For anyone, losing the ability to do the activities that you love can be disheartening. Whether you no longer have the ability to participate in an intense sport or simply go for a walk around the yard, it can have serious physical and psychological complications.
Such is the case for many people suffering from spinal pain. Because of their discomfort, either mild or severe, they lose touch with their passions, and, ultimately, themselves. Their mobility becomes limited and their quality of life disappears.
For those in the Four Corners area, Spine Colorado offers patients hope to recapture that quality of life and return to their old ways. By exploring all non-operative options before recommending surgery, they look to create positive patient outcomes that get people back to doing what they love.
A common first stop for new patients is physiology, where they may see Dr. James Santos. An expert in patient-centric treatment, he sets people on the road to long-term recovery by helping them control their condition through diet, exercise, education, and more.
Waves, mountains, and medicine
Like others at Spine Colorado, Dr. Santos took an interesting and winding journey into his work in medicine. After earning his bachelor’s degree at University of Texas, he followed in his father’s footsteps and entered dental school. But after 3 years, he decided that dentistry wasn’t for him and entered medical school at his alma mater.
He then received a Navy scholarship and completed his internship at the Oak Knoll Naval Hospital in Oakland, moving on to three years of active duty in New Hampshire.
In the Navy, Dr. Santos was trained to be a diving medical officer, otherwise known as an undersea medical officer. He says, “operationally, I would have been treating Navy divers, SEALs, and crew from submarines. But, most of my practice ended up being during peacetime, so I essentially worked family practice at my clinic in Portsmouth.”
After leaving the Navy, Dr. Santos was initially interested in orthopedics, but eventually moved towards physiatry. “I started to gravitate more towards non-operative care, and physiatry combined a lot of what I was interested in: sports medicine combined with some pain medicine.”
Following his passion, he completed his residency in physical medicine and rehabilitation at the University of Utah and practiced for 14 years in Albuquerque.
He was presented with an opportunity at Spine Colorado through one of his current partners, Dr. Bohachevsky, and jumped at the chance to join the team in such picturesque country. “My wife and I spent most of our winters in this area,” he says, “we lived in Santa Fe at the time, but we wanted to get a little closer to the mountains. So, it wasn't too hard of a decision to come into Durango, as it is for most people.”
Physiatry in action
Working at Spine Colorado, Dr. Santos sees a variety of spinal issues ranging from mild to severe. His patients come in seeking treatment from top to bottom—neck pain, associated neurologic arm pain, acute and chronic back pain, all the way to sciatic pain in the leg.As a physiatrist, his role is to provide non-invasive treatment options to improve patient quality of life. Focusing on rehabilitation over surgery, he creates individualized treatment plans to reduce pain and improve patients' mobility, strength, and overall functionality.
Before treatment begins, Dr. Santos works up a comprehensive patient evaluation in order to create a personalized treatment plan. “Our approach as physiatrists is to first do a full history and physical on each of our patients with appropriate diagnostic testing,” he says, “this could be MRI, imaging, X-rays, or possibly electro-diagnostic studies.”
Using the results, he designs a treatment plan tailored to each patient’s specific needs, recommending physical therapy, medicine, or injections on a case-by-case basis.
For many patients, physical therapy is the first course of action, as it usually addresses both the symptoms and the underlying causes of patient spinal conditions. Dr. Santos says, “typically, we have most of our patients go through physical therapy and see how they respond. If they do respond, then most of our patients will continue with the exercise program.”
If they don’t respond, medicine is explored as a treatment option, although in a limited capacity. “Medications are always a part of our treatment options,” he says, “but I tend to not try to prescribe too many medications, only what's necessary to help achieve some pain reduction.”
Addressing pain at the source
But if neither physical therapy or medicine create success individually, Dr. Santos relies on injections as a treatment option to reduce pain, improve function, and more.
Just as they sound, spinal injections are localized, targeted injections to the origin of pain in the spine. When used in tandem with physical therapy or medication, they can effectively reduce inflammation and manage a wide variety of levels of discomfort.
Spine injections also serve a dual purpose, providing Dr. Santos with diagnostic information about the exact location of patient pain, allowing for a more comprehensive treatment. Using the data from the patient evaluation, he decides the most likely spot, makes an injection, and monitors patient results. He says, “If the response is positive, then we know that's where the pain is coming from. If there’s no response to the spine injections, and we usually go after some other targeted area”
While they all seek to create results, the type of injection that Dr. Santos uses depends on the location generating pain.
For neck or low back pain that doesn’t radiate into the limbs, Dr Santos treats with injections in the facet or sacroiliac joints. This can provide relief from Axial Pain, which usually focuses around the spine and is characterized by an aching, dull soreness.
To treat patients with joint pain, Dr. Santos uses a common technique known as radiofrequency ablation, managing pain by targeting the cells responsible for transmitting discomfort. Dr Santos explains that “This is a procedure where small nerves are targeted using x-ray. And these nerves can be cauterized with a needle tip, essentially interrupting pain signals coming from the Fustat joints,” he says. “It can give long lasting pain relief from six to 18 months.”
