Healthy KC - What is Physiatric Medicine

What is Physiatric Medicine?

There is no magic to the specialty, it’s a branch of medicine that is constantly evolving AN INTERVIEW WITH C. LAN FOTOPOULOS M.D. DICKSON-DIVELY ORTHOPAEDICS

The debate on whether medicine is an art or science is as old as medicine itself, but is it magic? ‘Mystery, magic and medicine,’

Italian, Russian, Spanish and Arabic. He is a modern-day renaissance man, but he doesn’t practice magic, only medicine.

observed Howard Haggard, ‘in the beginning they were one and the

But what exactly is a Physiatrist? Dr. Fotopoulos explained “We

same.’ Although doctors and magicians have since parted ways,

concentrate on the rehabilitation of injuries. Brain injuries, Spinal

they both want to leave their ‘client’ better off than when they met.

cord injuries, post stroke issues, because of these conditions we

This is Dr. Constantine Lan Fotopoulos’s mission.

specialize in bio-mechanics, muscle and nerve systems, minimally

Dr. Fotopoulos is an interventional physiatrist specializing in minimally invasive and interventional procedures in the treatment

invasive surgeries, rheumatology and neurology. We really have to bring all these disciplines together into a holistic approach.”

of spinal disorders, including epidural injections, vertebroplasty,

Another term for a physiatrist is a Physical Medicine and

kyphoplasty, radiofrequency ablation, spinal cord stimulation and

Rehabilitation (PM&R) physician. Physiatrists treat a wide variety

sacroplasty. He has worked for Dickson and Dively Orthopaedics

of medical conditions affecting the brain, spinal cord, nerves,

for over 14 years. With a background as a diver in the US Navy,

bones, joints, ligaments, muscles, and tendons.

he also has expertise and certification in hyperbaric and diving

“The history of physiatry has generally been that they treat

medicine. Lan, as he is known to his patient’s, experience also

the patient in an in-patient rehabilitation situation after surgery,

includes: previous Team Physician Kansas City Explorers Tennis Team,

traumatic injury or life altering accidents.” Dr. Fotopoulos continued,

previous Team Physician Kansas City Royals Baseball Team, Boxing

“If you go back in history to after World War II amputees

and Mixed Martial Arts Physician for State of Missouri. In addition

were coming back home and nobody knew how to treat them.

to fluency in English and Greek, he has experience speaking

The doctors had to learn this specialty and many of them were

“ The care of traumatic injuries from the past has morphed into what we know today as Physiatry.”

C. LAN FOTOPOULOS M.D.

treated in a rehab hospital and a myriad number of orthpaedic devices were made for their injuries.”

Dr. Fotopoulos emphasized, “The care of these traumatic injuries from WWII has morphed into what we know today as

variety of injuries and be an occupational person, a specialist

playing volleyball to tear your ACL or be a football player to have

“There was a time when a person with osteoporosis was treated

in muscoloskeletal medicine, have knowledge in bio-mechanics

neck pain or a stinger.” Dr. Fotopoulos continued, “That’s the thing

with bracing and bed rest. We stopped doing that years ago because

and so on is what the specialty has evolved into today. Back pain

with Physical Medicine and Rehabilitation (PMR) and physiatry

people started dying from Pneumonia. “For every day of bed rest,

is the most common thing we see.”

you see a variety of injuries. Sports injuries happen to regular

they lost 10% of their muscle strength. So, if you are an 80-year old

physiatry, bio-mechanics and physical rehabilitation.” Dr. Fotopoulos

When asked why did you become a doctor? Dr. Fotopoulos

people and arm-chair athletes too. You don’t have to be working

person staying in bed for 10 days or a month can be devastating

continued, “The polio outbreaks that happened during the 1940’s

replied, “I didn’t really have a choice, my Dad was a general surgeon.

with a jackhammer to get Carpel Tunnel Syndrome. You can get

and it takes a long time to recover.”

and 50’s in children also contributed to the field of Physiatry.”

At one point. I wanted to be a stunt man or a conservationist,

it being on crutches or even using your wheelchair. My job is to help

President Franklin Delano Roosevelt had polio and he discov-

even a CIA agent. I respect the position of a doctor, I was raised

diagnosis the problem and provide rehab solutions.”

ered the magical, healing properties of the hot springs at the

in the old school of medicine. Believing in the team concept

Meriwether Inn in Warm Springs, Georgia. He was desperate

of care.”

