Dr Lee, I am Dr Irfan Tabba, Nephrologist in Karachi, Pakistan, very nice to see your many videos, a dedicated, spreading knowledge, teaching people and your God gift style of delivering & with very good English, I salute you, keep it up, this is one of the biggest service of humanity. Lots of prayers from my side.
excellent videos! I subscribed. In the future can you also include: 1. the degrees of (for example) contralateral/ipsilateral oblique or cranial/caudal tilt? I know it can vary with the patient, but as a new grad, it also helps me learn fluoroscopy. For example, showing us the difference btwn 10 and 20 degrees caudad vs cephalad and how the SEP looks/should look. 2. how much contrast you put in. 3. notes on proper patient positioning/where to put pillows, etc. THANK YOU!!! Your fan
Halo dr. Lee, My Name is Jimmy, Neurologist from Indonesia, I'm very thankful for your video, hopefully you can make regular videos like this. I wanna ask you dr. lee, why do you combine steroid+dextrose? I think that these two have different mechanisms and we can't give them in same time, and How many cc/ml do you mix these? Can we change mepivacaine to lidocain 2% bcoz we dont have mepi in Indonesia. Thank you dr. lee
Dear dr. Lee thank you for sharing your experience: in case of a central stenosis caused by a severe central disc prolapse and severe artrosi at the segment (for example L4-L5), if you want to add an inter laminar injection to release the subarticular stenosis, would you give the inter laminar (with often result in a paramedic positioning of the needle tip) without fear at the same level L4-L5 ? even if we use very little volume (2 ml of steroide mixture for example), we have the risk of expanding a narrowed space ! And very probably it's very easy to puncture the dura with the Quincy or they needle at the same level of the stenosis, because the epidural space there is "virtual" because of the stenosis....Would you select the inferior level for the interlaminar access ?
In case of severe stenosis, dural puncture did not proceed to CSF leaking. So I prefer the patholgic level rather than adjacent easy level. If you notice the dural puncture on site, you need to change the level. If you select the alternative level, the effect of steroid injection is low. In this case, currently I choose facet joint injection with Botox mixture at the stenotic segment. I believe it has longer stay of steroid in the pathologic area and it may modulate the chronic pain by migration to spinal cord horn. thank you.
While it is possible to repeat the procedure every two weeks, it is generally recommended to limit the frequency to no more than six times a year, in order to minimize the potential risks and ensure the best possible outcomes
dextrose는 원액을 50%를 사용하고, 4 % lidocaine에 mix해서 사용합니다. 그래서 대략적으로 40% 정도는 사용합니다만, 때에 따라서 다른 용액을 mix하기 때문에 예를 들면 triamcinolone의 경우도 그렇죠, 정확히 농도를 계산하기는 힘들지만 40% 이하로 농도가 내려갑니다. 이것은 지금 구매할 수 있는 약물의 농도 때문에 어쩔 수 없죠
Hello sir Do you conduct any online / offline workshop for teaching basics of this procedures ? How to find out about this workshop details or online training program schedule ?
Hi, No I do not provide online or offline workshop. but, I have shared the program at the Montpellier university pain diploma course. wwe.paindiploma.org. I wish we can reopen the course soon.
MY NAME IS LUIS AND I AM GETTING THIS PROCEDURE NEX WEEK L5-S1 AND SHOULD I BE CONSERN ABOUT IT WHAT CAN GO WRONG AND HOW LPNG DOES THIS TAKE IMA BE IN SLEEP
Dr Lee, I am Dr Irfan Tabba, Nephrologist in Karachi, Pakistan, very nice to see your many videos, a dedicated, spreading knowledge, teaching people and your God gift style of delivering & with very good English, I salute you, keep it up, this is one of the biggest service of humanity. Lots of prayers from my side.
thank you for your encouragement.
How to become member ? To watch your videos
Thanks for the lesson
thank you
Thanks
thank you
Excellent video. Thanks for the teaching.
thank you
Thank you for this video. I am going tomorrow to the pain management doctor at Sringagarind Hospital, Khon Kean, here in Thailand, for my infections.
Infection is one of the worse complications that we can produce. thank you for watching
Great technique
thank you
Such a great video with lots of educational tips. thank you for your sharing in this video
thanks
Thanks for the lesson doc...
Thank you!!
thank you
I LIKE YOUR STYLE INFORMATIVE PRECISE &UNDERSTANDABLE THANK U HOPE TO HAVE THE PLEASURE. GOD BLESS U. RESPECTFULLY CR ❤😮😅
thanks
thanks for the sincere effort
thank you
thank you. very helpful
Thank you so much for helping us be better doctors, whats the name of you floroscpe how can I buy one ? thank you kindly
www.ziehm.com/en/home.html. ziehm imaging.
excellent videos! I subscribed. In the future can you also include:
1. the degrees of (for example) contralateral/ipsilateral oblique or cranial/caudal tilt? I know it can vary with the patient, but as a new grad, it also helps me learn fluoroscopy. For example, showing us the difference btwn 10 and 20 degrees caudad vs cephalad and how the SEP looks/should look.
