News Archives - Michigan Head & Spine Institute Blog

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Dr. Richard D. Fessler
Richard D. Fessler , M.D. Neurosurgeon

In 2013 Dr. Richard Fessler predicted the use of telehealth would become the norm as technology was in place to create visits for patients via a smart phone. Fast forward to 2020, Dr. Fessler saw his prediction become reality. The pandemic of a lifetime gave the entire healthcare industry a push into telehealth. Insurance companies expanded coverage for this type of visit with a push from Center for Medicare Service or CMS to cover costs.

“At MHSI we were ready to offer our patients this option when COVID caused concerns about safety for our patients and staff.  With the insurance barrier removed, it brought reassurance we could deliver the telehealth option and patients didn’t have to be concerned about unnecessary out-of-pocket-costs,” said Dr. Fessler. “We are thankful that our patients accepted the technology and the new way we are able to provide care.”

For example, when Tony couldn’t take his back pain any longer, he met with Neurosurgeon Dr. Ratnesh Mehra virtually and had trust that his surgical experience would be equally the same and relieve his back pain. Dr. Mehra recalls the day they met online, “Tony was able to effectively communicate with me about his pain and what he was feeling. At that point we decided that surgery for Tony was the right course of treatment and I met Tony in pre-op in person for the first time.” Tony says, “One week after surgery I was walking…dancing.”

 

Watch how intense pain stopped Tony in his tracks!:

 

To schedule a telehealth appointment with an MHSI neurosurgeon, call 248-784-3667 or visit MHSI.us.

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Every year neurosurgeons advance the procedures performed to treat brain and spine conditions. Just a few short years ago minimally invasive surgery of any type was unheard of. Yet today, an incision of less than 2 inches allows a neurosurgeon to fix or replace a disc in the neck or spine.

Minimally invasive nasal endoscopy is yet another advancement to treat tumors of the brain. This approach allows the neurosurgeon to access the brain to remove a tumor without performing a craniotomy, which makes a “window” in the bone to allow access to the brain.

Dr. Jeffrey T. Jacob
Jeffrey T. Jacob, M.D. Neurosurgeon

Deciding between a craniotomy or using the nasal cavity to reach the brain, depends on what is best for the patient. “The goal is to be able to reach the tumor and remove all of it,” says Jeffrey Jacob, M.D. “Often, we are able to do that going through the nose with an endoscope, with a very small camera device.”

There are many types of brain tumors that can be treated with this approach. Brain tumors that are removed using the nasal endoscopic approach can be benign or malignant, and typically sit at the base of the skull or under the brain. This procedure removes the tumor and the blood supply to the tumor.

To perform a nasal endoscopy, Dr. Jacob partners with Adam Folbe, M.D., a rhinologist and endoscopic skull base surgeon at Michigan Sinus and Skull Base Center. Dr. Folbe goes through the nose and opens the window to the brain. He says, “There is no cutting of skin, muscle or fat resulting in no scars. Using this approach maximizes retrieval of the tumor with lesser disruption to the brain compared to the craniotomy approach.”

Patients who experience this approach have no signs of surgery on the outside of their body, because the nasal cavity is repaired with the patient’s own tissue, without stitches or sutures. During the post-surgical healing, patients are restricted from sneezing, blowing their nose, lifting and bending over for about three weeks.

Like any surgery, there can be side effects, like in Valerie’s case. Because of the location of her tumor, she lost her ability to smell. For Stephen, he experienced added restrictions as he waited for his vision to return to normal once the tumor was removed. Kevin didn’t experience difficulties after his surgery, but he did work hard to regain his strength and balance.

If you or a loved one is diagnosed with a brain tumor, consider all of your options and seek a second opinion. Like Valerie, you might find an option you didn’t expect.

