlson saw where my spinal cord was being pressed by my disc and requested immediate surgery. After successful surgery, my migraines have almost disappeared!

These two surgeries have changed my life. I can’t thank OSC and Dr. Carlson enough!

Michael Noehl – Hip Replacement

Patient Name – Michael J. Noehl – Age 55 – Yorktown, VA
Date of Surgery – February 5th 2014, at Mary Immaculate Hospital
Physician – Dr. Boyd Haynes

Issue: Right Hip degenerative joint disease exacerbated by lower back spinal stenosis/spondylitis of L-5 vertebra

In 2012, I came to the Orthopaedic and Spine Center (OSC) as a follow-up for a second opinion of my back injury that I received while on active duty in the Army. I had been experiencing increased levels of lower back pain and had not received medical care since my retirement from the Army in 2000. I met with Dr. Carlson who recommended pain management and to monitor my condition.

Over the next year, I started to have pain in my right hip. I came in to OSC and met with Dr. Haynes who diagnosed my condition and recommended surgery. At that time, I was very concerned, in fact, averse to hip replacement surgery. I wondered how I could need such a drastic procedure being so young. I told Dr. Haynes that I would prefer to manage the pain and see how it goes. He understood and prescribed me pain medications.

Over the next year, the pain increased in intensity and began to merge with the pain from my lower back injury. I began to take more pain medication and more often. Well, in December 2013, I reached my pain tolerance, as well as my ability for any prolonged standing without intense pain, and I sought out Dr. Haynes. In my visit, he reviewed current x-rays and advised that it was time to fix my right hip. He also believed that he could straighten out my lower back some through the hip replacement, which he believed would help alleviate my back pain. So, I agreed and we scheduled my operation on 5 February, 2014 at the Mary Immaculate Surgical Pavilion .

Through the whole process, Dr. Haynes and his staff were very comforting and understanding of my apprehension and concerns. They went the extra yard to ensure my concerns were minimized. The entire process, from attending the Mary Immaculate Total Joint Classes, Hospital pre-operative admissions testing, hip surgery and recovery was superb. Dr. Haynes and the staff of Mary Immaculate were excellent and provided the best health care I could have asked for. Dr. Haynes met with me the morning of my surgery and again explain what I could expect and that he would be with me throughout the process. He assured me that I would be in good hands. That helped me a lot.

My recovery is well underway and although it is early, I believe through my hip replacement and adjustments I am experiencing less pain from my lower back. I will continue to meet with OSC’s Dr. Carlson for follow-up care should I need to have corrective action done to resolve my back pain.

Erven S. Tyler – Spine Surgery

I had been experiencing sciatic nerve pain in my left leg for over 4 months. I had tried all types of treatment to diminish or eliminate the pain, to include a chiropractor, physical therapy and finally, an neurosurgeon at another facility other than OSC. To my great disappointment, the neurosurgeon briefly looked at my MRI, made a few cursory remarks and said “try oral steroids and if that doesn’t work, get a steroid injection”. I did as instructed but without success. I had no follow-up from the neurosurgeon’s office. I found myself with undiminished pain and no plan to solve my pain problem.

At this point my daughter, who had a back procedure several years ago, suggested I see the doctor who has done her procedure. She highly recommended him. This was how I became acquainted with Dr. Jeffrey Carlson. I personally met Dr. Carlson and his PA on Friday, 20 December 2013.

It was a pleasant surprise for me. Using my MRI, Dr. Carlson explained in detail what was causing my pain, clearly and patiently answered my questions and explained that nothing short of an operation would solve my pain problem. I fully understood this now, having seen my MRI.

Because of a previously scheduled procedure cancellation, I was able to have my operation three days later on 23 December. The OSC staff very efficiently scheduled the pre-operation tests needed to get me ready for my Monday operation in what must have been record time!

All went very well and my recovery and follow-up meetings with Dr. Carlson assured me I was healing properly.

I don’t remember the name of Dr. Carlson’s PA, but she was equally efficient and helpful and deserves recognition. (Tonia Yocum, PA)

Finally, I would recommend OSC and Dr. Carlson in particular, to anyone having issues similar to what I had experienced.

For me, it was my Christmas present!!

Terry Parrisher – Pain Management

Terry Parrisher had been living with severe back pain for more than 40 years when he first saw Dr. Jenny Andrus at Orthopaedic & Spine Center in the spring of 2011. His problems began in the mid-1970s, when he fell in the line of duty and injured his back. “I was in the Air Force at the time,” Terry remembers. “They x-rayed me and sent me to the Army Regional Hospital in Denver, Colorado.”

Those x-rays revealed more than just his back injury: they showed deterioration in his spinal column, and they led to the first of seven surgeries he underwent in an attempt to eliminate the worsening pain he was experiencing on a daily basis.

“The first operation I had was disc surgery,” Terry says. “But it didn’t get rid of the problem, so the Army doctor gave me medication for the pain.” Terry stayed on the medication until he retired from the Air Force, when he and his family moved to Newport News. By the early 1980s, the pain had become so intense that he again sought surgical help. “I was introduced to a local doctor who performed the same type of surgery on me the Army doctor had done,” he recalls, “but with little or no success.”

Later, in 1987, he visited the Medical College of Virginia for yet another surgery – and another disappointment. “Things just continued to deteriorate,” Terry says, “and by now I’d had a lot of nerve problems from all the surgeries.”

