Wednesday, March 14, 2018

My Back Doc

(Note: Dr. Vlach is the Doctor who treated may back problem in this manner on October 13, 2017. I have to admit, the injection was the single most painful thing I have ever experienced in this lifetime. By and by, it did the trick.  I can't play pickleball and have to be careful with the back but I have sufficient mobility and Life is Good.)
By ISABELLA ALVES
Copyright 2018 by "The Post-Register" Idaho Falls

As Dr. Sarah Vlach slides a needle filled with Platelet-Rich Plasma into Ginger Richins’ shoulder and knee, her eyes squeeze shut as she winces in pain.

But the pain is worth it.

Richins is getting the powerful healing properties of her own platelets to fix her torn tendons, as Vlach’s steady, focused hand injects the revitalizing platelets.

“Oh my God, you don’t want to know (what it felt like),” Richins said to a reporter observing the procedure. “It’s like you would imagine, a needle going into your body … it was painful … but pain doesn’t last.”

Richins is an avid llama hiker, and plans to hike the Pacific Crest trail, but as she was preparing for her hike, she noticed her knee was popping.

She’s had this procedure done before and had gotten great results, so she wanted to go under the needle a second time.

“I’ve seen Dr. Vlach for many many years,” Richins said. “I did this and after three months and I could just hike and hike and hike.”

In the white procedure room, with bright fluorescent lights, Richins lays sprawled on a bed, surrounded by a whirling fluoroscope X-ray machine and the pictures of ultrasounds as Vlach guides the tools over her injured shoulder and knee.

Vlach uses the ultrasound and X-ray to see exactly where the needles needs to be injected. The two screens in the room are filled with the fuzzy gray pictures of Richins’ tendons.

To a layman, it looks like something seen on an Etch A Sketch, but to Vlach’s trained eye these blurred gray lines depicts Richins’ injuries.

And this is what makes Vlach’s platelet and stem cell treatments stand out. She doesn’t “go in blind” with a needle, she knows exactly where the injury is and where to deliver the platelets.

“The biggest prob is that there are a lot of people with minimal to no training just jumping in and doing things (the injections),” Vlach said. “What I’m seeing now is that really anyone can hang a shingle and call themselves a regenerative medicine doctor.”

Vlach first started venturing into the realm of regenerative medicine when she saw the way she was trained to treat patients during medical school at the Mayo Clinic and a physiatry residency at the University of Utah wasn’t working.

Back when Vlach entered the field in 2005, doctors were encouraged to prescribe opioids for patients musculoskeletal pain, not treat them with with platelets or stem cells.

But for Vlach, this wasn’t good enough.

“I practiced that way for about five years doing what I’d been trained in my residency and doing what I thought was appropriate for patients,” Vlach said. “I just didn’t see people getting better I saw people quickly reaching tolerance effect with their opioids.”

Vlach saw people still in pain on opioid doses she thought were large and still not being able to do the things they love.

Getting better to Vlach means people are able to return to work, play with their kids and return to the activities they love.

She wanted to do more for patients than mask their pain with opioids, she wanted to treat the cause of it.

She started looking at alternatives to opioids and came across regenerative medicine, which includes platelet and stem cell therapy.

“I just didn’t know these tools even existed, I wasn’t educated in them, they weren’t offered to me in my residency training,” Vlach said.

Vlach offers a specific type of stem cell and platelet therapy as a physician in the Regenexx network. She applied to become a provider through a rigorous application process and has been offering it since August 2017.

To become a physician in the Regenexx network, providers must have extensive training in interventional orthopedics, such as fluoroscopy and guided injection based procedures, and be able to perform hands-on examinations of patients, according to the Regenexx website.

Most physicians who apply are rejected, and Vlach is the only provider in Idaho, according to Regenexx.

Back in the procedure room, classical music drifts in the air, cascading calmingly into Richins’ ears.

“Feeling OK?” medical assistant Melissa Checketts asks.

“Yeah,” Richins said.

“Let me know if you want a blanket,” Checketts replied, as Vlach positioned Richins for the next injection.

