Tiger Woods Undergoes Second Microdiscectomy on Back

September 23, 2015September 23, 2015 / Thomas Cohn, MD

Tiger Woods went under the knife again recently, opting to have a second microdiscectomy operation preformed on his ailing back.

The surgery means that Woods will withdraw from the final three scheduled events he had on his calendar, and it brings another disappointing season to a close. Woods failed to contend in any of the year’s four majors and he missed five cuts in 2015. Woods announced on Friday that he hopes to return to competitive golf in “early 2016.”

“This is certainly disappointing, but I’m a fighter,” Woods said. “I’ve been told I can make a full recovery, and I have no doubt that I will.”

This is the second time Woods has undergone the intricate operation on his back. His first microdiscectomy was back in March of 2014, and he only competed in seven events that season.

Surgery and Looking Ahead

Woods said on his personal website that he pursued a second back surgery after feeling pain and discomfort in his back and hips in recent weeks. Woods is used to playing through some discomfort after undergoing a host of operations throughout the course of his career, but the spinal compression came as surprise, as he had recently committed to playing in three tournaments to round out the year.

“He committed, thinking it was going to be a regular checkup,” said Woods’ agent, Mark Steinberg. “Obviously, that area where he had the microdiscectomy had to be treated again. And it leads us to where we are now.”

The microdiscectomy operation removed a small disk fragment in his back that was compressing a nerve, which was the source of his pain. Woods announced that he “will begin intensive rehabilitation and soft tissue treatment within a week,” adding that “healing and recovery times differ for each individual based on many physiological factors, but Tiger is encouraged he can return early in 2016.”

Dr. Cohn Comments

Here’s the deal with Tiger Woods. At this stage in his career, the only thing on his mind is chasing Jack Nicklaus on the career major’s list. Jack finished with 18, and Tiger currently sits at 14.

Tiger said he hopes to return to competitive golf by early 2016, but let’s be honest, he doesn’t care about the Sony Open of the Farmers Insurance Open. Tiger Woods wants to be back and healthy for The Masters, golf’s first major in 2016, which takes place in April. Obviously Tiger would like to get some rounds in before April, but I don’t expect to see him playing in minor tournaments in January or even early February. He’s always stuck to his schedule, and I believe his ultimate goal is to have his body and his short game in their best form at Augusta National.

That’s easier said than done, however. Tiger Woods will turn 40 in December, and unlike a fine wine, athletes don’t typically get better with age. Tiger has been playing golf professionally for more than half of his life, and although it’s less physical than football, it still takes a big toll on your body. What’s more, the smallest imperfections in your body can cause you to hit the ball a long distance from where you’re aiming, so pain and discomfort is less than ideal for an athlete who depends on precision. When you consider his age, his health and the formidable foes he has in young players like Rory McIlroy, Jordan Speith and Jason Day, I think it will be incredibly difficult for Tiger to win one more major, let alone catch Jack.

I wish him the best in his recovery, and I hope we can once again catch a glimpse of the golfer that took the world by storm back in the late 90’s and early 2000’s.

Finding Compassion in Medicine

May 4, 2015May 4, 2015 / Thomas Cohn, MD

Medicine has become a tough endeavor recently, as the physician is routinely under many pressures. Institutions and employers want as many patients seen as possible in an effort to increase their bottom line, while staff to assist the physician are often kept at a minimum to keep costs low. Tests and procedures should not be ordered or they need to be ordered more frequently, depending on who is paying the bill, and of course the physician should know which is the pertinent case. The physician also is getting paid too much and does not work enough hours. The physician also should do administrative work, read more current journals, and be responsible for quality improvement projects for the practice. They also must attend continuing education courses and constantly recertify their qualifications. The demands are endless.

As for the patient, they only want a good physician that can solve their problems quickly. Now that medicine has become more of a business, finding a good and caring physician is even harder. Physicians often feel they need to be done seeing a patient as quickly as possible. This is just the opposite of the needs of the patient. Many physicians have just given up with the pressures of the business, and have become mediocre at all aspects of medicine.

Striking a Compassion Balance

Finding the physician who has found the balance in medicine and who has the desire to provide high quality care is difficult. There is no magical way to find those special physicians, and word of mouth is often still the best method. There are rating services, but unfortunately most physicians try to hide from them and may not be very well represented. Furthermore, many of the best physicians let their skill be their only voice, and the best physicians often feel no need to advertise, as their work should speak for themselves.

In any profession, 90% of the practitioners are good, and 10% are exceptional. In medicine, this also holds true. The best physicians find a way to balance all the needs of the changes in the business of providing care. The most telling sign is that the patient always comes first. The physician will know his patients and their history, and will be willing to develop a joint treatment plan. They are up-to-date on research, and can explain complex medical problems without being flustered. Often they are experienced and can figure out what is wrong and what needs to be done quickly.

Medicine has become increasingly complex for both the patient and physician. Finding good medical care is difficult. Word of mouth, and sometimes the Internet can help find the better caregivers. Even good physicians are hampered by their surroundings and the business aspects of their offices. Every visit may not run smoothly, but having a physician that really knows how to help you is worth some inconveniences. Look for a physician who is mature, board certified in his specialty, and is prepared whenever they see you.

Tiger Woods is Great, But…

April 13, 2015 / Thomas Cohn, MD

The Masters is over, and for first time in a long period Tiger made the cut and finished a tournament. To no one’s surprise, Tiger did not make a run for the leaderboard on Sunday, but he certainly opened some eyes by finishing tied for 17th. At 38 years of age, he is no longer in his prime and now appears fortunate when he makes the cut and finishes. In the future he may have a few more outstanding tournaments, but they will likely be few and far between, and it is likely he will only win a few more tournaments throughout the remainder of his career.