Frustrated, he went the next several years without any surgical intervention, until once again the pain forced him to seek help: this time from a neurosurgeon, who performed three surgeries on his back – three surgeries within a nine-day period. “The first time, the screws he put in were too big,” Terry remembers, “so he had to go in the next morning and take them out and put in smaller ones. Then he found out that he’d covered up a live nerve in my back. Every time I moved, it was exerting pressure on the nerve and it felt like somebody was sticking a knife in my back.” Terry recalls there were two neurosurgeons in the operating room during the third procedure.

Less than a year later, he had tremendous difficulty walking. He could move about – slowly and painfully – using a walker or a cane, but the pain was so great that he spent most of his days lying down to escape it. He was 57 years old.

He decided to try again. “I saw a doctor who showed me what he thought could be the problem, and he inserted rods in my back. It helped some, but I still had an excessive amount of pain. My life was about 50% – I could hardly do anything.” At that point, Terry says, he was determined there would be no more surgeries. He wasn’t going to put himself or his family through that again.

That’s when he heard about Dr. Andrus and the spinal cord stimulator. “I either read about it, or saw her on television talking about it, and I wanted to learn more,” he says. “I got some literature, and my wife and I read all about it. We knew there’d been success with it, but we also knew it wasn’t the kind of surgery I’d had before.” They made an appointment to talk with Dr. Andrus, to find out more about the procedure – and to ask if she might be able to offer him some relief.

Dr. Andrus explained to the Parrishers that the procedure has two-parts. “Initially it’s done as a trial, to give patients a chance to try it and see if they like it,” she says. “We first put a small lead into the epidural space – it’s essentially an electrical lead, which we can then stimulate to send electrical pulses to the spinal cord. We replace the pain signal with something more pleasant.” Think pacemaker, only to regulate pain, and directed to the spinal cord rather than the heart.

“Once we’ve completed the trial, and we know that the device really does help their pain – and just as importantly, that they feel they can do more – we can arrange to put it in permanently,” Dr. Andrus notes. “Terry’s case was a bit complicated, as he had spinal stenosis in the area where I typically place the leads.” She explained this to Terry, who says, “Dr. Andrus told me she’d leave it in one week, to see if it helped.”

It didn’t take the full week for Terry to know. “I had success right away,” he says. “It was instantaneous.”

A short time later, in May of 2011, Dr. McFarland performed the second part of the procedure: inserting a bigger lead, sewing it down, and putting in the battery. The result? “Out of the 100% pain that I had, I have about 10% now,” Terry says, and adds, “But you have to understand: when you live with 100% pain for 40 years, and then all of a sudden you have 10% pain, that’s like having no pain at all.” The 10% he manages easily with one pill a day – that and his little remote control, a device that turns the system on and off, and allows him to adjust the stimulation within parameters set by Dr. Andrus. Terry Parrisher calls it a miracle.

That’s not the end of Terry’s story, however, and not the reason he’s so quick to sing Dr. Andrus’ praises. “My family and I were so excited after they put in the stimulator in May, it was a real rich time,” he recalls, “But at the end of last summer, I was diagnosed with cancer in my jaw, and I had to undergo surgery to replace the bottom part of my mouth.” He faces more surgery, but first has to spend time in a hyperbaric chamber – every day – to prepare his body for the next procedure. He says, quite simply, “I could not have made it through the cancer treatments if I had to contend with the kind of pain I’d been suffering for so many years. I just couldn’t. I’d never have made it without Dr. Andrus.”

Larry Pederson – Knee Replacement

Dr. Haynes is well accustomed to treating patients with orthopedic problems and returning them to their everyday normal activities. But he’s also treated patients who’ve been able to accomplish extraordinary things after his care. One such patient is Larry Pederson.

At 67, Larry admits he often forgets he’s had a knee replacement, but that might well be because he’s too busy road-biking 2 to 3 hours a day at his home in Colorado – after a daily routine that includes thirty minutes on the Stairmaster, sit-ups, pushups and weight-lifting. A self-described ‘maniac’ about exercise, who rides competitively and has the trophies and awards to prove it, Larry still remembers the pain that led to his 2002 surgery at Orthopaedic & Spine Center.

“Ten years ago, I was running about 50 miles a week and doing marathons,” he says, “and I had a bad case of Achilles tendonitis from a knee injury I had 30 years earlier, when I was in the Army.” He began seeing Dr. Haynes, a fellowship-trained specialist in sports medicine, who treated him with injections and anti-inflammatory medications. “It wasn’t that serious,” he remembers, and Dr. Haynes’ conservative treatment worked well – for three or four years.

But as Larry concedes, “When I got to be around 50 or so, my knee started giving me greater problems. I had developed osteoarthritis in both knees, but at one point, the pain in my right knee was getting more and more severe.” He called for an appointment, and saw Dr. Haynes 24 hours later.

“Larry was doing all the right things,” Dr. Haynes recalls. “He was using Aleve and glucosamine chrondroitin, but his pain was getting worse.” Dr. Haynes knew about the arthritis, but these new complaints were about a different section of his knee. “When Larry came to see me, he had pain on the inside of his knee, but his arthritis was mainly in the kneecap. I ordered x-rays, which confirmed the kneecap arthritis, but when I examined him, there was more pain on the inside of his knee – where we didn’t see a lot of arthritis. And the pain was getting worse.”

