Patient Education

Breaking Free from Pain

A lengthy search for answers leads patient to Cleveland Clinic Center for Spine Health – and relief

For 30 years, Valerie Stapleton compromised her life due to pain that came and went in her neck and shoulder. From its start as discomfort, the pain escalated to tremendous suffering, leaving the self-taught artist unable to pick up a brush or function in everyday life.

Through the years, Ms. Stapleton, 67, sought medical opinions at various hospitals and received care near her home in Chillicothe, Ohio. Doctors told her that scans of her neck area indicated cervical dystonia, a neurological movement disorder. That explained why her head persistently and uncontrollably turned to the left. This condition was caused by a traumatic injury in 1979.

Constrained by her neck spasms, “I had a lot of embarrassment,” Ms. Stapleton recalls. “I didn’t like to go out in public or eat out in restaurants. I knew this was something I had to live with, so I accepted it and tried to overcome it.”

A Needed Referral

Ms. Stapleton suffered alone, as many artists do, and never relied on medication to ease her pain. “Artists are tough,” she says simply. “I didn’t focus on what I was feeling or what my body was doing—that was the only way I made it through the years and progression of pain.”

But Ms. Stapleton’s condition worsened in March 2009. Her weight had dropped from 123 to 102 pounds. She couldn’t eat and could barely walk. And, she was frustrated that repeated visits to doctors uncovered no definitive answers to why the pain in her neck had crept to her shoulder and disabled her so she couldn’t drive, do yardwork or create art. That summer, a good friend urged Ms. Stapleton’s doctor to refer her to Cleveland Clinic Center for Spine Health.

"Get Me to the Right Doctors”

In September 2009, Ms. Stapleton saw medical spine specialist E. Kano Mayer, MD. He and a team at the Center for Spine Health found a fracture in Ms. Stapleton’s neck—a loose vertebra that was causing the pain. She needed a cervical fusion, which involves stabilizing the neck with screws and pins, and a bone graft.

“They said the cervical fusion would be like a needle holding my vertebra to my skull,” says Ms. Stapleton, relieved that someone finally nailed the cause of her pain. “I was crying and I said, ‘I prayed that God would get me to the right doctors.’"

Ms. Stapleton prepared for surgery in November. She was startled at just how close to death she had come. “Dr. Mayer told me before surgery that no matter what I did, I had to be careful not to fall,” she says. “If I fell, I could have caused the spinal cord to break and I could have died instantly.”

Spine surgeon Ajit Krishnaney, MD, performed the procedure and within two days, Ms. Stapleton was ready to leave for physical therapy in Marietta, Ohio, closer to her home. “The doctor couldn’t believe how well I bounced right back after surgery,” she says.

A Life Reclaimed

Today, Ms. Stapleton is catching up on chores at home and getting accustomed to moving her body differently now that her neck is stabilized. Her shoulder pain is gone. “They literally saved my life and took away all that horrible pain,” she says.

Now, Ms. Stapleton doesn’t have to compromise her lifestyle. She isn’t back in front of her easel yet, but her artistic gifts include her way with words: She is also a poet. “I’m very grateful,” she says quietly. “There are not enough thank yous in the world for my doctors at Cleveland Clinic.”

Fighting Severe Back Pain with Alternative Therapies

Jan Kodish always led a full, active life. She used to clock 200 to 300 miles on her bicycle every week. She has a border collie-German shepherd mix—“80 pounds of personal protection,” she jokes—that demands daily walks.

But over the years, her activity level dropped as deep back pain set in and restricted her lifestyle. “I could not do simple tasks comfortably, like go to the grocery store,” says Ms. Kodish, 54, of Mayfield Heights, Ohio. “I couldn’t even lean on the cart to give me momentum to do my shopping. I just could not stand up. It got progressively worse.”

Ms. Kodish never experienced a car accident or injury. The pain was unexplainable—until her internal medicine doctor, J. Harry Isaacson, MD, referred her to the Center for Spine Health at Cleveland Clinic, where she was seen by medical spine specialist Tagreed Khalaf, MD.

