should be coming or surgeon i became a neurosurgeon because i was good at science in school i wasn't very good at writing papers so i could become a lawyer or something like that and i wasn't very good  balance on my checkbook at all so i couldn't be in business so i was good at science and mourning time exactly so i ended up studying psychology in chemistry and got interested in the chemistry of the brain and and the becoming a neur there you go and it takes a good while to become a neurosurgeon after medical school how many years after medical school there is an internship and then six more years after that and then if you do subspecialties another year or two after that ok and i thought we talk about some common things like back and neck pain tell us a little bit about neck pain the people would have to come see you in other words just not regular neck pain or you're sore when data gets better what kind of neck pain requires a neurosurgeon visit there are three main causes for the common neck pain usually it's either muscular downy or nerve related there's rare things like infections in tumors but that's pretty rare but the more common things are muscle nerve and bone so muscle spasms muscle strains irritations that can happen either acutely from lifting something or pulling something or an accident or chronically or changes like a small fracture which is uncommon unless there's a trauma more commonly arthritis or wearing down of the joints because joints smooth guarding surfaces when you're born that's what we wear down and you get bone rubbing on bone as that happens that creates pain and then the third thing is pressure on the nerves of the spinal cord that can cause neck pain similar similarly in the lower back it's the same kind of cause if you have in your neck can cause headaches yes the muscles in the back of the neck actually are continuous from the sacre the bottom of the spine all the way to the back of the head those muscles in the cow are what we call the flaming yawn and that's where you have when you have do you regularly prescribe medicine as opposed to any other thing when you have neck pain typically the recommendation for acute neck pain or back pain without any kind of other nerve symptoms like weakness or numbers or pain is rest he or ice and then over the counter anti information medicines like advil or leave or tylenol if that doesn't work over a month or two or if you develop any kind of nerve signs then we usually check people and that's when we start a little bit stronger anti information medicines sometimes steroids and usually physical therapy ok is it more common because i know i started out on neck but is it more common to have lower back pain or to have neck pain in your profession to use more commonly we see low back pain and the reason is because we're operate beings the years and years of all the pressure on the low back is a heavier pressure and more wear and tear than on the net the head weighs a little bit more than about fifteen twenty pounds depending on how big your brain is i guess but but that's a lot of weight on the neck but there's even more weight on the low back so there's more commonly wearing down there ok more men than women young old it's variable there's a small genetic component but a lot of it is most common area  so the stronger and more flexible they are the more the joints collide and the less they grind the less they wear down the weaker they are the more they grind and the faster they were down so people stay kind of in shape and i'm not talking away left i'm talking about  good swimming is very good because takes all the stress off your joints but it's a very good a robot exercise is good for all the muscles and we usually recommend that running jogging those are all good but but they if you don't do core strengthening core stretching that can be a problem too because up it's a lot of pounding on that area ok are there any age groups that you see as opposed to other age groups typically everything becomes more common and more severe as you get older because your parts are wearing out and they're less resilient when you're eighteen you can get up and run a marathon without stretching or anything or anything but when you're fifty pretty much you have to get up and stretch just to get in your car in the morning because your muscles are so tight and stiff so the older the worst things are usually got it if somebody has back pain that's going down their leg what take us to the diagnosis and how you work and evaluate a patient for that surely the difference between back pain or neck pain versus back pain or neck pain with it radiating down your arm or your leg is that when it radiates down your arm or leg typically you're talking about nerves then being involved when it's mainly in the back where the neck is usually muscular bony when it radiates down your leg or your arm into the nerve being irritated the nerve can be irritated from direct pressure like a bone spur leg so we try to pinpoint based on the examination in the complaints exactly where it's irritated and then depending on that that determines what we do as far as treatment ok if you have  combination yes it really depends on the symptomatology if it's something where you having back pain radiating down leg typically what we would do would be to get an m r i because that's a very good test for looking at what's called soft tissues to the nerves the disks the muscles in the layman's it's not a good test for looking at the bones on the other hand if we were thinking it was more back pain related to the bones we want to get more of a cat scan and maybe what's called a bone scan or bending x rays of the spine which tell more about the bones ok and tonight's guest if you just tuned in is dr don whiting he's a board certified neurosurgeon works at canada's bergen other hospitals in the west health system he's one of the guys that fixes you when you have a problem if you have an m r i and let's say it shows a disk take us through the treatment of this because surgery is not the first  know there's a treatment algorithm or a treatment pathway that we typically follow and it really depends on the symptoms so if you have back pain alone then it's more medicines and therapy very