The next step – an MRI – revealed a very large tear in his meniscus. “We don’t do knee replacements right away,” Dr. Haynes continues. “We always try other options first.” In this case, it was an arthroscopic repair, which relieved Larry’s pain and worked well for nearly a year. But Dr. Haynes cautioned him: in presentations like his, where the tear is large, it’s not unusual for problems to recur.

“He told me when he scoped my knee that it would probably lead to a knee replacement at some time down the road,” Larry recalls, “because there was so much calcification there, there was no meniscus left and no cushioning, so as my osteoarthritis got worse, my knee would essentially disintegrate.” Dr. Haynes also told him what to be on the lookout for – common indications that his knee was getting worse. One of those symptoms was a mechanical “locking” of the knee.

For Larry, it happened one afternoon when he was home alone, painting the inside of a closet. “I’d been sitting on a stool, working for about an hour, and all of a sudden it happened,” he remembers. “My knee locked and I couldn’t move it at all. I couldn’t stand; I couldn’t manipulate it. I had to call my wife to come home and help me.”

After getting to the bed and managing to lie flat, Larry and his wife worked to extend his leg and move the knee joint so it would function. “I went to see Dr. Haynes the next day,” Larry says, “and told him, ‘It’s time.’”

Dr. Haynes scheduled the surgery – a total knee replacement. “Today, I might do a partial knee replacement on a patient like Larry,” the surgeon says, “but good tried and true partial joint implants weren’t available ten years ago.” Because of his physical condition, and his motivation, he’d have been a good candidate for that surgery.”

As it was, ten days after his total knee replacement in 2002, Larry jumped in a pool and spent 90 minutes treading water and swimming, which he credits with speeding up his recovery. Two weeks after the procedure, he was walking with a cane; and six weeks later, he left the cane in Dr. Haynes’ office and hasn’t used it since.

Dr. Haynes says the knee replacement will last the remainder of Larry’s life, and it’s a good thing: he continues to exercise strenuously, although not as a runner. “I did run a little bit after the surgery, a few 5 and 10Ks, but I couldn’t be competitive, so I didn’t like it,” he admits, “so I started doing a lot of hiking.” He stresses that he means hiking in the mountains, not flatland: by then, the Pedersons had moved to Colorado. When Larry Pederson hikes, he walks out his backdoor straight up a cliff to 12,000 feet. “I average 3 to 5 miles a day,” he says.

If he feels the rare twinge in his knee, he dismisses it: “With the biking, my calf and thigh muscles are so well developed they compensate for any kind of knee problem I might have. I don’t have aches or anything, even after exertion.”

And he’s quick to point out that none of this would be possible without Dr. Haynes’ care. “None at all,” he says, “I couldn’t do any of this without the surgery. I’d be using a cane or crutches, or more probably, I’d be in a wheelchair.”

Ten years after the surgery, he may have to remind himself he’s had his knee replaced, but he can’t imagine his life without it. “Life after surgery is 100% better,” he says. “There’ll be pain in the recuperation period, but it goes away entirely and you become stronger and have a better outlook than you did before. There’s no nagging pain. Your attitude changes to a much more positive one after the pain goes away. You’re motivated to do more things, and become more active.”

Larry admits he’s still obsessed with being active: “No one’s as maniacal about exercise as I am. But I have a good reason. My wife is a gourmet cook. I have to exercise a lot to offset my caloric intake.”

And of course, there are still trophy cases to fill!

Herman Gibbs – Spine Surgery

Coming from a long line of men who made their living on the water – his father was captain of a fishing trawler – Herman “Skip” Gibbs first injured his neck more than forty years ago when he dove into shallow water as a teenager. He went to the doctor after the accident and got muscle relaxers, he remembers, but because he grew up in a family where men weren’t supposed to be weak, he didn’t complain much when the pain didn’t resolve. “It wasn’t uncommon to just accept things,” he says, “men especially.” He’d talk briefly to his personal physician from time to time if the pain got worse, but by and large, he learned to accept it.

And after learning to accept the pain, Skip spent the next several years learning to adjust to it. He devised his own treatment: he’d double up a towel and wrap it around his neck when it got bad; then he began wearing a foam cervical collar whenever the pain became extreme. And he took over-the-counter medications like Tylenol. “I just didn’t push the issue,” he says.

But as he got older, and began to explore a series of strenuous occupations, it began bothering him more and more. “I’ve done a little of everything to earn a living,” he says, “all of it physically demanding.” He took a job with the fire department early on, working fires as well as the ambulance unit, where he even delivered babies. He liked the work well enough, but the pay wasn’t great, so he decided to go into “the family business” – to become a tugboat captain.

In those days, Capt. Gibbs says, there were no courses and no technology to teach an aspiring seaman how to operate a tugboat. He almost literally taught himself the rules of the harbor, doing a journeymanship for three years. “Coming from a family of watermen, I had a head start,” he concedes, “but we had no simulators. We learned on the water.”

Learning on the water may have been easy for Skip, but with his injury, life on a tugboat was far from it. He continued to use the collar and over-the-counter analgesics to ease the pain, but “…my neck would be aggravated by any little thing,” he says. “On the sea, if I was working on a boat with low hatches and bump my head, that would set it back again. It would flare up and become increasingly uncomfortable.”