 

Watch Stephen’s brain tumor story below:

Watch how a large pituitary tumor interrupted Kevin’s life:

Watch Valerie’s full story below:

 

To schedule an appointment with Dr. Jacob or any of the neurosurgeons at MHSI, call 248-784-3667 or visit MHSI.us

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September marks another effort to raise awareness about Chiari malformation. Chiari malformation is a disease of the brain where brain tissue is pushed down into the spinal canal. It occurs when the base of the skull is abnormally small or misshapen, causing pressure on the brain which forces it downward. Chiari malformation may cause blockage in the flow of the cerebrospinal fluid, which may cause the normal fluid spaces in the brain to enlarge, also known as hydrocephalus.

It was estimated that the condition occurs in about one in every 1,000 births. However, the increased use of diagnostic imaging has shown that Chiari malformation may be much more common. Complicating this estimation is the fact that some children who are born with the condition may not show symptoms until adolescence or adulthood, if ever. It can also be hereditary, and often those with Chiari will recall a family member with the same symptoms. Family members such as siblings Ezra and Katelyn, and mother Tammy and daughter Sheena.

Watch Ezra and Katelyn’s journey with Chiari below:

Chiari Malformation Corrected for Mother Tina and Daughter Sheena:

Adults and children alike can go through life and from doctor to doctor, with severe symptoms and are not diagnosed until an aware physician recognizes the symptoms. Patients Tina, Lu Anna and Tyler each had a physician acknowledge their symptoms and refer them to the leading expert in Chiari decompression, Neurosurgeon Dr. Holly Gilmer.

To learn more about Chiari malformation, the symptoms, and treatments, click here.

For most patients, the diagnosis is elusive for many years until the patient meets a doctor who is aware of Chiari, and understands the symptoms presented can become more manageable with surgery. One of the goals of Conquer Chiari Walk Across America is to raise awareness and funds to support further research. At this event, patients, their families and friends, along with doctors join in to walk to raise funds every third and fourth Saturday in September.

Click the graphic below to download the flyer:

Conquer Chiari Walk Across America

 

If you or a loved one is experiencing symptoms of Chiari malformation, call 248-784-3667 or visit MHSI.us to schedule an appointment with Dr. Gilmer.

 


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Sacroiliac Joint Pain

 

Lower back pain is the most common type of pain as reported by half of all working Americans. It can develop gradually over time from stationary occupations (desk jobs, long distance driving, standing for extended periods) and pregnancy. It can also occur suddenly after suffering a traumatic event (a bad fall, auto accident, sports injury). Michigan Head & Spine Institute specializes in determining proper diagnoses and the neurosurgical treatments required to help patients with chronic back pain symptoms.

Sacroiliac Joint Pain
One frequently overlooked diagnosis for lower back pain is the sacroiliac joint. At the bottom of the spine, as part of the sacrum, the sacroiliac joint connects the sacrum to the hip bones (iliac) that make up the structure of the pelvis. Both sacroiliac joints help to provide stability while supporting the body. When this area becomes inflamed (known as sacroiliitis) the irritation can cause pain and discomfort. It is often misdiagnosed because many doctors are either not aware of the condition, or are not examining for it when back pain is described. Only after stabilizing this joint, called sacroiliac joint fusion (SI Joint Fusion), can relief from pain be achieved.

What is Sacroiliac Joint Fusion?
SI Joint Fusion is a minimally invasive outpatient surgical procedure. The neurosurgeon creates a small incision off to the side of the back, and using intraoperative navigation inserts two small bolts across the sacroiliac joint to help stabilize this joint. The surgery is performed in about 30 minutes and patients are able to go home a few hours later, usually with their pain greatly reduced.

Dave’s Lifetime of Lower Back Pain
Dave, a patient at MHSI, had experienced lower back pain since his childhood. Misdiagnosed by his doctors for decades, he continued to suffer into adulthood.

“My back problems started at 12 years old while playing football. Doctors then said there’s not a lot you can do except take aspirin and painkillers,” he remembered, “I dealt with that through high school while playing sports, and was kind of limited with what I could do.”