“Ms. Kodish presented for an evaluation of low back and leg pain,” says Dr. Khalaf. “Prior to her evaluation, she was unsure of the cause of her symptoms and her function was significantly limited.”

After an appropriate evaluation and work-up, Dr. Khalaf diagnosed a triple pain. Ms. Kodish had lumbar stenosis (narrowing of the spine), osteoarthritis and a bulged disc all in the same spot.

Relief without Drugs

Though Ms. Kodish has worked the last 35 years as an administrative secretary at Cleveland Clinic Lerner Research Institute, she was unaware of the array of services available to her as a patient with severe back pain. Motivated to avoid medications and find alternative solutions for managing her pain, which she rated a 9 on a scale of 1 to 10, she was willing to try anything.

Dr. Khalaf first recommended physical therapy. When that alone did not provide relief, she prescribed cortisone shots to reduce inflammation caused by the bulged disc. At first, the injections eased Ms. Kodish’s pain—but not for long. Dr. Khalaf suggested trying acupuncture, the traditional Chinese medical practice of inserting and manipulating needles at various points.

“I was at the point where I would have done anything to relieve the pain, and I was desperate and hopeful that it would work,” Ms. Kodish says.

At first, she received acupuncture weekly in 15- to 20-minute sessions. Then, her treatments tapered to biweekly for a half-hour and, eventually, to a monthly regimen.

“I was put at ease by the doctor, who completely understood my arthritic pain and used charts to explain where they put the needles into different nerve points,” says Ms. Kodish, describing her first acupuncture experience with Daniel Mazanec, MD, Associate Director of the Center for Spine Health.

Ms. Kodish brought her own music and relaxed during the therapy, feeling comfortable and euphoric. “I slept well the next night and felt ongoing relief,” she says. “My pain level went down over the months from 9 to maybe a 3.”

Getting Back in the Game

Ms. Kodish wanted to pair acupuncture with physical therapy so she could get back to her active lifestyle. She enrolled in an eight-week pool therapy program through Cleveland Clinic’s Department of Physical Medicine and Rehabilitation and worked one-on-one with a therapist. She also entered a core strengthening program to improve her posture and better align her back.

“It’s not just one thing that’s helping—it’s everything,” she says. “It’s like building a house.”

So, with Dr. Khalaf’s consent, Ms. Kodish layered another treatment on her regimen: an anti-inflammatory diet. The plan eliminates foods such as sugars, dairy products and meats that trigger inflammation. “I’m probably the healthiest I’ve ever been,” Ms. Kodish says. “For someone with a strong history of a sweet tooth, I feel calmer.”

A New Lifestyle

Today, Ms. Kodish adheres to her diet, swims five days a week and revisits acupuncture therapy when her pain flares up. She often can predict the “bad days” when her osteoarthritis triggers discomfort because weather is usually the culprit. But now she knows how to work through that pain.

“Every step of the way, I was grateful to have people here who were kind and could guide me to bring the horrible pain down to a manageable level,” she says of her care at Cleveland Clinic.

Ms. Kodish is biking again, though not competitively and in moderation. Meanwhile, her dog, Sam, enjoys evening walks. Ms. Kodish has learned to pace herself, and lifestyle changes have enabled her to control the pain without medications—her ultimate goal.

“Ms. Kodish has done well with the variety of treatment options available. Her significant improvement is a reflection of her dedication, hard work and compliance with her home exercise program,” Dr. Khalaf says.

Ms. Kodish has encouraging advice for others suffering from chronic pain: “Keep trying. Do not give up. The answer is not always in a pill.”

Our physicians work closely with physical therapists and occupational therapists to develop a complete, individualized treatment plan for each patient that considers his or her diagnosis, lifestyle and treatment goals. We take pride in working as a team to achieve the best possible outcomes for our patients.

