A laminectomy is a surgical procedure typically performed on patients with spinal stenosis that suffer from chronic back pain. A laminectomy makes the spinal canal larger, reducing pressure on the spinal nerves. The bony arch at the back of the spine that covers the spinal canal (lamina) is removed at the site of nerve irritation. Your neurosurgeon will also remove any bone spurs from around the nerves, reducing irritation and inflammation they have caused. It may be necessary to remove part of the facet joints or part of the discs as well.

As we age, bone strength decreases and can cause fractures in the spine called vertebral compression fractures. A vertebral compression fracture occurs when too much pressure is placed on a weakened vertebrae, and the front of it cracks and loses height. They can result from a fall or doing everyday things such as reaching, coughing, or sneezing. In many cases, people get better with conservative treatment such as rest, medication, or a brace. If you are suffering from severe back pain from a recent fracture that is not responding to non-surgical treatment, your doctor may recommend kyphoplasty. This minimally-invasive procedure repairs a vertebral compression fracture. It helps restore the spine’s natural shape and some patients experience rapid pain relief after the procedure.

Before the procedure, you are anesthetized. The physician guides a needle through the skin of your back and into your fractured vertebrae. A special x-ray device called a fluoroscope helps the physician position the needle. A balloon device is placed into the vertebrae through the needle. The physician inflates this balloon to expand the fractured bone. When the balloon is deflated, it leaves a cavity in the middle of the vertebral body. Once the balloon is removed, the physician injects bone cement through the needle. This cement fills the cavity and hardens inside the vertebral body, stabilizing the fracture.

What is a facet joint injection?

The facet joints, found on both sides of the back of the spine, can become irritated and painful. A facet joint injection may help diagnose the source of a patient’s pain, or may be used to relieve pain and inflammation.

What is radiofrequency ablation?

Radiofrequency ablation (RFA) is a procedure used to provide longer term back pain relief than that provided by simple injections or nerve blocks. This procedure is also called radiofrequency neurotomy or radiofrequency rhizotomy. It can treat pain that doesn’t respond to medications or to physical therapy. By selectively destroying nerves that carry pain impulses, the painful structure can be effectively denervated and the pain reduced or eliminated for anywhere from a few months to up to 12 months.

Radiofrequency waves are electromagnetic waves which travel at the speed of light, or 186,000 miles per second (300,000 km/s). Radiofrequency Energy is a type of heat energy that is created by a special generator at very high or super high frequencies. With the use of this specialized generator, heat energy is created and delivered with precision to target nerves that carry pain impulses. The resulting “lesion” involves a spherical area of tissue destruction at the tip of the RF needle that can include pain-carrying nerves.

Once a structure has been determined to be a pain generator, its nerve supply is targeted for interruption. A small insulated needle or RF cannula is positioned next to these nerves with fluoroscopic guidance (live video X-Ray). Your doctor knows where to place the RF cannula because he is an expert in anatomy. The shaft of this cannula except for the last 5 to 10 mm is covered with a protective insulation so that the electric current only passes into the surrounding tissues from the very tip of the cannula. When the cannula appears to be in good position, the doctor may perform a test and release a small amount of electric current through the needle tip at two different frequencies. This test helps to confirm that the cannula tip is in close proximity to the target nerve and that it is not near any other nerve. After a successful test confirms good cannula tip position, a local anesthetic is injected to numb the area. The RF generator is then used to heat the cannula tip for up to 90 seconds, and thus the target nerve is destroyed.

There are a multitude of chronic pain conditions that respond well to this treatment. Chronic spinal pain, including spinal arthritis (spondylosis), post-traumatic pain (whiplash), pain after spine surgery, and other spinal pain conditions are those most commonly treated with RFL. Other conditions that are known to respond well to RFL include some neuropathic pain conditions like Complex Regional Pain Syndrome, (CRPS or RSD), peripheral nerve entrapment syndromes, and other assorted chronic pain conditions. A patient’s candidacy for RFL is usually determined by the performance of a Diagnostic Nerve Block. This procedure will help to confirm whether a patient’s pain improves just for the duration of the local anesthetic (or not). Patients who have little to no pain relief after a diagnostic nerve block are not candidates for a neurodestructive procedure like RF Lesioning.