That’s not surprising: a tugboat’s top speed of 6 to 9 knots may make the ride look gentle from the dock, but tugs move huge ships that are full of cargo – they move barges laden with heavy, bulk materials – often in rough seas that could jostle his neck severely. “At first, the pain was tolerable,” he says, “because I would just hyperextend my neck with one of those collars, and after a couple of days, it would start to improve.” He dealt with the pain for forty years, but it progressed, until “the last ten years were the worst,” Skip admits. And one day, it became too much to bear.

“I was working in New Jersey, longer stretches than normal,” he says. “It got so bad I didn’t feel I could use my arm.” The seasoned captain, who had learned early on to accept pain, finally told his boss, “You gotta get me off the boat – I’m in too much pain.”

Knowing the captain was no complainer, Skip’s employer took his request seriously, and referred him to his personal chiropractor. “She took one look at me and said she wasn’t going to touch me until I had an MRI,” Skip remembers. “That’s how I found Orthopaedic & Spine Center.”

He had the MRI and met with Dr. Carlson in September of 2010. “Capt. Gibbs had done all the regular things that people do to try to stay away from the surgeon,” Dr. Carlson recalls. “But by the time I saw him, he was having a lot of numbness and pain going down into his shoulder blade, as well as down into his fingers. The MRI showed that he had two large disc herniations in his neck. That explained the pain and dysfunction in his arm.” Dr. Carlson continues, “It’s no wonder he wasn’t able to perform his duties. You can’t even think straight when you have the kind of pain he was experiencing.”

At that point, Capt. Gibbs knew, a decision had to be made. Dr. Carlson had thoroughly explained his options: he could try medication, either pills or injections. He could continue with chiropractic-assisted therapy – or he could undergo surgery. “He gave me a DVD to look at and to discuss with my wife,” Skip remembers. “I asked a thousand questions, and we reviewed all the information.”

They were both apprehensive about the surgery, Capt. Gibbs remembers, “but Dr. Carlson impressed me. I appreciated his straight talk. He showed me on the MRI how my spinal column was pinched, almost completely closed. He told me I barely had any fluid in my spinal column running between the upper the lower portions – and he explained that if it closed off, I could have permanent damage.”

Skip’s case was further complicated by his medical history: years before, he’d been diagnosed with rheumatoid arthritis, had been told he was borderline lupus, and had a bad thyroid. He’d also sustained a mild heart attack 3 or 4 years before the surgery. “I had a small stent,” he says, “and Dr. Carlson worked with my cardiovascular physician and my other doctors. He really went the extra mile to be sure I was getting the best result.”

His surgery was October 25, 2010. When he woke from anesthesia, he remembers, “all the tingling, the pain, the numbness, were all were gone. After forty years, it was all gone.”

Describing the surgery itself, Capt. Gibbs says, “Dr. Carlson put a titanium plate in there, with six screws. It was a new procedure – he went through the front of my throat.” In fact, he says, “Dr. Carlson is one of the innovators of going through the front of the throat to put the plate in. Formerly, he’d have opened the back of my neck and pried your muscles apart. But because he avoided doing that, the recovery time is cut down to about 10%.” And as for post-operative pain, Skip admits to some discomfort: “maybe a day or two worth” – and adds that he stopped taking post-operative pain medication on day three.

Today, he defies anyone to find the scar on his neck. “The surgical cut was so clean and so smooth that as it healed, it just looks like a normal wrinkle. I actually have to tell somebody I’ve had surgery.” Nearly two years later, he remains pain free.
For Capt. Gibbs, there was another bonus. “I had scoliosis, a curvature in my neck, something I inherited from my mother,” he says, “and just off the cuff, I asked Dr. Carlson if he could straighten my neck during the surgery.” Dr. Carlson said he could – and today, Skip notes, “My neck is as straight as it can be.”

Don Hollomon – Hip Replacement Surgery

At OSC, they call him ‘the bionic man.’ All told, Don Hollomon has had neck fusion, both knees replaced and hip replacement. As Dr. McFarland describes it, “Each of those procedures puts metal in your body – metal knees, metal hip and a plate and screws in his neck. He’ll be patted down every time he tries to fly.”

Despite having all those procedures, which also include a rotator cuff repair, today Don Holloman describes his physical condition this way: “When I was young, there were 600 things I could do – and I did them all, including marathon running. Now, with all these reparative operations, I can do 400. I don’t worry about the 200 I lost – I concentrate on the 400 I can still do and thank OSC every day for them!”

At 65, he includes running in the 200 things he no longer does; but among the 400 he continues to do are climbing up on the roof, cutting the grass – and zip-lining: strapping himself into a parachute harness and sliding down a line at a speed approaching 30mph, at a hundred feet above the ground. “It’s quite thrilling,” he says.

“Don’s one of those guys who’s always been very active,” Dr. McFarland notes, “and he’s worn out his joints because of it. He’s got a lot of arthritis.” His initial visit to OSC was for rotator cuff issues. “I was in really bad pain,” Don remembers. “I did some research and got a recommendation, and saw Dr. Coleman. He checked it out and did the repair.”

Some time after that surgery, Don began experiencing significant pain in his neck – so significant, he recalls, “that I literally thought I was going to die. I had muscles that weren’t working in my arm, numbness and tingling, and excruciating pain. I even began redoing my will, I was so convinced I wasn’t going to make it.”