One such solution is Vertebroplasty. It is a procedure used to treat painful vertebral compression fractures in the spinal column,

Kyphoplasty is like vertebroplasty, but uses special balloons to create spaces within the vertebra that are then filled with bone cement. Kyphoplasty can correct spinal deformity and restore lost height.

to find anything that would help him walk again so he could run

Dr. Fotopoulos is also Sports medicine doctor. “I do see a lot

which are a common result of osteoporosis. For people with severe,

Radiofrequency ablation (RFA) is a nonsurgical, minimally

for president. He hired physicians and highly trained medical staff

of athletes. I have been lucky enough that I used to work for about

disabling pain caused by a compression fracture, vertebroplasty

invasive procedure that uses heat to reduce or stop the

that pioneered techniques in the field of physical rehabilitation

8 years with the Kansas City Royals professional baseball team.

can relieve pain, increase mobility and reduce the use of pain med-

transmission of pain. Radiofrequency waves ablate, or “burn”,

techniques. The physical therapy techniques that were invented

So, I’m accustomed to taking care of athletes and regular folks

ication. Vertebroplasty is an outpatient procedure for stabilizing

the nerve that is causing the pain, essentially eliminating the

there, such as hydrotherapy, are still used today. The physical

who happen to get sports injuries. We also used to take care of

compression fractures in the spine. Bone cement is injected

transmission of pain signals to the brain.

therapy techniques helped FDR and he shared his success

the KC Explorers World TeamTennis team and a couple of the

into back bones (vertebrae) that have cracked or broken, often

Spinal cord stimulation, unlike RFA, is when you use small

with thousands of other children who were also afflicted with

minor-league hockey teams in the area.”

because of osteoporosis. “The cement hardens, stabilizing the

leads or wires in the epidural space between the vertebrae to

polio. “Physiatry was born about 70 – 80 years ago.” Said Dr.

Dr. Fotopoulos emphasized, “When you think about it, a lot of

fracture. Think of it as putting a cast inside the body to stabilize

send a mild electrical current to the spinal cord. The wires carry

Fotopoulos. “From this initial start after the 1940’s to today the

sports injuries are not just sports injuries. Not just baseball play-

and support the spine. And the clear majority of people are all but

the current from a pulse generator to the nerve fibers of the

natural progression for a physiatrist to treat patients for a

ers get elbow pain or get a rotator cuff tear. You don’t have to be

pain-free the next day.”

spinal cord. When turned on the device stimulates the nerves in

the area where pain is felt. Pain is reduced because the electrical pulses mask the pain signal from reaching your brain. It is a viable treatment option for candidates that have chronic debilitating pain for more than 3 months in their lower back, leg (sciatica), or arm.

“Surgery is not always a good idea and this gives us another tool to help the patient and alleviate pain.”

Sacroplasty is when you use a cement that is injected into the sacrum and the sacrum fracture instead of the vertebral body. It is done for insufficiency fractures to reduce pain and improve stability.

“You can have a compression fracture with osteoporosis, but you can also break your tailbone.”

On the horizon, there are a couple of exciting new procedures.

One is called Vertiflex Superion (for spinal stenosis). It’s a state-ofthe-art device in a class of its own in terms of how lumbar spinal stenosis is treated. This procedure involves the deployment of a small titanium device in between one or two vertebrae to alleviate pain and symptoms related to spinal stenosis. “It restores the height of the bone. Literally it’s like a car jack you put between the vertebrae, almost like a spreader that increases the space between the vertebrae.”

SpineJack® is another new procedure that is intended for internal fracture reduction and fixation directly within the injured vertebral body. To surgically reduce vertebral body fractures created by compression forces, the SpineJack® deploys in a controlled cranio-caudal way, leading to a fracture reduction, while preserving the surrounding bone trabeculae. Once the fracture has been reduced, the SpineJack® maintains the restoration of the fracture.

Dr. Fotopoulos stated “I had a kid who was getting ready to graduate from college, he fell and had a burst fracture on three of his vertebrae. He had a surgery and had to have his vertebrae fused together otherwise he would’ve been paralyzed. A lot of stuff happened and he had no job because of pain, he was living in his Mom’s basement and things weren’t looking good. We put the spinal cord stimulator on him and it helped him get better. I saw him recently and now he has his own place, has a good job and a girlfriend. His life has really turned around and so there is some hope for people with chronic pain.”

“As a whole I like talking to my patients. I learn something from them every day. I get to know them and their family. It’s a rewarding job.” If you have back pain and need Dr. Fotopoulos to diagnose, establish a rehabilitation plan and work his magic, call 913-319-7678, ext. 3109 or check out www.dd-clinic.com.

DICKSON-DIVELY O R T H O P A E D I C S

Saint Luke’s Hospital Campus Medical Plaza Building 1 Ste 610, 4321 Washington St., KCMO and at 3651 College Blvd., Leawood, KS 66211

913.219.7678, ext 3109 • DD-Clinic.com