Dean Serletic’s Post

As a subspecialist who has been performing VA for 20+ years with high success rates, I’m going to give you the secret to my success—and I think most people who do this at a high level would agree. While it seems very basic and foundational to me, it seems a lot of doctors don’t understand this. So here it is. I always confirm pain with the tap test (closed fist percussion followed by isolated spinous process percussion) at every level I ever treat. I mark the spinous process and use a metal bar under fluoroscopy to confirm the precise level(s) each and every time. If a patient is not positive at that specific level—even if they lit up on MRI—I don’t treat it. Why? Because it has healed in the interval and is no longer symptomatic from that fracture. So why do they still hurt? Often a patient comes back with a new interval fracture since the last MRI. If you treat the one that lit up on MRI, but it is no longer symptomatic, the patient will obviously not improve. On the other hand, if you leave fractures untreated and they don’t heal, the patient will continue to have pain. This is such a basic concept, right? Unfortunately, most of my colleagues don’t think this way. A lot of doctors who perform VA operate under what I refer to as an “imaging based diagnosis paradigm” and never lay a hand on the patient. Physical exam is essential when treating VCFs. I examine them every time I see them. When I see a patient converting from a positive to a negative percussion exam at the treated level confirms successful treatment. That’s great and simple if it’s one fracture. But so many patients have multiple fractures. The most common cause of a patient having pain after vertebral augmentation is an untreated level that wasn’t identified. Tap test is about 90% accurate (Langdon et al) whereas imaging misses a lot of clinically symptomatic fractures. The only published study on STIR accuracy in the spine (Lensing) showed a sensitivity at 0.56 for Medicare aged patients. Even if it were 80% sensitive, we would miss one it of 4 if relying solely on imaging. With VA actually being a life saving procedure in about 8% of patients, those aren’t good odds. So I would encourage you when you consider intent to treat for vertebral compression fractures to operate on “physical exam based diagnosis paradigm” rather than imaging. I think this disconnect is one of the primary reasons for the misinformed controversy in the VA literature. #Subspecialist #painspecialist #valuebasedmedicine #osteoporosis #bonehealth #vertebralaugmentation #kyphocube #mskrad #musculoskeletal #interventionalradiology #outpatient #ambulatory

"What is an Amygdala Hijack...#Neuroscience #EmotionalIntelligence #IntegralThinking #IntegralEQ #IntegralCoaching #HumanDevelopment #ProfessionalDevelopment #LeadershipDevelopment #LeadershipMaturity #LeadershipAgility #KnowBetterDoBetter #ActFromAwareness #MindfulnessNotPerfection #BalanceNotPerfection #ProgressNotPerfection🌟🙏💙🌐💙🙏🌟

Mitosis is the process by which a eukaryotic cell divides to produce two genetically identical daughter cells. It is essential for growth, repair, and asexual reproduction. The process is divided into several stages: 1. Interphase (Preparation Phase) Although not technically part of mitosis, interphase is crucial as it prepares the cell for mitosis. It consists of three phases: G1 phase (Growth 1): The cell grows and performs its normal functions. S phase (Synthesis): DNA replication occurs, resulting in two copies of each chromosome. G2 phase (Growth 2): The cell continues to grow and prepares for mitosis by synthesizing proteins necessary for cell division. 2. Prophase The chromatin (a complex of DNA and proteins) condenses into visible chromosomes. Each chromosome consists of two sister chromatids joined at the centromere. The nuclear membrane starts to break down. The centrosomes (organelles that organize the microtubules) move to opposite ends of the cell, and spindle fibers begin to form between them. 3. Metaphase The chromosomes align at the cell's equatorial plane, known as the metaphase plate. The spindle fibers attach to the centromeres of the chromosomes via specialized structures called kinetochores. 4. Anaphase The sister chromatids are pulled apart toward opposite poles of the cell. This occurs when the centromere splits, and the spindle fibers shorten, separating the chromatids. 5. Telophase The separated chromatids reach the poles of the cell. The nuclear membrane reforms around each set of chromosomes, which begin to de-condense into chromatin. The spindle fibers disintegrate. 6. Cytokinesis Although not technically part of mitosis, cytokinesis often overlaps with telophase. It is the final step of cell division. In animal cells, the cell membrane pinches inwards, creating a cleavage furrow that separates the cytoplasm and forms two daughter cells. In plant cells, a cell plate forms, which eventually becomes the new cell wall, dividing the cell into two. Summary Mitosis ensures that each daughter cell receives an identical set of chromosomes, maintaining genetic consistency. The process involves the stages: prophase, metaphase, anaphase, and telophase, followed by cytokinesis, which divides the cytoplasm and completes cell division.