Don admits he put off visiting any physician until he could tolerate no more, but when he saw Dr. McFarland in January of 2008, the surgeon described a procedure that would eliminate his pain: a bilateral cervical fusion. “He made it sound as simple as a tonsillectomy,” Don says. “He assured me it would take care of all my pain. And it did.”

Once his neck was resolved, Don was able to concentrate on the growing pain in his knees. “At one point, I couldn’t get my knee in the car without physically grabbing my leg. I went back to Dr. McFarland,” who immediately recognized the bone-on-bone pain syndrome and told Don he needed to have both of his knees replaced. Having heard what he calls “horror stories” about knee replacement recuperation, Don knew he didn’t want to go through that twice. He told Dr. McFarland he wanted both done at the same time.

Bilateral knee replacement is a very rare surgery, Dr. McFarland says. “We do it only 3 or 4 times a year. It’s really for patients who are medically healthy, and who will be aggressive about therapy. It’s a much, much tougher recovery, and there can be complications with bilateral knees if people aren’t motivated to do the work. But with Don, I had no doubts. He’s a former military man; he’s tough and he’s very strong – and he’s got a good support system at home. I had no doubt he’d push right through it.”

“I remember the most important thing Dr. McFarland said to me,” Don says. “He told me that after the operation, there’d be nothing I could do to break my knees. That took away all my limiting factors.” Following the surgery in May 2008, Don stayed in the hospital three days. He acknowledges the recovery was painful, but entirely manageable.

He very quickly returned to an active lifestyle, but by 2010, Don realized the pain in his hip had become an impediment. His visit to OSC resulted in another pioneering procedure: in August, he became the first patient in Virginia to undergo a hip replacement – as an outpatient. “The direct anterior muscle-sparing approach made this surgery possible,” Dr. McFarland explains. “The procedure had become so minimally-invasive, and our anesthesiologists so effective at controlling post-operative pain – and of course, considering Don’s recuperative history – that I was convinced there was no reason he’d need to stay overnight in the hospital.”

Don remembers the day well: “They put my foot in a boot, and put me on a special table so Dr. McFarland could go in to my hip through the front. He didn’t cut anything but skin – so much better going in through the back of the hip with all the muscles that would have to be cut. Afterward, I had zero pain in the hip.” And best of all: “Later that day, the therapist asked if I could stand and walk a bit. I hadn’t taken any pain medication because I wanted to see what it would feel like after the anesthesia wore off.” Don accepted a walker from the nurse, and headed down the hall to the nurses’ station, where he surprised them by lifting the walker over his head and taking several steps. “My hip never did hurt,” he says.

Fourteen days after the surgery, he sent OSC a photo of himself walking down a set of stairs, totally disregarding the handrail. Later, he posted a video of himself, defying anyone to tell which hip had been replaced. Even Dr. McFarland had to look twice.

Not everyone has Don Hollomon’s stamina – or bravado – but today, Dr. McFarland doesn’t hesitate to offer out-patient surgery to his hip replacement patients, if he feels their health, motivation and support systems are appropriate. “It was a natural decision for Don,” he says. “He’s got that great supportive home environment, and he’s a trouper.”

It may well run in the family: several months later, Dr. McFarland replaced Don’s 87-year old mother’s hip. Janet Hollomon had had hip surgery years ago following an accident, with a resulting 5/8” shortening of her leg. Not only did the surgeon replace her hip, he realigned her leg and corrected the shortening within 2-3 millimeters. Today, she walks without a cane, without a walker – and without a limp.

Dr. McFarland isn’t surprised at her result. “Each patient is an individual,” he says. “The procedures themselves are pretty straightforward – you go through the same steps as surgeons to implant the devices each time – but a lot of how patients recover is based on how they follows our directions after the surgery. Some patients don’t necessarily comply with everything we want them to do, and that can impact their outcome.”

He adds, “I typically don’t take patients to surgery unless I really feel that that they need surgery, and unless I really feel they’re healthy enough or compliant enough to have a really good outcome. At OSC, we want to see people do well – we want to see them happy. There are a lot of other options for patients we know aren’t going to have that type of outcome, so more than anything, I have a more conservative philosophy when it comes to surgery.”

As for ‘the bionic man,’ he has a message for anyone who’s been living with arthritic or orthopedic pain. “There’s no reason to suffer,” Don Hollomon says. “Don’t be afraid, and above all, don’t put it off.”

Clay McCaskey: Patient-Specific Knee Replacement

Like many baby boomers, Clay McCaskey began noticing little twinges in his knees in his 50s; and like many of his peers, he attributed it to developing arthritic changes. “It started with just a little pain,” he remembers, “but it gradually got worse.” For anyone in his age group, the thought of losing function is upsetting, but for Larry, it was far more than that. He’s played racquetball competitively since the early 1970s – by 1977, he was the third ranked singles player in Virginia – and he had no intention of giving up the game. “Unlike a lot of people who play a little in the winter, and then move on to different sports when the weather warms up, I played racquetball year round,” he says, “several times a week.”

An engineer by training, Clay approached the worsening situation methodically, doing extensive research. He visited a surgeon in his hometown of Richmond, who told him he could give him some relief by arthroscopically removing a part of his meniscus, but he cautioned it would only be a temporary solution; Clay would eventually need a knee replacement. “I was only 58 at the time, and I wasn’t ready for that,” Clay says, because everything he’d read about knee replacements indicated he’d no longer be able to play racquetball – or any impact sports. “That didn’t work for me,” he says. “I’m a baby boomer, and I’m stubborn. I wasn’t going to put up with that.” He opted for the temporary fix of arthroscopic surgery.

The surgery did help, and Clay returned to the racquetball court – but, as with most arthritic knees, the pain eventually returned and got progressively worse. Still, he continued to play until “I got to the point where every step hurt. Ultimately, I was in so much pain that I couldn’t play,” he says. “I could hardly walk. It literally felt like an ice pick in my knee. I knew I had progressed to the point where I needed to investigate a knee replacement, because I had a bone-on-bone situation. You could see it on my x-rays.”

He researched the latest technologies with the same intensity he showed on the racquetball court, using his engineer’s training to identify the newest devices on the market. “I saw all kinds of appliances and learned about current knee replacement methods,” he says, “and I was intrigued by what I read about a company called Conformis, which manufactures custom knee replacements fitted to the patient’s particular anatomy.”

As he describes his research, Clay can’t help slipping into engineer mode – he was as fascinated by the technology itself as the restoration of function it promised. “They take a CT scan of your knee and make a custom appliance using computer technology,” he explains, “and they claimed accuracy within millimeters. As an engineer, that was impressive and important to me.”

Once he decided on the appliance he wanted, Clay went to Google to find surgeons in Virginia who had experience with the Conformis system. He found four, but one – Dr. Snyder – had two very definite advantages. “When I read his bio,” Clay recalls, “I found out that he played handball – a competitive sport even more strenuous than racquetball – so I knew he’d understand my motivation.”

Secondly, Clay learned, Dr. Snyder had had a knee replacement himself – at the Conformis factory in Boston. So impressed had he been with his own result that he undertook the training to enable him to perform the procedure in his practice in Newport News. Clay knew he’d found his surgeon. He made an appointment and drove the hundred miles to the OSC facility.

Dr. Snyder remembers their initial conversation: “Clay came to the office fully prepared. We talked for about 30 seconds, and he knew exactly the surgery he wanted. He was ready to get started.”

Because the damage was on the medial, or inside of Clay’s knee, Dr. Snyder was able to perform a partial knee replacement. Before this new custom-fitting procedure, patients like Clay, in their 50s with previous arthroscopic surgeries and little or no cartilage left on the inside of their knees, wouldn’t necessarily require a total knee replacement – although many surgeons did them.

Dr. Snyder explains: “Partial knee replacements have been around for years, but they never really caught on, primarily because they were technically very difficult to do. And because we didn’t have custom-fitted pieces, we’d have to try different sizes to get the best possible fit – during the procedure. Total knee replacements could be done more predictably and faster.” But now, he continues, “the technology has changed. These custom-made partial replacements are much easier to put in. Conformis digitizes the CT scan and makes a three-dimensional mathematical model of the knee that exactly mirrors the contour of the knee. The company also makes all the supporting instrumentation that goes along with the implant, and sends it to the surgeon pre-sterilized, along with a jig – a precise pattern – to use while making the cuts. Everything is ready to use, so we no longer need several trial sizes and trays of instruments in the OR.”

“Because it’s so precise,” Dr. Snyder adds, “I didn’t have to remove a lot of bone. I basically scraped away the residual bad cartilage, taking very little bone. The device sits in Clay’s knee like a crown sits on a tooth. Only the part of his knee that was bad was impacted.”

And because very little bone was involved, his recovery was far less painful and lengthy. Clay returned to Richmond the day after surgery, and immediately started in-home therapy. “Dr. Snyder arranged everything,” he remembers, and “after only 10 days, I started outpatient therapy.” He describes his progress as steady, and says his knee now looks normal.

The real proof for Clay of course, was to be found on the racquetball court. He tested his knee seriously about four months after the surgery, and was back at full throttle after six months. Today he still plays three times a week, but enjoys doubles more these days. He has a group of baby boomers he plays with regularly – one of his partners is 78 – and has no intention of slowing down. “From my research, I know that even with the minimal bone loss, I might need another surgery – in 15 years or so,” he says. “If I keep playing racquetball, that might very well come true.” Applying engineering standards, he likens his knee to a car – “it might last five years, it might last 15. It’ll depend on how I drive and maintain it.”

Should that day come, Clay says, he won’t hesitate to return to Dr. Snyder. And he’ll arrive for his appointment fully prepared with research in hand, ready to proceed.

Christiana Grenoble – Pain Management

Christiana Grenoble remembers the exact moment she knew she had hurt her back. “It was during a Tai Chi class,” she says. “I was in the middle of one of the harder postures, already on one foot. As I twisted into the pose, I heard a pop in my back and that was it.”

It was November of 2010, and Christiana was hardly a novice. She’d been doing Tai Chi for 20 years, a martial art widely known for its sequences of graceful movements and even transitions, a moving combination of yoga and meditation. “That’s true,” she says, “but Tai Chi can also get pretty ‘out there,’ pretty rigorous.” She’s no stranger to rigorous activity, having been a practitioner of Kung Fu as well, and accustomed to exercising every day.