Years later, after an accident falling down some steps, Dave’s back condition became even more severe. Doctors prescribed physical therapy treatment and steroid shots, still he had no change in his excruciating symptoms.

“A friend of mine referred me to Michigan Head and Spine Institute, and specifically Dr. Fahim,” Dave, a MHSI patient.

Daniel Fahim, M.D., neurosurgeon, is a leading expert in the education and treatment of SI joint fusion:

“I remember Dave telling me he was having pain off to his left side,” Dr. Fahim said, “I examined him and looked over his imaging studies, and we finally uncovered something that had been missed for a long time. He had a problem with his sacroiliac joint, something that most doctors don’t think about, or know about.”

Dr. Fahim explained that many doctors will immediately look to the spine for sciatica, or disc herniations, causing compression on nerves. If they cannot determine the cause of the condition they may give up, or even worse, perform surgery on the back believing that’s the source of the symptoms.

“I’ve taken great pride in being able to identify that problem in many patients who have been sent to me from all over the state,” he said, “Finally, we’re able to uncover that it’s the sacroiliac joint, and that’s something we can fix if we can confirm that’s the cause of the pain.”

Before an SI joint dysfunction diagnosis could be determined, Dave was first given a steroid injection. When the injection only provided temporary relief from his pain, Dr. Fahim was able to conclude that SI joint fusion could be the solution Dave’s spent his life looking for.

“After my surgery, and I was feeling better, I was able to open my new business, Red Kettle Coffee Roasters in Port Huron, Michigan,“ he said proudly, “I was able to be on my feet long enough to do this. That was my concern, to be mobile and not get fatigued. I’m doing a lot of the physical labor I couldn’t do before.”

Watch Dave’s story below:

Thanks to Dr. Fahim, and MHSI, Dave can now spend hours standing, lifting and moving freely while running his new coffee shop.

In addition to Dr. Fahim and Dr. Mehra, many of the MHSI neurosurgeons perform SI Joint Fusion. If you or a loved one is seeking treatment for any conditions related to the spine and back, schedule an appointment online or contact MHSI at 248-784-3667.

To learn more about spine conditions, click here to see other patient videos and how MHSI’s expertise can make a difference.


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Medical illustration of brain tumor

 

It doesn’t get much more serious than being given the diagnosis that you have a brain tumor. Though brain cancer is rare and may be a life-threatening situation when detected, many forms of tumors can be successfully treated.

A brain tumor is a collection, or mass, of abnormal cells growing in, or next to the brain. But, what are the different types of brain tumors, and what are the symptoms to look out for?

Brain Tumor Symptoms
There are so many different types of brain tumors, and because each is so complex, brain tumors can cause different effects for each person. Physical problems and behavioral changes can occur throughout the body severely impacting one’s life. The symptoms will depend on the individual’s particular tumor, its location, and can result in:

  • Drowsiness
  • Personality changes
  • Confusion
  • Impulsiveness
  • Blurred vision
  • Balance problems
  • Headaches
  • Nausea
  • Vomiting
  • Seizures

Types of Treatable Brain Tumors
Though there are many different types, a brain tumor is classified by where it was originally formed. If it originated in the brain, it’s called a primary tumor and can be either noncancerous (benign), or cancerous (malignant). A tumor that originates in another part of the body and travels to the brain is called a meta tumor, and they are always cancerous.

Metastatic Brain Tumors – Also known as secondary tumors, they originate outside of the brain in another part of the body and then spread to the brain.

Meningiomas – Originating in the meninges, these thin layers of protective tissues surround the brain and spinal cord. Meningiomas usually grow slowly and most are not cancerous.

Pituitary Tumors – Found just under the brain, the pea-sized pituitary gland makes hormones that affect many of the body’s functions. A pituitary tumor can cause it to release too much, or too little, of these hormones which can cause serious problems.

Glioblastoma Multiforme – These are the most challenging forms of brain tumors to treat. MHSI physicians have access to the most current technology to deal with this cancer including image-guided surgical treatments.