if you have back pain and leg pain and nerve pressure on an m r i then a lot of times we like to try medicines and therapy is the first line of treatment and then if that doesn't work sometimes we even get what's called steroids injections in the spine area  specialist the combination of those things as well as the rest like we talked about earlier about eighty percent of the time we get those symptoms to go away because what happens is if you have a herniated disk which is the the cushion between the bones in the spine a piece of that squirts out and pinches on the nerves that disk is a water containing cushion between the vertebrae that keeps the bouncy and when it has a blood supply that keeps a full water and hydrated when it hurting it's it tears away from the blood supplies so it was slowly dehydrate and shrink so it will go away on its own as long as you can decrease the information and get the symptoms to start to abate so about eighty percent of time just with conservative therapies it gets better ok are any conservative therapies in other words as a physical therapist chiropractors osteopaths anybody or everybody kind of get in the same help frame there are there are when it comes to the therapy options as opposed to the medicine or injection options there's a variety there's physical therapy there's car practitioner in which have similar ideologies are predators tend to have more of a manipulation along with heat and alter sound a massage table treatment program but as a therapist have more of an exercise strengthening process on with heat ultrasound and matter and therapies so they have a similar ideology do similar things in general sometimes when those typical things don't work there's even a an m d type of person called a physical medicine and rehab doctor and their specialty is dealing with  so they sometimes can add different things like acupuncture different medicines different exercises sometimes even things you're doing in your lifestyle either at work or at home they're causing these things to keep recurring and they can kind of help you manage your lifestyle as well ok  one of the things we tend to beat up on this show is smoking and how bad it is that also contribute to back pain and that yes not only does it give you cancer but it also dries out your disks and makes the spine wear down faster well it's interesting i've never heard that good amount of time and didn't get any improvement national was having worsening symptoms so then we talked about surgery surgery the goal was to take the pressure off of the nerves so they can heal in the neck unlike in the low back typically we go from the front of the neck to get to the spinal cord in the nerve but to do that have to take the whole disk out in the past what we would do would be to put a wedge a bone in there and fuse those bones to the they would never move again and all your motion would be above and below which makes them sometimes wear down quicker but over the last ten years or so there's been studies that we helped to be involved with one of the for artificial discs so you take out the disk to get to the bad part fix the bad part and then put our official one in so they still have motion so that's one of the newest things that was just actually f d a approved about two years ago that in that particular case we did so they didn't have to lose that motion is still has that motion and what are these dismayed what do they look like or they look like there's five different kinds on the market right now we were in the studies with three of them but there is one which he got that has to tell me i'm plates that are real rough above and below this little thin thin disks ok that meet up with the bottom of the bone and above and below in between is a polyurethane kind of almost like a little piece of hose ok but real thin a real flexible ok in between there that's filled with water ok so it balances it moves side to side it's the same consistency as a regular desk ok it's like the ice cream sandwich that i like to when it's a little bit warm because it's a little sliding just like that but the other one most of them are either stainless steel or to tame him ball and socket kind of mechanisms so they kind of pivot just like an artificial hip for our official joint so it just kind of pivots which gives you most of the motion have you had fairly good success with  had great success we as i mentioned we were in some of the early studies so we've have about nine year experience on these and they've only been out for two years but we have people come back a veteran for nine years and across the board they seem to do better than people that fusions down the road with getting back to activities quicker but also having less wear and tear at the levels above and below is that when you do these artificial discs is that only for the neck or is it also for the lower back are official discs for the neck and the lower back they're very often used in the neck because we go from the front take out an otherwise healthy disk to get to a small part that sir needed that so the rest of the joints are working normally so if you replace the disc the rest of it all moves in the lower back there's artificial this but it's not common to use because typically we go from the back and don't have to take the disc out and i say to get the pressure off the nerve so we replace a disc it's usually for back pain and that's usually too stenosis who gets that and how do you fix it people like us get that their order to get the more you get it and it comes from the bones wearing down so ever saw anybody who's joints are worn down older people or their knees are real big as because the joints stop guarding and started grinding for years and your body makes bone around that joint trying to stop the grinding but it gets bigger and bigger the same thing happens in your spine but those joints that are  surrounding the spinal nerves so as the spinal nerves wear down as the bone spurs wear down they pinch on the spinal nerves and his bony pressure on the nerves that gets worse over time and that leads people to have pain the longer they stand of the longer they walk when is it more common in little old ladies as opposed to you know younger guys like ourselves