It’s great clinical practice to check on a patient's progress and then deliver a data-driven report. The INSIGHT standardizes your exams and reporting while delivering consistency in care plans. Informed and inspired patients continue their care far beyond their symptoms. Before you know it, you will have created a lifetime patient who not only stays but becomes a tremendous referral source who helps to build your practice. We have made it easy for you. Check out this quick video that shows how straight forward it is to use our prepared sequence of scan reports to show and tell your patients about their progress over time. https://lnkd.in/g6pfVxyN #ChirosOfCLA #adaptation #adjustment #chiro #chiropractic #chiropracticadjustment #getadjusted #healthylifestyle #holistichealth #nervoussystemregulation #neuroAGE #familychiropractic #healingjourney #stress #subluxation #mindbodyhealing #wellness #neuroscience

Like many people who have Epilepsy I often get asked how it feels when I have a seizure? It is very hard to explain with words but it's something I'm finally managing to do, however, experimental moving imagery can certainly help give an alternative insight too. I tend to get a warning before a seizure, and part of that warning feels like a dark fuzzy vibrating feeling, where everything becomes a blur and I feel like my head is spinning, it happens in a split second but I know that when I have it, I need to sit somewhere safe. This is my interpretation of it. #epilepsyawareness #epilepsy #epilepsytalk #neurology #siezures #movingimage #animation #epilepsyeducation

Agree, Jim!!! 👍☺️ The "healed" fractures are not the problem. It's the new interval-adjacent level untreated fractures that are the problem. And then, as you stated, -- there ends up being a scenario where a procedure is performed, and the levels that are painful have been ignored. -- And this leads to a so-called "bad rap" for the procedure and overall process. 😳 This can be avoided by following the guidelines that Dr. Webb has put forth. 👍💯💪 As always, Great discussion!!! Jim!!! 👊🔥

BoneChat discussion 43 covered various topics related to the orthopedic industry, including funding conferences, career advice, industry trends, and the challenges of raising capital in the current economic climate.  https://lnkd.in/eHSxyr2y

I am excited to announce that I presented a poster "Development of Perceptual Grouping Ability in Visually Impaired Humans following Late Sight Onset" at the Society for Neuroscience (SFN) Neuroscience 2024 conference🧠. This research investigates the development of perceptual grouping abilities in individuals with long-term visual deprivation due to congenital blindness (7–20 years, mean age 15.63 years) following sight restoration surgery. Electroencephalography (EEG) data were collected from the Project Prakash (PP) subjects and age-matched healthy controls, while participants viewed displays containing either structured patterns (line segments formed by dots) or non-structured pattern (random dots). ERP responses were examined in the occipital regions before and after surgery, focusing on differentiating structure from non-structure. The findings show that after sight restoration, PP subjects developed the ability to discriminate between structured and non-structured visual inputs, with neural responses comparable to those of control subjects. These results suggest that perceptual grouping skills evolve with visual experience and are not entirely dependent on early visual input, highlighting the brain's capacity for plasticity and visual learning after prolonged blindness. I would like to extend my deepest gratitude to my supervisor, Prof. Tapan K. Gandhi, FNAE, FNASc for his exceptional guidance, unwavering support, and continuous encouragement throughout this research journey. Your mentorship has been pivotal to the success of this work. 👉 Check out the full article here: https://lnkd.in/dNGPE7hS #SFN2024 #Neuroscience #EEG #developmental_study #ProjectPrakash #CognitiveScience #brain_plasticity #conference

BoneChat discussion 43 covered various topics related to the orthopedic industry, including funding conferences, career advice, industry trends, and the challenges of raising capital in the current economic climate.  https://lnkd.in/eprDUBE3

If you've never seen the TED Conferences presentation The Birth of a Word by MIT professor Deb Roy it's one of the all time greats. Humanity is learning, slowly but surely, how children learn language. It turns out that the number of words that a child hears in their early years is critical, in part due to early plasticity in brain structures. Exposure to (lots of!) language in early life sets the child up for a lifetime of puzzle solving that leads to success in life as one of eight billion fancy monkeys. (See: Thirty Million Words: Building a Child's Brain by Dana Suskind  Professor of Surgery and Pediatrics at the University of Chicago Medical Center). In recent conversation with Joseph (Joe) Salesky I was reminded of an axe I sometimes grind a little bit, just to keep it sharp. illumineX has been in the business of building things since 1998. Most people in the business of building new things will at some point discover that those things don't always survive. There are lots of great ideas that come and go because they haven't been coupled to a business model. It can be quite a challenge to figure out how to make an idea, even a great idea, self-sustaining. If you wanted to create a business model which would sustain the project of helping toddlers learn more words, what would you do? https://lnkd.in/dDdW_TPK