Schwannoma – The most common type of benign peripheral nerve tumor in adults and rarely cancerous. When schwannoma grows larger, it can make removal more difficult. This type of nerve tumor can occur in any part of the body, and at any age.

 

Keith’s Brain Tumor Story
Before Keith, a patient at Michigan Head and Spine Institute, was diagnosed with his brain tumor he was an accomplished musician hoping for a big break.

“I got my first guitar when I was 12. It’s what calms me. It’s where I can focus on one thing and the thousand thoughts going on in my head will go away.”

But, that was all about to change when he started experiencing unexplained health problems and physical ailments.

“The first symptoms I had were the nausea, dizziness and headaches,” he said, “It got to the point where I couldn’t eat. The only thing that was staying down was water.”

Knowing something was wrong with his health, he went to an emergency room hoping it was just an ear infection. After undergoing some tests, his ER doctor came back with unsettling information.

“A brain tumor was not on my list.” – Keith, a patient at MHSI

Diagnosed with a sporadic case of hemangioblastoma, a benign tumor, Keith was seen by Dr. Daniel B. Michael, M.D., Ph.D., Neurosurgeon with Michigan Head and Spine Institute, trusted experts for treatment and diagnosis of tumors, diseases and other conditions of the brain.

“I noticed he was having trouble using his right hand and, in addition to his usual employment, he’s also a guitarist,” Dr. Michael explained, “That resonated with me. I play bass guitar, so I knew how important it is to be able to use both hands.”

After reviewing his CT scan, Dr. Michael confirmed Keith had a large mass at the back part of the head in the region of the cerebellum. This part of the brain also contributes to coordination.

“I just wanted it to stop hurting, to stop feeling sick,” Keith recalled.

While being prepped for surgery he also remembered the last thing he told the anesthesiologist, “I said, ‘I’m a musician.’ When I came back out, I still wanted to be a musician.”

Keith’s surgery was successful. He then underwent a second nonsurgical procedure called Gamma knife treatment to remove the last bit of his tumor.

“When I woke up after the surgery, I knew it was fixed. The pain I was having before was gone,” he said relieved, “I like the way Dr. Michael had a very confident way about himself.”

As for Keith’s guitar playing and music career after his surgery at MHSI:

“I’ve been in a few bands, had a little stardom,” he updated, “I’ve met a lot of people in the industry since the surgery that say they’re going to help me, so we’ll see what happens.”

To learn more about conditions of the brain and brain tumor procedures, please visit our MHSI Patient Education page at: Conditions of the Brain.

Watch Keith’s full story below:

 

If you or a loved one is seeking treatment for a condition of the brain, or are seeking a second opinion on an existing diagnosis, schedule an appointment online or contact MHSI at 248-784-3667.

To view more information about MHSI’s neurosurgeons, visit: https://www2.mhsi.us/doctors/neurosurgery-physicians/. For more information about MHSI’s  neurologists, visit: https://www2.mhsi.us/doctors/neurologists/


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The Importance of Getting a Second Opinion and Gaining Peace of Mind
If your body is telling you one thing, and your physician another, it may be time to seek a second opinion regarding surgery or treatment. When uncertain of an original diagnosis, or continuing to experience pain or discomfort – a second opinion can allow you to take control of your health and put your mind at rest.

Why Should You Get a Second Opinion?
The Mayo Clinic conducted a study of 286 patients that found as many as 88% of the people seeking a second opinion will leave a physicianʼs office with a new or redefined diagnosis. Of those patients, 21% will leave with a “distinctly different” diagnosis. Whereas only 12% will learn that the original diagnosis was correct. These results showed that one out of every five patients was incorrectly diagnosed.* 

Percentages such as these prove the importance of looking for a second opinion when necessary, and that patients should follow to their instincts.