Seventh-grade English teacher W. Clark Pollitt used to struggle to walk to the school cafeteria at lunch time. No, it wasn’t the prospect of institutional food that slowed him down. It was a tumor that was thought to be inside his spinal cord.

Mr. Pollitt, 35, had always been athletic, and when he began noticing a decrease in his running abilities, he became concerned. When pain in his back stopped him from running in November 2008, he went to see a doctor near his home in Louisville, Kentucky. The physician diagnosed a schwannoma, or tumor, on Mr. Pollitt’s spine. As they discussed scheduling the procedure to remove the tumor, the physician offered a grim outlook.

“He said the surgery could leave me unable to walk or control my bladder,” Mr. Pollitt recalls. Internet research on the topic delivered a similarly scary prognosis. Mr. Pollitt shared his concerns with Paul Rychwalski, MD, a friend who coached soccer with him. Dr. Rychwalski, a pediatric ophthalmologist, was in the process of moving to Ohio to join Cleveland Clinic Cole Eye Institute. After some investigation, he steered his co-coach to Edward Benzel, MD, Chairman of Neurosurgery at Cleveland Clinic. Mr. Pollitt made the six-hour drive to see Dr. Benzel, and never looked back.

“Dr. Benzel set me up for a full day of testing and analysis before surgery, including a more precise MRI that revealed something the doctors in Louisville had not caught: My tumor was actually outside the spinal cord itself,” Mr. Pollitt says. “This new diagnosis brought much more hope for a more positive outcome and left me feeling much better on the day of surgery.” Like the doctor in Kentucky, Dr. Benzel described the negative outcomes that could result from the procedure, but he did so in a way that left Mr. Pollitt and his wife, Megan, feeling fully informed and not frightened.

“He was very realistic with us, and he took the time we needed to get answers to all of our questions,” Mr. Pollitt says. “We were there a full hour. You know how some doctors have their hand on the doorknob while they talk to you? He never did that.” The tumor was in the spinal canal in Mr. Pollitt’s lower back, Dr. Benzel told him. It was pushing on the spinal cord, and could have caused paralysis if not removed. Dr. Benzel explained that the surgery has two distinct phases. First is a laminectomy, which involves removing the roof of the spinal canal. This procedure is commonly performed on people with spine disorders. Its use for spine tumors is relatively uncommon, due to their relative rarity. The next step, Dr. Benzel explained, would involve opening the dura, or sac surrounding the spinal cord, to remove the tumor. “This second part is a very intricate and delicate procedure,” he noted.

Mr. Pollitt underwent the surgery on Tuesday, Dec. 30, 2008, and left the hospital the following Saturday. He stayed in the area with his wife’s family for a week and a half before heading back to Kentucky to resume his active lifestyle. “Despite having been a runner and soccer player for many years, in the weeks before the surgery I had been reduced to no running at all and only walking short distances,” he recalls. “I would walk to my mailbox, get the paper and have trouble making it back up the driveway. Within two weeks of the surgery, I was walking two to four miles a day, and soon started jogging most of that same two-mile route, with only short intervals of walking.”

At a follow-up appointment in early February, Mr. Pollitt asked for and received permission to go skiing in Jackson Hole, Wyo., with his wife and children: Alex, 7, and Lily, 5. “I was able to ski – and ski well,” he says. “Six weeks out of surgery, I skied exactly like I did before surgery and I was thrilled. I skied black diamonds and I skied mogul runs, and I never felt one ounce of pain in my back.”

Looking back, Dr. Benzel notes whimsically, “Black diamond and mogul skiing was not what I envisioned when I said it was OK to ski – but Mr. Pollitt knew his limitations and did not exceed them.” In fact, the biggest postoperative challenge Mr. Pollitt faces is getting his leg muscles back in shape after the deterioration they sustained when pain made it impossible for him to exercise.

“I have set a personal goal of jogging a 5K race by July 4 – which, thanks to Dr. Benzel and Cleveland Clinic Center for Spine Health, I plan to achieve!” he says.