Vlach said an issue she’s seen is a passive approach to patient care. There’s a “fix-me” culture where doctors are treated more like mechanics, but this isn’t how she works.

She makes sure the patients are involved in the treatment process and works with them as a team. Vlach wants people to understand that the patient is the primary driver in their own health, it’s their body and they’re in control of it.

Vlach demonstrates this philosophy during her patient interactions.

“I don’t see anything major,” Vlach says as she guides the ultrasound over Richins’ knee looking for a cyst or any other complications.

“You don’t?” Richins asks.

“No,” Vlach replies as she readies her needle.

“Oh my gosh,” Richins gasps, as Vlach reassures Richins that she “promises to tell” her before she sticks her.

Between Richins, the nurses and Vlach it looks more like a minor surgery is taking place than an outpatient procedure — and that’s exactly how Vlach would describe it.

“I encourage my patients to think of these as minor surgical procedures instead of simple joint injections because there’s a lot for them to go through,” Vlach said.

She said a lot of patients are willing to go through short term, limited discomfort because with this procedure they’re likely able to avoid a more invasive, painful surgery. That’s exactly what Richins was avoiding. Richins had knee surgery in the past for a torn meniscus, and said her surgeon didn’t want to operate on her again until she needed a new knee, which she’s trying to avoid. Surgical recovery is often a long, painful process, one that Richins didn’t want to go through again. With the platelet injections, Richins can avoid surgery while also healing her injuries.

The procedure isn’t right for everyone, but it’s another tool for people to avoid an invasive surgery or opioids. Vlach said there are some people who genuinely need the drugs, opioids, such as people with failed back surgeries or cancer.

But having regenerative medicine options is another way for patients to get the help they need.


“I feel every day desperately sad for many of the patients that I see and I’m trying to be a small light to help facilitate change,” Vlach said. “Because what else can you do.”

Monday, March 12, 2018

Shakedown Cruise

We're going out for a short shakedown cruise this week before we head to Nogales next week to begin The Drive on US 89 from Mexico to Canada.

We've learned the hard way that short shakedown cruises are absolutely necessary before undertaking any really long Road Trip.  Call it a pre-trip checkout or whatever.  It's how you find out what you forgot or didn't think of.  No matter how many times you hit the road, you WILL forget something or fail to think of something.  It's just The Law of Road Trips.

When we migrate north or south, the bed of the pickup is chock full of stuff.  It's stuff we need to live for months in either location.  However, for this sort of Road Trip, the truck bed is mostly empty.  Very lean.

Here's what you're looking at (from left):

Black box on bottom hold sewer hoses fittings and stuff to dump the trailer's load now and then.  Blue box on top is all the other supplies for visiting a dump station.  Gloves, cleaners, etc.  The blue box also carries  a supplemental catalytic heater in case our battery goes dead or the heater decides not to work.

In the middle are three containers. The white bucket contains everything necessary to change a flat tire. No fiddling around wondering where tire-changing stuff is located.  When you change a tire, you want your tire changing stuff instantly accessible.

Behind the bucket are two black boxes.  The small one contains a high volume air pump that can fill a truck tire in minutes.  We check our tire pressures every morning before pulling out of camp.  You really need an expensive high volume pump to do the job right and quickly.  The larger of the black boxes holds all the trailer stabilization jacks and extra leveling stuff.  Behind those boxes are two solar panels we've owned for well over 20 years.  They still work great.

The cooler is a "just in case" thing.  It's empty and will remain so unless the trailer fridge decides to quit working.  In such a case, it's always a really good idea to have a back up. (If we were going into Bear Country, the cooler could not be displayed in such a blatant manner.  But where we're going this week there are no bears.)

The wood stuff at least is for leveling and also stepping into the trailer.  Ditto the stool at right.  And then there is a broom and a small rake.  You'd be surprised how often we need to the rake and broom to create a tidy campsite.

One of these days, we will get around to doing an inventory of all our electronic stuff we travel with.  Suffice to say it's one heck of a lot of stuff.