When You Should Get a Second Opinion?
If you are not getting the answers that help you make an informed decision regarding a surgical procedure, or treatment option, you should ask more questions of your doctor. Ask yourself if pursuing the diagnosis will have lifelong consequences to your lifestyle and wellbeing. Would it be invasive or a risk to your quality of life? Focus on chronic and serious conditions when questioning treatment outcomes, and when inquiring about exploring other treatment options.

A physician should accept and respect your wishes for seeking a second opinion. They can also assist by offering referrals, and providing all of your medical records and test results. This will help your physician to communicate with the second physician, if needed.

Watch Valerie’s full story below:

Angela’s Second Opinion Story
“I was hit by a drunk driver, and immediately had this pain down my arm and wrist,” Angela said.

She’d gone to her primary care physician who diagnosed her injury as a pulled muscle from the seat belt. After seeing a chiropractor, and a neurologist, her pain still continued to worsen. Frustrated, Angela knew she required a second opinion.

“I was devastated and couldn’t do this anymore,” she explained, “My husband said to phone our insurance company and have them recommend another doctor for me, or we were going to find one.”

Angela’s insurance adjuster gave her the phone number for Michigan Head and Spine Institute.

“From the very first appointment I had a new diagnosis, a plan of action and was set up with a physician for pain management,” Angela said, finally relieved, “This doctor literally saved my life. Between his pain management and conservative treatment, Michigan Head and Spine Institute went above and beyond.”

Watch Angela’s full story below:

How a Patient Can Get a Second Opinion 
Patients have rights – you have the right to a second opinion. MHSIʼs multidisciplinary team can offer further knowledge and peace of mind for a brain, neck or spine diagnosis or surgery. If you, or a loved one, need more information about getting a second opinion contact Michigan Head and Spine Institute at 248-784-3667 or visit MHSI.us to schedule an appointment.

Immediate Telehealth Appointments Available.

*Mayo Clinic, 2017. Journal of Evaluation in Clinical Practice


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Michigan Head & Spine offers Telehealth appointments through Zoom Cloud Meetings. The following tips will help you prepare for a Telehealth visit.

Schedule an appointment
Your appointment can be scheduled through the office where you see your MHSI provider. On the day of your appointment you will receive a Zoom link and passcode. If you need to reschedule your appointment, please contact us within 24 hours of the appointment via the patient portal or by calling 248-784-3667.

Find the right location
Find a quiet place to communicate with your physician. Make sure this is a location where you won’t be disturbed by others coming into the room or background noises like the television, radio, pets, or noisy appliances. Be sure to have plenty of space around you – you may be asked to move around during your appointment so your physician can see your movements. DO NOT hold your Telehealth visit while you are driving or sitting in a vehicle – MHSI will reschedule your appointment as a result. Make sure there is plenty of light in the space where you hold the meeting so your provider can see you clearly.

Prepare your personal details
Come prepared to discuss your medical history or any pre-existing conditions you have. Be sure to mention any symptoms you may be experiencing since your last appointment. Check your prescriptions so you can discuss refills if they are needed. And, be sure to write down any questions or concerns you may have so you don’t forget to ask during the appointment. 

Set up technology
Telehealth appointments require an internet-connected device and use of a video source from a smartphone, computer with camera, or tablet. Make sure that your equipment is fully charged or plugged in and reliably connected to the internet before your appointment. Headphones or earbuds provide the best sound quality and can help reduce feedback or background noise.

Our virtual appointments are available through the Zoom Cloud Meeting application. Be sure that you have downloaded the most current program from the App store for your phone, tablet or computer. The application is free to download.

Test your software in advance of your scheduled appointment by visiting the Zoom website at https//zoom.us/test. 

Get connected
Be sure to be connected to the internet and locate the meeting link. Follow these steps to connect:

  • Click the Zoom link in the email or text to launch the Zoom application. 
  • Enter the Meeting ID and Passcode from the email appointment to join the meeting. 
  • You will see a preview window and a button that states “Join with Video,” click the button to begin. 
  • You may be asked by Zoom to allow permissions or enable video and audio.
  • Join the audio by selecting “Call via device audio” or “Call via internet”
  • Please be patient with your provider if they do not arrive precisely at the appointment time.