He also commonly addresses radicular pain in the neck or the lower back with injections. This usually results from an impingement like a herniated disc, so it’s very helpful in uncovering the exact location of the issue.
Ultimately, Dr. Santos’ overall goal with injections is to avoid surgery for as many patients as possible. “Before any surgical options are usually considered, we do try injections to help not only pinpoint which nerve might be the one affected and causing the pain, but also to achieve therapeutic results with long-lasting reductions in pain, thereby avoiding surgery.”
Individualized patient care and outcomes
For Dr. Santos, surgery is always a last resort, but it’s ultimately up to how the patient responds to their personal treatment plan. Spine Colorado will try everything non-operatively before they have a patient go for a consultation with a surgeon like Dr. Martyn, making the right approach a balancing act between patient tolerance and their response to treatment.
When it comes to the spine, pain and discomfort are generally very subjective and personal, so non-invasive treatment creates outcomes that work for some, but not for others. Dr. Santos says that “if patients can manage the pain to the point where they can enjoy life and not be miserable, then we've achieved our goal. But, a few of our patients find that they are still having a lot of difficulty in their activities in life, and end up going into surgery because they did not respond to any of the non-operative treatment.”
This balance between quality of life and pain tolerance is at the core of nonoperative medicine. Just as treatment plans are individualized, client results are also very case-by-case depending on their threshold and physiology. Dr. Santos notes, “Some people just respond to that one session of physical therapy, other people, multiple sessions of physical therapy plus medications and injections, and some people eventually require surgical options, but the goal is still the same. We want to improve their quality of life.”
To that end, he notes that there’s no silver bullet for back pain, but his treatments provide the relief that brings the lives of patients back to normal. “One of our jobs is not to eliminate the pain, but to manage the pain so that people can get back into life and do all the things they like to do without severe pain. Sometimes that means elimination of the pain, but a lot of times that can mean just reduction of pain, or it's a manageable level.”
Impactful community work in Durango
When treating patients, Dr. Santos appreciates the rewarding nature of working with the community in Durango. Because the locals live such an outdoor lifestyle, he has a deep understanding of what they may be missing out on as a result of their pain.
This outdoor lifestyle was what drew him to the area in the first place, and he remains an avid outdoorsman outside of his practice. He was originally drawn to the area for its winter sports, even before he lived in Durango full-time. “My wife and I spent most of our winters snowboarding, skiing, ice climbing, or rock climbing in this area,” he says.
Now that he has his summers in Durango as well, he enjoys everything that the area has to offer —year round. “Outside of work, I spend a lot of time outdoors,” he says, “In addition to snowboarding and rock climbing, my wife and I are avid mountain bikers too. That's how I spend most of my time and that's how I unwind.”
Because he enjoys much of his time exploring the wilderness in Durango, he also finds it immensely rewarding to get locals back to doing the activities they love. “I've seen the effects that chronic pain or acute pain have on people's activity levels—especially in this very active community. You have a lot of people who are devastated that they can't get back into their sport because of pain. It is motivating to help those people recover from spine pain so that they can get back into their activities, which, understandably, are very important to them.”
He also finds it gratifying to work with Durango’s older, less mobile patients and getting them back to doing their favorite activities. He says, “knowing that they're getting back richness into their life, their gardening or their social activities, is also satisfying. We see people return to having that quality of life.”
He notes that although an active lifestyle is important in spinal health, problems are also caused by the natural changes caused later in life. “Degenerative changes in the spine are an aging process that we all go through, and they don't always cause pain. But when it does cause pain, it can become chronic. One of our jobs is not to eliminate the pain but to manage it so that people can get back into life, get back into exercise, get back to work, and do all the things they like to do in life without severe pain.”
That being said, he does believe that a healthy Durango lifestyle is the best deterrent for acute or chronic spine pain. Although spine health isn’t guaranteed, exercise, a good diet, and healthy weight loss are the best things to keep people out of the clinic. “That exercise did you do? That's the most important thing,” he says, “Often times, people who haven't maintained themselves get hurt. We try to get them back into the same routines of good exercise and keeping the weight off and eating right. Good lifestyles.”
Returning quality of life
As a physiatrist at Spine Colorado, Dr. Santos’ non-operative approach and individualized treatment plans make a difference in the lives of patients. By approaching spinal discomfort with physical therapy, medicine, injections, or a combination of treatments, he looks to create long-lasting reductions in pain that avoid surgical outcomes.
More importantly, he seeks to give patients back their quality of life by reconnecting them with the activities they love. By addressing pain at the source, Dr. Santos can get them back to places they enjoy—whether that’s working in the backyard or exploring the Great Outdoors.
Schedule an appointment and begin to restore your quality of life.