In The News - Perlman Clinic

Get Treated at a Walk-In Clinic in San Diego

7/15/2017 - written by Perlman Clinic

What to do when you twist your ankle Saturday morning or your toddler develops a nasty cough in the middle of the night? Of course, you can visit your nearest emergency room, but is it worth it? You run the risk of waiting for hours before being seen, not to mention waiting in a room full of sick people. How much will that visit cost? You weigh up the pros and cons of your apparent two choices – waiting days to be seen at your doctor’s office or potentially waiting hours in an emergency room. You have a third option: consider visiting an urgent care or walk-in clinic. Choose not to suffer through days of discomfort waiting to get an appointment at your doctor’s office, and likewise not to spend hours and hundreds of dollars at an emergency room. There are many differences between a walk-in clinic and an emergency room, and a multitude of reasons that make a walk-in clinic a better choice for many people in numerous situations.

Shorter Wait Times
One of the main benefits of going to an urgent care clinic rather than an emergency room is the difference in wait time. If you have an urgent but non-emergent injury or illness, you will continue to wait at an emergency room as patients with more severe ailments take priority, regardless of arrival time. At walk-in clinics, patients are seen on a first-come-first-serve basis. This fact, among other factors, results in a drastic difference of wait time to be seen by a healthcare professional as well as total time spent at the facility. At a walk-in clinic you can typically expect to be seen by a provider within minutes, and spend no more than 90 minutes in total at the clinic. Although wait times at an emergency room vary, a wait of a couple hours before being seen by a provider can be expected.

More Affordable
The cost of an emergency room visit can substantially exceed a visit to an urgent care clinic, in some cases as much as 20 times the cost of visit to urgent care. Treatments can vary wildly in cost at an emergency room, much more so than in an urgent care facility. Further, if you choose to be seen at an emergency room rather than an urgent care clinic for a “minor” symptom such as a cough, your insurance company may deny coverage and you could be required to pay out of pocket for the visit.

Closer to Home
Walk-in clinics continue to expand, adding more locations and options for the community. With the expansion of these clinics, you will undoubtedly find one convenient for you, close to home or work. For example, Perlman Clinic has four locations, soon opening a fifth!

Longer Hours than Doctors’ Offices
Most physicians’ office hours are between 9-5 Monday through Friday, sometimes open as late as 6 P.M. Considering full-time work and school, it can be difficult to make time for an appointment during these hours. Urgent care clinics are designed to accommodate work and school schedules, providing their patients with extended hours, sometimes including weekend hours.

Better Patient-to-Staff Ratio
Urgent care clinics, like Perlman Clinic, employ a higher number of health care professionals than an emergency room. Beyond the better patient-to-staff ratio generally offered by clinics versus emergency rooms, Perlman Clinic schedules two patients per hour per provider versus a majority of clinics, who schedule between three and five patients per hour. This means their providers can spend more time with patients, answering questions and building a relationship. Patients feel attended to and cared for by nurses and doctors that aren’t distracted and harried.

Patient Education
Another advantage to scheduling fewer patients per provider is the clinics’ availability to provide education to their patients. You will benefit by learning about your diagnosis and treatment, and in some cases be informed when you should seek emergency care or a follow up appointment to monitor your recovery.

More Services than an Emergency Room
Most emergency rooms only provide patients with a one-time visit to service their immediate ailment. Patients are then left to schedule an appointment for follow-up with a doctor who doesn’t know their history, as well as a new set of costs associated. If a referral is needed, we are now looking at a third set of appointments and fees. However, Perlman Clinic offers more services than urgent care alone, including primary care, pain management, integrative medicine, concierge medicine, and endocrinology. There is a confidence in knowing that the same group of people who aided in your immediate affliction will be the same group who will see you back to health. Read our article on the difference between Emergency Rooms & urgent care clinics for more info.

Who Should Use a Walk-In Clinic?
If you are someone experiencing a mild to moderate injury or illness, a walk-in clinic is a great option for a consultation and treatment on a walk-in or appointment basis. Prescription needs, referrals and follow-up visits, as well as additional services will be seen to at a walk-in clinic, and with much less cost and time spent.

Why You Should Avoid Opiates When Treating Chronic Pain

5/15/2017 - written by Perlman Clinic

Have you ever heard of opiate pain pills? This type of pain management solution is prescribed to millions of patients across the US every year, yet in the end, it’s becoming more of a problem for our nation than a solution. There are multiple side effects—including addiction and tolerance.

It can seem appealing to those with chronic pain to simply take a pill to make the pain go away. But the problem is that eventually, opioids can take a toll on the body. Chronic opiate therapy is a bad idea—and pain management centers across the nation are trying to offer alternatives.

The Opiate Problem

An opioid is defined as “a class of drugs that…are chemically related and interact with opioid receptors on nerve cells in the body and brain.” Illegally, opioids can be found in the form of the street drug heroin, while legally, opioids are known as oxycodone, hydrocodone, codeine, morphine, and others. In the short term, opioids are effective and relatively harmless for pain relief. However, opioids tend to produce euphoria alongside pain relief. This aspect of the drugs makes them addictive.

As such, there is an opioid crisis on our hands in this nation. People enjoy not only feeling pain relief, but they like feeling good (the obvious result of euphoria). Many patients who are prescribed opioids in the short term, such as to bring pain relief after a surgery, get hooked on that euphoria and find excuses for being prescribed more. The results have been devastating—in 2014, over 28,000 US residents died after an opioid overdose. The US Department of Health and Human Services has been developing programs to help opioid addicts recover, such as substance abuse treatment centers, mental health counseling, and bringing awareness of the problem to the mainstream.