For more assistance a short video on How to Join a Zoom Meeting can be viewed here.

We will try to assist you in getting connected the best we can – but we cannot provide IT support. Please have assistance available with you at your appointment time if you have difficulties connecting. If you are unable to get connected, your appointment may be rescheduled.

Click here to download our connection tips sheet and keep it for future reference during your scheduled appointment.


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Richard D. Fessler, M.D.
Richard D. Fessler, M.D.

Michigan Head & Spine Institute extends congratulations to our own Richard D. Fessler, M.D., who has been named The Detroit Medical Center’s (DMC) Specialist-In-Chief of Neurosurgery. In addition to continuing to treat patients at MHSI, Dr. Fessler will provide medical direction and leadership for the DMC’s Department of Neurosurgery assisting in the growth of the program as well as serving as Chief of Neurosurgery at DMC Detroit Receiving Hospital. The DMC’s CEO has stated that Dr. Fessler will be integral in the efforts to build upon the program’s rich history and tradition of providing the community with advanced, high quality and compassionate care.

Dr. Fessler is one of the founding partners of MHSI where he treats complex vascular abnormalities of the brain, neck and spinal cord for the treatment of aneurysms, carotid artery disease and stroke. He has been named an HOUR Detroit Top Doc for more than 12 consecutive years.

Dr. Fessler has been affiliated with the DMC over the years. He formerly served as Chairman of the Department of Surgery at Ascension St. John Hospital in Detroit and as the Medical Director of the health system’s Stroke Network and Telemedicine Program. He is responsible for creating several statewide programs offering state-of-the-art care to stroke and aneurysm patients. Prior to joining Ascension, he served as Vice-Chairman of the Department of Neurosurgery at William Beaumont Hospital in Royal Oak.

For more details about Dr. Fessler, read his profile page on the MHSI website by clicking here.

 

 


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A subspecialty of neurosurgery and neurology, a neuroendovascular specialist surgically treats complex brain and spinal cord vascular lesions from inside the blood vessels using minimally invasive techniques.

The goal of an endovascular procedure is to keep blood flowing through the blood vessels or to prevent a blood vessel from bursting. Catheters (small hollow tubes) and very small devices, some no thicker than a strand of hair, are used to fill the space in the vessel and seal it. This helps prevent blood flow and the potential for the blood vessel to burst. In some situations, to keep the blood flowing and relieve pressure on the vessel a stent or flow diverter is inserted.

A special x-ray called angiography is performed in a special procedure room at the hospital.  This helps the neuroendovascular specialist determine where the blood flow is restricted in the vessel, where the vessel is bulging or tangled and preventing proper blood flow. Angiography is also used to guide the catheters through the vessels from the groin to the treatment area where the repair is made during a minimally invasive procedure.

Rarely does a patient have the option to choose a neuroendovascular specialist.  The treatment for conditions like an ischemic or hemorrhagic stroke or an impending rupture that can occur with a brain aneurysm or an arteriovenous malformation or AVM in the brain or spine begin in the emergency department.

It is comforting to know that MHSI’s Richard Fessler, M.D., is the area’s leading neuroendovascular specialist. In fact, he was one of the first neurosurgeons to bring this specialty to metro Detroit.  He also trains other neurosurgeons this subspecialty, including Interventional Neurologists Ahmad Thabet, M.D., and John Whapham, M.D., and Neurosurgeon John Steele, M.D.

MHSI neurosurgeons and interventional neurologists are on staff at all the southeastern Michigan health systems, and are on-call in all the major emergency departments to treat conditions requiring neuroendovascular procedures and neurosurgical cases.

Watch Heather’s, Duane’s and LaMonte’s stories in their own words: