• President’s Message
     In this issue of Healthy Living, we focus on the Neuroscience Center of Excellence, exploring conditions of the spine, neck and brain in depth. Aches and pains are nothing new to most adults,... click for more
  • Barbara Sinatra and Ma...
    In April, the Junior League Sustainers of the Coachella Valley and the Barbara Sinatra Children’s Center at Eisenhower will partner to recognize National Child Abuse Prevention Month. On April 2,... click for more
  • Eisenhower Physician P...
    Over the past several years, Svetlana Rubakovic, MD, FACP has been invited to present new research data about melanoma genetics to the international melanoma community — namely, the 7th International... click for more
  • The Memory Assessment ...
    Since 2007, residents of the Coachella Valley who are struggling with memory changes — and the people who love them —have been offered close-to-home access to the Memory Assessment Center (MAC). The Center offers a newly revised, first-of-its-kind program for diagnosing Alzheimer’s disease, dementia or a related memory disorder, as well as a wealth of care and support resources tailored to their individual needs.

    The Memory Assessment Center, under the operation of Eisenhower Medical Center and located in the Uihlein Building on the Eisenhower campus, is a collaboration between Eisenhower, the Keck School of Medicine of the University of Southern California (USC) and the Alzheimer’s Association®, California Southland Chapter, that provides a comprehensive, multidisciplinary approach to evaluation, care and support. click for more
  • Eisenhower Desert Orth...
    In keeping with its longstanding tradition of community service, Eisenhower Desert Orthopedic Center (EDOC) is involved in numerous activities and programs that “pay it forward” to local residents.... click for more
  • A Primer On Choosing A...
    The importance of having a primary care physician cannot be overstated. A primary care physician is a doctor who helps patients maintain their overall health and well-being, as well as coordinating a patient’s care when specialists or other medical professionals are needed. Seeing patients at regular intervals and not just during times of illness, a primary care physician can also help a patient to establish and maintain healthy lifestyle goals. Family physicians, geriatricians and internists are all primary care physicians.

    Getting to know a patient over time can have a profound effect on the health of that patient — understanding a person’s family history, workplace situations and stress, age-related concerns and more. Establishing a long-term care relationship with a patient can help a primary care physician treat an acute problem or focus on a larger issue. Regular visits to one’s primary care physician may also help expedite the diagnoses and treatment of high risk factors like high cholesterol or hypertension before a serious illness has had time to develop. In short, the primary care doctor is a patient’s first line of defense for getting well and staying well. click for more
  • Breast-Imaging — Seein...
    In the world of breast imaging, dense breasts present the most difficult problems in detecting cancer. Standard mammography equipment often cannot detect cancer lesions in women with dense breast tissue. According to Eisenhower Radiologist John Cutrone, MD, Board Certified in Radiology/Diagnostic Radiology, “It’s like looking for a small cloud behind a big cloud. Some small cancers, which are typically white on a mammogram, are easily obscured by breast tissue, which is also white.” 

    Thanks to a generous donation from BIGHORN Behind a Miracle (BAM), Eisenhower Schnitzer/Novack Breast Center was able to purchase the most advanced, state-of-the-art dense breast imaging diagnostic tool available, and is only the second facility in California to offer this exciting new technology. The SenoBright® Contrast-Enhanced Spectral Mammography (CESM) from GE Healthcare is a powerful diagnostic modality — able to detect minute cancers, as well as reduce the waiting time between detection and diagnosis. click for more

  • Relief From A Lifetime...
    Engineer and private pilot Neil Whelchel was just nine years old when he first experienced the rapid palpitations. “I would change my position or hold my breath and it would happen. As I got older the episodes got longer.”

    Whelchel went to doctors who ran electrocardiograms (EKG) and ultrasounds but nothing ever turned up and he was often dismissed. Rapid heart rate — supraventricular tachycardia — was something the young man learned to adapt to. He even taught himself to “reset” his heart by doing vagal maneuvers (methods used to reset or slow the heart rate). “At the time, I didn’t know that I was doing vagal maneuvers. I just was curious and aware of my body and was able to figure it out.” Whelchel would hold his breath and bear down, or press on his carotid artery to reset himself. He would sometimes use ice on his face, chest or back to put his heart back into rhythm. click for more

Back On His Feet

Avid Walker Gets Moving Again

"I thank God and I thank the doctor for what he was able to do," says Jay Kepner. "What a blessing it is to walk; you just don’t realize."
The pain in his back and leg had gotten so severe that 74-year-old Jay Kepner could barely walk.

“Even with a walker, I couldn’t go any distance,” recalls the Bermuda Dunes resident, a former long-distance runner who, after a hip replacement in 2008, began to walk for exercise, customarily clocking five kilometers. “I was in excruciating pain. It hurt to sit or to stand for any length of time. I couldn’t trim my roses or pull weeds.”

Nor could he fulfill his service as a lay minister to give communion to Catholic patients hospitalized at Eisenhower Medical Center.

“It entails quite a bit of walking, and I just couldn’t do it,” he says. “I couldn’t do anything.”