In her early 40s, Christiana was accustomed to the occasional backache after a strenuous workout, but they always resolved within a day or two. So when she felt the pop, she figured she’d be OK after taking it easy for a few days. In fact, she waited about six months, thinking – and then hoping – the problem would just go away. When it didn’t, she made an appointment with her family doctor. “I was in a lot of pain at that time,” Christiana remembers. “I couldn’t walk more than 50 or 100 feet without problems. And my foot was starting to go numb. I couldn’t manage – I couldn’t even do normal household activities anymore.” Knowing Christiana’s high threshold for pain, her doctor suggested that she go to physical therapy and see a pain management doctor. “She didn’t want to just give me a prescription for pain killers; she wanted me to see a specialist,” Christiana remembers.

To call her experience with the first pain management doctor unsuccessful is being charitable. “It was a nightmare,” Christiana says flatly. “He put me through a series of tests, first saying I had this condition and then that condition. And he kept giving me medications like oxycodone that were just way too strong, crazy stuff. I couldn’t sleep; I was edgy all the time. I thought that must be what methamphetamines felt like.” Distressed, and with worsening pain, she stopped seeing that doctor and weaned herself off the narcotic drugs.

She treated herself with over-the-counter Motrin while she looked for appropriate medical care. She was referred to various area orthopedists and chiropractors, who were stymied by her presentation – she was even briefly treated for a slipped disc, without success – and finally, it was suggested she see Dr. Sureja for pain management.

Based on her previous experience, she was skeptical, but made the appointment anyway. “He seemed awfully young, but I felt like he was genuinely interested in helping me,” Christiana recalls. Ever pragmatic, she added, “I figured it could take a while to figure out what was wrong, so I decided to give him two years.”

Dr. Sureja picks up the story. “Throughout the course of her previous treatments, she’d tried various anti-inflammatories, pain medications and non-specific steroid back injections, but they hadn’t helped,” he notes. “I conducted a thorough examination, and reviewed her imaging with her. I suspected her pain was coming from inflammation and arthritis within one of the facet joints, one of the very tiny stabilizing joints located between and behind adjacent vertebrae.” Dr. Sureja observed some swelling around the joint, which “…could have indicated that she might have stressed that area doing one of her Tai Chi exercise,” he says, “we just weren’t sure. Based on how she described her pain – where the findings were located on the MRI and what her physical exam showed – we thought it was probably coming from that tiny little facet joint.”

Dr. Sureja sought to prove his theory of Christiana’s pain, and performed a facet joint injection, a procedure that is done for both diagnostic and therapeutic reasons. Dr. Sureja explains, “Under x-rays, we placed an anesthetic into her joint to determine how much improvement she had over her usual pain. What we found by doing that was that she had significant and tremendous improvement.” Christiana recalls, “He basically found the spinal joint and re-created the pain. Literally, when he put the needle in me, it caused me exactly the pain I felt when I was standing up or walking.”

Once he confirmed that her pain was coming from that particular joint, Dr. Sureja then injected cortisone, which gave Christiana several months of relief. The next step was a medial branch block, another diagnostic procedure which temporarily interrupted the pain signal from the medial branch nerves to the facet joint. She remembers it well: “It was amazing. I had resigned myself to the fact that I was going to suffer the rest of my life, but when he found the nerves and put in the medicine to block them, I felt better immediately. I felt 75% better.”

And it will get better still for Christiana: Dr. Sureja plans to perform a radiofrequency ablation. “We’ll cauterize the nerves going to her joint to help block the painful impulses coming from the inflamed area,” he says, noting that “…it may need to be repeated at some point, especially for someone like Christiana who is extremely active and doesn’t want to continue getting cortisone – and who is adamant about avoiding narcotic pain medication.” But he adds that in some cases, patients who undergo the procedure have no return of pain. Radiofrequency ablation is safe, and performed in Dr. Sureja’s office without general anesthesia. She’ll even be able to return to her job as a computer programmer/engineer the next day.

Christiana is looking forward to the next step. She’s already regained a lot of her quality of life and function, because Dr. Sureja was able to specifically pinpoint where her pain was coming from, and diagnose it successfully. She’s lost 50 pounds and is anticipating a healthy, active lifestyle. Her goal – which she once believed unattainable – is now within her reach: “I want to be able to walk without suffering. I want to be out of pain, without having to take medication every day.”

For patients like Christiana, Dr. Sureja knows, chronic pain is debilitating above and beyond the physical stress it imposes. “For many people, there are psychosocial changes that can occur with pain and loss of function – depression, anxiety, a sense that their self-worth has decreased,” he notes. “But with improvement in x-rays and diagnostic imaging like MRI, we’re able to see the structures in the spine more clearly. We’re able to pinpoint the pain and treat that specifically, rather than simply masking it or putting somebody on opiates for the rest of their lives.”

As for Christiana, she considers herself lucky to have medical insurance that will cover the costs of her treatment. But, she adds, “Even if I didn’t, I’d save the money to have these procedures. It’s very exciting.”

Beverly Williams – Reverse Shoulder Replacement Surgery

The first time Beverly Williams saw Dr. Coleman, she was in a wheelchair. “I was having tremendous pain in my left ankle,” she says, but that’s not why she sought care at OSC. Only in her 40s, Beverly has suffered from debilitating rheumatoid arthritis since the late eighties, so she attributed her ankle pain to RA. “I assumed it was part of the joint breaking down,” she says. It was a natural assumption: she’d already had all but one of her joints replaced – all but her left hip.