2. how much contrast you put in.
3. notes on proper patient positioning/where to put pillows, etc.
THANK YOU!!!
Your fan
thank you. I will try it in the feature
thanks
thank you for watching
These things destroyed my life! No joke!
I don't understand
Halo dr. Lee, My Name is Jimmy, Neurologist from Indonesia, I'm very thankful for your video, hopefully you can make regular videos like this. I wanna ask you dr. lee, why do you combine steroid+dextrose? I think that these two have different mechanisms and we can't give them in same time, and How many cc/ml do you mix these? Can we change mepivacaine to lidocain 2% bcoz we dont have mepi in Indonesia. Thank you dr. lee
You can watch some videos about the dextrose in my youtube channel. there is a reason.
Dear dr. Lee thank you for sharing your experience: in case of a central stenosis caused by a severe central disc prolapse and severe artrosi at the segment (for example L4-L5), if you want to add an inter laminar injection to release the subarticular stenosis, would you give the inter laminar (with often result in a paramedic positioning of the needle tip) without fear at the same level L4-L5 ? even if we use very little volume (2 ml of steroide mixture for example), we have the risk of expanding a narrowed space ! And very probably it's very easy to puncture the dura with the Quincy or they needle at the same level of the stenosis, because the epidural space there is "virtual" because of the stenosis....Would you select the inferior level for the interlaminar access ?
In case of severe stenosis, dural puncture did not proceed to CSF leaking. So I prefer the patholgic level rather than adjacent easy level. If you notice the dural puncture on site, you need to change the level. If you select the alternative level, the effect of steroid injection is low. In this case, currently I choose facet joint injection with Botox mixture at the stenotic segment. I believe it has longer stay of steroid in the pathologic area and it may modulate the chronic pain by migration to spinal cord horn.
thank you.
But Its
easy confirmation by lateral view !?
Thanks
I recommen contralateral oblique view
dr. Lee, I still hv 1 question, can we repeat this procedure? and what is the exact duration to repeat this procedure when we using steroid?
While it is possible to repeat the procedure every two weeks, it is generally recommended to limit the frequency to no more than six times a year, in order to minimize the potential risks and ensure the best possible outcomes
Thank you dr lee
선생님 영상이 이미지트레이닝에 아주 좋아 큰 도움 받고 있습니다. 궁금한 점이 dextrose가 나래이션에서는 50% 하시고 화면에는 30%로 적혀 있던데 어떤게 맞을까요?
dextrose는 원액을 50%를 사용하고, 4 % lidocaine에 mix해서 사용합니다. 그래서 대략적으로 40% 정도는 사용합니다만, 때에 따라서 다른 용액을 mix하기 때문에 예를 들면 triamcinolone의 경우도 그렇죠, 정확히 농도를 계산하기는 힘들지만 40% 이하로 농도가 내려갑니다. 이것은 지금 구매할 수 있는 약물의 농도 때문에 어쩔 수 없죠
@@practicalpainmanagementwit8115 아하 전체 dextrose 농도는 결국 40% 미만이겠군요. 자세한 설명 감사드립니다.
Hello sir
Do you conduct any online / offline workshop for teaching basics of this procedures ?
How to find out about this workshop details or online training program schedule ?
Hi, No I do not provide online or offline workshop. but, I have shared the program at the Montpellier university pain diploma course. wwe.paindiploma.org.
I wish we can reopen the course soon.
Please avoid music in videos sir.. it's a wonderful video.. but music made it difficult to follow
old video. I can not fix it. Sorry
MY NAME IS LUIS AND I AM GETTING THIS PROCEDURE NEX WEEK L5-S1 AND SHOULD I BE CONSERN ABOUT IT WHAT CAN GO WRONG AND HOW LPNG DOES THIS TAKE IMA BE IN SLEEP
what is LPNG and IMA. I don't think sedation is an good idea. It increase the risk of nerve root injury.
I WANTED TO SAY THAT I DID NOT GET THIS INJECTION AND WHAT U MEAN ABOUY THAT
Good video but Background music is disturbing...
Sorry for that. it was old videos.
Do you provide online training ? How can I join with you?
I am sorry I do not provide online training
@@practicalpainmanagementwit8115 How about in clinic training if I go to Korea? So do you provide any training if I want to learn from you please?
@@kimdamrong8350 I try to post every procedures in my practice. and it is the only thing I can do for you. sorry.
hello dear friend where are you at? thank you !!!
👍👍👍
thank you