Kepner had tried conservative measures including pain and anti-inflammatory medications and some physical therapy. He also had seen a chiropractor with whom he discussed atreatment called decompression therapy, a non-surgical approach to relieving back pain and other problems associated with spinal disc injuries. “But he was honest and said I wasn’t a candidate for that treatment,” Kepner says. “He recommended that I see Dr. Shen.”

Alfred Shen, MD is a Board Certified Neurosurgeon with Eisenhower Neuroscience Institute who specializes in complex and minimally invasive spinal surgery, surgical treatment of brain tumors and stereotactic radiosurgery.

“I first saw Mr. Kepner in August of 2012,” Dr. Shen says. “His symptoms of leg and back pain had been progressively worsening over the past year and, in the four months before his visit he could only walk 50 yards. He’d have to stop and rest after 50 yards before resuming, only to have the pain hit again.

“For his age, he was in otherwise excellent health, and this [not being able to walk] was a major handicap for him,” Dr. Shen adds. “He also is a great communicator and was able to pinpoint where the pain was, explain what aggravated it or what made it better, and that it was his leg, not so much his back, that bothered him.”

“We examined Mr. Kepner and observed that he did have some weakness in his legs,” he continues. “He had trouble getting out of a chair and had to use his arms to push off. For someone who up until recently had been walking 5,000 meters, that was a drastic change.”

“His MRI revealed stenosis (narrowing of the spinal canal and compression of the spinal cord and nerves) at two of his spinal levels,” Dr. Shen notes. “He also had a tremendous amount of arthritis in his back, as well as degenerative disc changes.”

The diagnosis was a condition called neurogenic claudication. “It’s a constellation of symptoms affecting the leg and back,” Dr. Shen explains. “The hallmark of the condition is that symptoms get worse when you walk long distances. After a period of rest, one can resume walking.”

“Another thing is that people with this condition tend to walk with a stooped posture,” he notes. “When they go to the grocery store they’ll grab a cart and lean on it as they shop, since it’s the only way for them to get through the store.”

“Many of these patients can, however, ride a stationary bike seemingly forever even though they can’t walk a block,” he adds. “The forward-flexed posture helps open the stenosis.”

What Dr. Shen found particularly disturbing in Kepner’s case was the evolving leg weakness. “It suggested possible damage to the nerves that innervate [stimulate] the thighs.”

While corticosteroid injections were another conservative measure that might have provided Kepner with some pain relief, Dr. Shen told him that they were not a long-lasting solution, and that he felt surgery was the best option.

“I really appreciated that he took the time to explain everything,” Kepner says. “He has a nice demeanor and good bedside manner.”

The procedure that Dr. Shen performed is called a laminotomy and decompression. It involves partial removal of a small portion of the lamina (the thin, bony layer that covers and protects the spinal canal and nerves) to alleviate pressure on the spinal nerves. In Mr. Kepner’s case, this involved both sides of the spinal cord at the two levels.

“We make small windows in the bone to free up the underlying ligaments and nerves passing through that segment,” Dr. Shen explains. “We do it under a surgical microscope; it’s a very meticulous type of surgery, like working through a keyhole to free up the nerves.” Kepner’s procedure took between three and four hours.

“It’s a traditional, open surgery — you might even say an old-fashioned procedure,” he notes. “But ‘oldfashioned’ still works very well in the right hands.” It worked extremely well for Kepner.

“From the minute I woke up, I haven’t had a moment of pain,” he says. “Dr. Shen had given me some pain medication before my operation which I used a little, but after the operation, nothing.”

Kepner’s surgery was on a Thursday in mid- September, and he was home on Saturday. He was prescribed a back brace to wear for additional support, and Dr. Shen told him to gradually increase his physical activity.

“I saw him two weeks after surgery and he was already walking a half mile at a time,” Dr. Shen says.

Today, Kepner is back to walking his 5K distance, often while pushing his grandchildren in a double stroller. “I also got all my trees pruned, and I’ve increased my barbell weight from five to 25 pounds,” he says. “And I’m back to serving at the hospital.

“I thank God and I thank the doctor for what he was able to do,” he adds. “What a blessing it is to walk; you just don’t realize.”

Considering Surgery for Back Pain? Help Your Surgeon Help You

“When you see a doctor about back or leg pain, be as specific as possible about what the problem is,” advises Neurosurgeon Alfred Shen, MD. “If you say that everything hurts, it’s hard to hone in on what the problem is. But if you can articulate exactly where the pain is, where it radiates and what makes it worse or better, it’s extremely helpful.”

“In this day and age, everyone gets imaging studies and expects them to reveal precisely what the problem is,” he continues, “but it takes some back and forth communication between doctor and patient to figure it out.”

“In Mr. Kepner’s case, his MRI looked awful; he had such severe multilevel disease and diffuse arthritis that the changes in any level of his spine could have been causing his pain,” Dr. Shen says. “But because he was so good about communicating the details of his pain, we could accurately determine its source and apply a specific treatment to ensure a good outcome.”