A former reporter with The Daily Press, Beverly had worked in the field for years, covering the courts, criminal and civil, in both Hampton and Newport News. She suffered the effects of RA, undergoing several joint replacement surgeries throughout her journalism career, until she ultimately took a less strenuous job with the communications department at Ferguson Enterprises.

It was in 2009 that her reporter’s keen eye caught a notice in the paper announcing one of OSC’s community lectures: Dr. Coleman was speaking about new modalities in rotator cuff repair and shoulder replacement. She’d had surgery on her right shoulder in 2000 in Richmond, and “…swore that I’d never go through that again, because they cut through my rotator muscle to get to the joint. That recuperation – the physical therapy – was so painful.” But her left shoulder had started to break down, and she was in constant pain. “I knew something needed to be done. Pain is something you remember, and I wasn’t sure I wanted to go through that again. But I knew I couldn’t keep going the way I was. It was hurting to get dressed – I started wearing cardigans because I couldn’t get clothes over my head.”

With her reporter’s curiosity, she was also intrigued by the new technology. She attended the lecture and subsequently made an appointment with Dr. Coleman.

After examining her and reviewing her x-rays, Dr. Coleman remembers, “Beverly’s joint was destroyed and she literally had no rotator cuff. Ten years ago, when people like Beverly came to see us, we’d have to say, ‘sorry, we can’t help you, we can’t make you better.’ We would give them cortisone shots and they’d keep suffering.” He told her that a conventional replacement – putting a ball where the ball was and a socket where the socket was – could give her some pain relief but no function. She’d be unable to lift her arm, and worse, the repair could quickly fall apart, leaving her back where she started.

But that was ten years ago, he assured her, and then described the new procedure: a reverse total shoulder replacement, which relies on different muscles to move the arm. “The very clever French researchers who discovered this particular device realized that if you put it in basically backwards – that is, if you put a ball where the socket was and a socket where the ball was – then the outside muscle, the deltoid muscle, can do the work that the cuff used to have to do,” Dr. Coleman explained, noting that “It’s a mechanical issue; it has to do with the lever arm being better with that arrangement.”

At the time, Dr. Coleman had been doing the reverse total shoulder replacement procedure for about six years. “It was the Holy Grail of shoulder surgery,” he says. “Everybody had been looking for something like this. They’d tried dozens of different techniques – all kinds of things trying to solve the problem – but the French figured it out and it’s become the standard. Everybody now generally agrees this is the best way to solve a problem like Beverly’s.”

Shoulders are Dr. Coleman’s real focus, and he had adopted the procedure early on because he recognized its value, especially since he knew it would offer relief from pain as well as improving range of motion. They booked the surgery.

Of the post operative period, Beverly says, “It was totally different from the right shoulder. Instead of cutting through the muscle, Dr. Coleman was able to just move it out of the way to do the replacement. My healing time and physical therapy were so much better.” Today, she says, “I have more range of motion with my left shoulder, the shoulder Dr. Coleman did.” Naturally right-handed, she’s even begun doing some things with her left hand. She still protects her left hip, but realizes that it too might ultimately break down because of RA. “After the seminar and meeting with Dr. Coleman, I felt I was in good hands, really comfortable,” she says, and “after the surgery and the physical therapy at OSC, there was no doubt I was in the right place. If my hip becomes an issue, OSC would be my first option because of the treatment I received there.”

For someone who had suffered so much and for so long, such a good result would have been remarkable. But that’s not the end of the story, and not why Beverly remains grateful to Dr. Coleman and to OSC. Recalling her eighteen months in the wheelchair, Beverly explains: “At one of my appointments with Dr. Coleman, my mother asked if he knew anyone who works on feet and ankles. He immediately referred me to a local foot and ankle reconstruction specialist, who took one look at my ankle and said I had a ruptured tendon.” She had been walking on a ruptured tendon for about 4 years, until the pain forced her into the wheelchair. Her foot was already beginning to deform to the left.

“It was because Dr. Coleman referred me to the foot and ankle specialist that I got my ankle straight and got out of the wheelchair,” Beverly says. Able to walk without ankle pain, and move without shoulder pain, she was able to exercise, and has lost around 150 pounds. And the wheelchair? “I use it for a desk chair!”

She calls herself “literally, a new woman”; and in fact, when Dr. Coleman saw her at a community event – where she was a featured speaker – he didn’t recognize her. “She was out of the wheelchair, moving around comfortably, and she just looked terrific,” he says.

Today, Beverly devotes her time to working on behalf of patients with RA. As part of the Patient Ambassador Program with The Snow Companies, Beverly produces a monthly webcast, providing information and encouraging conversations about how to live successfully with rheumatoid arthritis.

“No one knows what causes RA,” she explains, “although it’s known that it can be hereditary. In my family, my paternal grandmother was diagnosed in her 70s. I’m the first one to get it so young.”

She still has RA, but before her first visit to OSC, Beverly would never have dared imagine the life she’s living today. “Everything is working, and I feel really good. I’m so thankful to Dr. Coleman, not just for getting my shoulder straight, but because he helped me get my ankle fixed. He started it all. I owe him so much.”