or is it get more common guys or the think i'm getting  but i guess there are some people particularly people that are big time athletes that have can generally small canals so they're born with a smaller canal so it does takes less time to get narrowing but most people it's just a time over wear and tear a continuum so it's most commonly symptomatic it starts developing early on that is most common symptomatic by the time you're in your sixty's or seventy's and again most back pain just so we can reiterate most back pain you don't require surgery for correct yes about eighty percent of time you get better with conservative therapy when we see it ok and that's only the people who didn't get better in the first four to six weeks just with the rest right the most the patien are they referred in from desire troops medical doctors how do they come to see in the first place there's a variety of ways we end up seeing people for non trauma pain and typically it is from their family doctors or family members who we've taken care of but usually family doctors ok and if somebody want to get a hold of you obviously they can dial the number on the screen i'm going to i'm going to switch gears on you know a little bit i know that you're an expert also in brain and some surgery on the brain tell us about the new and exciting things you've been doing with some people it have is a parkinson's disease yes while for about fifteen years we've been doing brain surgery for parkinson's disease would put electrodes in sees me into the brain and then under the skin with a ton of little wires and hook them to pacemaker type batteries by the collar bone and then wait about sixty four thousand combinations of settings that we can set to change the electric current in the brain to re modulator how it works so all we can do with people with parkinson's is treat their symptoms with electricity and cut their medicines which in and of themselves have side effects so that a lot of times we can get them their lives back but that it's kind of like frankenstein so with the bolts on the side as they were then we got rid of the bolts and are a little bit a lot more cosmetically desirable movement disorders and also o c d psychiatric disorder obsessive compulsive disease ok there's investigational work looking at all timers traumatic brain injury epilepsy we're doing the work on looking at when you say can you tell me the difference between essential tremors and you know because i find it interesting that people that used to shake you can get him to stop shaking oh well sure essential tremor is just tremor about fifty percent of the time it's genetic so somebody in your family or a lot of people in your family had it and about fifty percent of the time a spontaneous no medicines really work well but we always tr several the thing that most people use is they'll have a glass of wine before dinner and that makes their head hand settle down so they can eat but typically that gets worse and worse and they can be calm life changing move had dental hygienists with his little short thing who carry guns without a lot of people that their jobs would allow them to have a bad tremor and we've done that and you can get rid of the tremor most of the time now that's essential tremor parkinsons disease has a tremor but it's a resting and it's because there are certain fibers in the brain that are inhibiting those muscles one and normally should be relaxing and we can get in there and shut that circuit off that's that's actually tremendously amazing as i assume that's computer aided yes  have we take their m r i and cats can put into a computer we have that has a navigation system which is kind of like a mini g p s for the brain and we can get anywhere we want to be in the brain within one millimeter  that's that's really wild stuff tonight's guest is dr don whiting and we started talking about back pain but i decided to switch and some other stuff and it's just tremendously amazing we're really in the forefront of that's what happened certain parts of the brain just lose their control and then we do just put a thermostat in and regulate it and a lot of times you can kind of reset that homeostasis ok when you do when you do this surgery there's a take long to do  it depends where you do it it's done we're we're actually did a study looking at everybody in the world who does it and the how they do it the times they do it how long it takes and  the u s and germany are more efficient than say france or italy because they're always taking wind breaks and smoke breaks but it takes them about two or three times as long and i'm not kidding that's true but on average it takes us about an hour and a half to two hours to do both sides of the brain got the whole surgery most people it's a little bit longer but in the u s an average is about four hours about you know it's it's just like that this that keeps smaller part of your practice as opposed to the lion share which i would assume would be more pain neck pain or is it yeah i mean more and more volume wise it's a smaller percentage but but as far as  prevalent but the percentage of volume wise nationally is a big number when you when you do these deep brain stimulation is it are there any restrictions afterward i mean can they not go through airport security  and it just goes to show you know there's just a tremendous forefront of north surgery that i think take us back twenty five years ago none of this stuff was even really much on the horizon i was still in grade school  into spine fusions and things like that so i see people gullible the same day or the next day worries me five or six days i was tremendous and the the risk i would assume the rest of infection all that other stuff goes down tremendously to and turn around to get back to work the of the risk of infection the return to work the muscle symptoms all those things are much smaller that's tremendous tonight's guest has been dr don whiting to get ahold of and you can see the byline that we have you can pull us up on the internet is to stay healthy and take about a half an hour a day to take care of yourself stretching a little bit of a road bike exercise you know don't smoke and that put me out of business and and stay on the treadmill