The Dangers of Chronic Opiate Therapy

While it may make sense to take opioids after a surgery or to help recover after a sports injury, it doesn’t make as much sense to use them to treat chronic pain. Although researchers have found that opioids are effective for treating chronic pain, the side effect of addiction is too high a risk to take.

When considering a treatment for chronic pain, you must take into account that you are talking about a long-term pain solution. This is because the nature of chronic pain is that it lasts longer than three months, and for many sufferers, will never completely go away. If you choose an opiate to treat this pain, you are exposing yourself to the possibility of dependence and even drug resistance, requiring higher and higher does to achieve the same results. The higher the dose, the higher your risk of overdose and death. Dr. Jenny Andrus of Orthopaedic & Spine Center explains:

Ultimately, opiate therapy should not be considered at first when looking at chronic pain solutions. If this is the case, then what else can we use?

What’s a better option?

There are many other ways to treat chronic pain. At pain management centers, you will find a long list of treatment options, most of them medication free. For example, you might find relief from the following treatments:

  • Yoga
  • Chiropractic
  • Dietary changes
  • Biofeedback
  • Guided imagery
  • Acupressure
  • Massage
  • Osteopathy
  • Lifestyle changes
  • Spinal cord stimulation

While most pain management centers tend to combine alternative therapies with some form of medication, most patients are supplied with a multi-disciplinary pain program. Such programs aim to find the combination that works best for the patient. So what works better than opiate therapy for chronic pain? Many things!

For instance, you might find that guided imagery, which teaches you to focus on images that relax you when you start to feel pain, combined with a stretching routine and massage, can turn off the pain signals in your brain. You can also take a more drastic approach by getting a nerve block, which is an injection of numbing medication directly to a nerve.

People with spinal cord pain may benefit immensely from a spinal cord stimulation device, which sends an electric signal to interrupt the pain signals sent by different nerves. Sometimes if the pain is isolated to the musculoskeletal system, a combination of spinal manipulation (chiropractic), acupressure, massage, and stretching may be enough to manage the pain. The point is that there are many alternatives to opiate therapy.

What do you use for chronic pain relief?

In the end, you must do what is best for your body. Sometimes it can be a long journey to discover what treatment options will solve your chronic pain and allow you to live a full life. But ultimately, those options should not involve opiates, at least as much as can be helped.

Nerve Blocks: What Are They and Should I Get One?

4/20/2017 - written by Perlman Clinic

If you have chronic pain, you’ve probably asked around for pain treatment options that might be more effective. In your research, you might have heard of something called a “nerve block.”

There are different types of nerve blocks, varying by the location and intensity of pain. Remember that chronic pain is defined as pain lasting longer than three months. If this describes your pain, and doctors haven’t been able to offer much in the way of a pain solution, a pain management clinic—where nerve blocks are often an option for treatment—might be what you’ve been looking for.

What are nerve blocks?

The goal of a nerve block is pretty clear from the name of this treatment: to block pain signals from nerves. For many, chronic pain is derived from an autoimmune disease, arthritis, an old injury, or another source (usually nerve related). In these cases, there is no specific cure, and a patient’s only option may be to simply manage the pain.

Good thing there are pain management specialists! Many medical companies exist solely to develop pain treatment options, which are in turn provided to the general public through doctors and pain management clinics.

A nerve block, then, becomes an appealing option. This treatment option functions as a local anesthetic or anti-inflammatory treatment, depending on the cause of pain. Nerve blocks are usually administered via injections with the aim of “turning off” the pain signal. Your physician will use image guidance to pinpoint the exact location of the nerve for better results. This type of pain relief is temporary and often administered to the spine, neck, legs, or buttocks. 


Diagnostic Nerve Blocks

Diagnostic nerve blocks are used to discover the nerve sending the pain signals. In a diagnostic nerve block session, a doctor injects anesthesia in one section of skin where they think the pain might be originating. After the injection is complete, they allow time to determine how much the pain has decreased. If the pain is still present, they will inject another site, repeating the process until the pain has significantly decreased.

Diagnostic nerve blocks may take a little time in office, but once a patient shows significant improvement in pain levels after injection to one place, the patient can then plan to receive additional nerve blocks or a radiofrequency ablation to this area in the future without having to repeat a diagnostic session.

Sympathetic Plexus Blocks

It might sound funny to call something inside the body “sympathetic”—it’s like we’re personifying tissue and organs. But that’s not the case at all. The sympathetic nerves are bundles of nerves that run the length of the spine from the neck to the tailbone. These nerves run pretty much all of the body’s organs. Keep in mind that a plexus is defined as “a network of…interlacing blood vessels or nerves,” which is how the sympathetic nerves can be described.

When it is determined that pain signals have been transmitting through these sympathetic nerves, a sympathetic plexus block can be helpful. A sympathetic plexus block is a type of nerve block that seeks to stop the pain signals in these nerves. The plexus block is usually administered with local anesthesia, a needle, and x-rays to determine the exact location of the pain-causing nerve.

Medial Facet Joint Blocks

Facet joint blocks involve injection of anesthetic in order to numb a nerve, just like any nerve block. The important thing about this type of nerve block is its location. The name of this type of block is derived from both the medial branch nerves and the facet joint, where the medial branch nerves send pain signals from injured facet joints—located in the neck or back—to the brain.

Usually a medial facet joint block is injected into one of the small joints which can be found on either side of the vertebrae in the spine. A lumbar facet joint block, for example, is injected into a facet joint on both sides of the lower spine. If more than one joint is involved, you may receive more than one injection. This type of block is common for patients with arthritis in their lower backs.

Do I need a nerve block?

The only way to determine if a nerve block is for you is to talk to your doctor and pain management specialist. If you have chronic pain that might be related to nerves near the spine, a nerve block might very well be within the realm of possibility for your treatment.


Do you suffer from chronic pain?

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