Tiger has now had lumbar back surgery, knee surgery, and may have hip problems besides the above, not to mention he injured his wrist in Sunday’s final round. He pulled out of a tournament earlier this year when he aggravated his back. Most likely, for him to play well, the conditions must be perfect, and he has to have a good day when his pain is controlled. To play at a high enough level routinely is unlikely since either his back or joints will cause just a slight issue such that he will not be good enough to play against the younger and healthier players.

Gold is a Young Man’s Game

To win at a professional level, one must be a top athlete in perfect physical and mental health. All sports at this level require one to be in the best physical shape to master the skill necessary to play a perfect game. After having the physical skill, one needs to have absolute mental concentration for the game. If one has physical pain, the concentration for the perfect game is not present. If one has had back and knee surgery, one also does not have the perfect physical balance to be at the top of one’s game.

As we age, there are many changes that occur in the body, and after age 25, for most sports, we are slightly past our prime for physical ability. By the late 30’s we are definitely past our prime for almost all intense sports, especially individual events. There are a few older athletes who are competitive later in life, but this is generally a rare event. The best athletes perform as well as they do because their bodies and minds are in perfect condition for their sport.

For professional golf, a new leader is likely to emerge in the future, and that leader could easily be 21-year-old Jordan Spieth, who ran away from the competition at Augusta this weekend. Tiger was the first very young winner to take the stage. Now, it will likely be someone who is in the young twenties and has great mental strength to deal with the pressure of winning, which sounds a lot like Spieth or Rory McIlroy. I think they’ll be the face of professional golf for the next 5-10 years.

Stem Cell Treatment for Back Pain

October 27, 2014 / Thomas Cohn, MD

Chronic back pain is extremely common in America. About 10 percent of the population has chronic low back pain. In general, 85 percent of the population will suffer from back pain at some point in there lives. In any one year, about 70 percent of the population will seek care for back pain. The economic cost of back pain in the United States is about $200 billion annually. New treatments that could reduce the cost and improve the outcome of back pain, especially pain generated from the discs, is of major interest to patients and healthcare providers.

A recent study published in Pain Physician studied two patients with discogenic low back pain. The authors took stem cells harvested from umbilical cord blood and transplanted them into discs of patients with low back pain. The patients have been followed for two years, and they have had significant improvements in pain and function. They also have had no complications. The patients treated had to fit a slim criteria: No other significant illness, no failure of more conservative care, and only a single disc in the lumbar area that had a tear and caused pain during a discogram. At two years from transplant the discs was returning to a more normalized state. In other words, the stem cells regenerated the normal internal structure and healed the disc.

Stem Cell Study

This study is definitely preliminary, since only two patients participated, but the concept is promising for the future. If we can help the body heal itself and return to normal function, it would be a preferred method to medication that diminishes symptoms or surgery which changes structure and function in the body. The process of harvesting stem cells is complex, and keeping them healthy and from being killed or causing problems once injected are significant long term problems. We also do not know exactly which discs may be helped and at what stage of injury stem cells may be of most benefit. We only know the stem cells have the potential to be a solution in certain situations. Years of further research are necessary to determine how this treatment may work.

The message to take from this research is that there is hope for the future. Scientists and doctors are trying new ideas and some are working. For a certain class of those suffering from back pain related to disc issues, there may be ways in the future to restore the discs back to health with stem cells. That said, the best solution as always is to take care of your body, get regular exercise, and work on building strength in the muscles in the area. There is no free ride with a magical solution. We still need to maintain our health and not overly stress or injure our backs. These solutions are only for limited cases, not for fully herniated discs or those with multiple disc problems.

The Risks of Complications From Pain Injections

October 20, 2014 / Thomas Cohn, MD

Every action has risks and benefits. In the medical world, every medication has risks, and sometimes the risk of doing nothing is worse than treating the issue. This is especially true in many medical conditions such as hypertension or diabetes. The same goes for pain medicine. There are risks and benefits for everything that is done, but there are also many alternatives to treat any particular problem. Choosing the right treatment plan is an individualized decision between the patient and the physician.

Interventional pain treatment has risks and benefits, and there are well known complications from most procedures. The main risks are fairly clear, but there are four complications that arise more often than others. They are:

Infection. Whenever the skin is broken, this is a possibility, and is prevented usually by cleansing the skin with alcohol or special antibacterial soap.

Bleeding. Most procedures are done with a fairly small needle. If a patient is not on a blood thinner or does not have a bleeding disorder, this complication is uncommon.

Allergic reaction. This is rare, but if it does occur, it can be treated.

Damage to another critical structure with the interventional equipment. This can usually be avoided by taking routine precautions and by having a skilled physician preform the procedure.

Complication Likelihood

Recently, a study was done recording complications from many of the common injection type procedures preformed by pain physicians. Almost 20,000 procedures were done, and the rate of anything abnormal was found to be less than two percent. The most common minor problem was a vasovagal reaction (Feeling like one is going to faint). The next most common issue was an increase in pain, which resulted in the procedure being stopped prior to completion. Other notable problems included one serious allergic reaction (1 in 20,000), and 10 dural punctures (1 in 2000). There were no major complications resulting in any serious injury or permanent neurologic damage.

Treating pain is a complex problem. For every problem, there are often multiple options and pathways to improvement. Sometimes, the pain physician may suggest an interventional procedure to help one improve function and decrease pain. As noted above, the risks of most of these procedures are extremely small. The most common issues are feeling faint or light headed and having increased pain during the procedure and temporary increased symptoms. An experienced interventionalist will make the procedure beneficial and minimize risk to the patient.