Is this procedure painful? 

This procedure can be moderately painful, it ranges from mild to severe, but typically severe pain is for a minute or less. Patients are often given mild intravenous sedation during the procedure, but sedation is not absolutely required. Deep sedation is not a safe alternative and is therefore not offered for RFA procedures. It is quite common for neck or back pain to increase for a few days or longer after before it starts to improve.

What should I do to prepare for my procedure?

If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you are receiving IV sedation, follow the instructions from your doctor or nurse on limiting food and beverages before the procedure. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure. If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox.

What should I do after my procedure?

Following discharge home, you should plan on simple rest and relaxation. If you have pain at the needle puncture sites, icing this area should be helpful. If you receive intravenous sedation, you should not drive a car until the next day. Patients are generally advised to go home and not return to work after this type of procedure. Some patients do return to work the next day.

Could there be side effects or complications?

Your physician will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed.

Can this procedure be repeated if my pain returns?

It is possible for the treated nerve(s) to regenerate, which could lead to recurrent pain. However, this procedure is repeatable for nerve regeneration if it worked the first time around.

What are epidural steroid injections?

Conditions such as herniated discs and spinal stenosis can compress nerves, causing severe pain and inflammation. An epidural steroid injection may reduce inflammation and provide back pain relief, while avoiding the need for surgery to fix the problem.

The procedure is performed with the patient lying down. A region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle. Using x-ray guidance (also called fluoroscopy), the physician guides a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel. A contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves. Then the anti-inflammatory steroid is injected and absorbed by the inflamed nerves to decrease swelling and relieve pressure. Some patients may need only one injection, but it may take two or three injections to provide significant pain relief. 

As one of the most commonly used non-invasive and conservative treatments for a variety of cervical spine issues, the injections are known to provide comfort for more than half of those who use them, and they can be safely repeated if pain returns or if therapy needs to progress a bit farther for the best outcome.

As part of its ongoing effort to ensure all people feel welcome at its facilities, St. Charles Health System has named Dr. Shilo Tippett as its first manager of caregiver inclusion and experience.

Tippett will oversee the organization’s work to establish and grow a culture of inclusion, diversity, equity and acceptance (IDEA) for St. Charles patients and employees – work that is central to the health system’s vision of creating America’s healthiest community, together, said Jody Saffert, director of People and Organizational Development for St. Charles.

“We already had a grassroots effort of caring, compassionate and committed caregivers who wanted St. Charles to be a more inviting and inclusive place to work and receive care,” he said. “Securing resources and action behind this commitment is what advocates of this work want and need to see. It can’t just be words on paper – action is needed.”

Tippett is a Central Oregon native, a resident of Madras and a member of the Confederated Tribes of Warm Springs. Before taking her new job, she spent seven years practicing as a clinical psychologist at St. Charles’ Madras Family Care Clinic, where she had daily interactions with the people in her community. But when she saw that the health system was hiring an IDEA manager, she knew it was her opportunity to make a broader impact on St. Charles and the region it serves.

“There’s a lot of research showing that bringing in more people with different backgrounds and experiences brings more creative ideas and satisfaction to a workplace,” Tippett said. “And the more diversity we have among our caregivers, the stronger we’ll be and the better care we’ll provide for our patients.”

Bringing more diverse workers to a predominantly white area will be a challenge, but Tippett believes St. Charles’ status as Central Oregon’s largest employer means the organization has an opportunity to make an outsized impact on the community by leading the way.

“If we start to set the tone for what diversity and inclusion looks like in our communities, we are definitely going to make a difference,” she said. “It's not going to happen overnight, of course. It’s going to take a sustained effort. But when I think about how much St. Charles can accomplish on this front and how we can affect Central Oregon, I’m excited about it.”

Tippett will work closely with the health system’s IDEA Council, a group of caregivers that formed five years ago to focus on IDEA-related initiatives at St. Charles. The caregivers are passionate about the work, but they all fit it in around their other personal and professional duties, said Carlos Salcedo, co-chair of the council. That means people come and go as they are able, which has affected the group’s ability to keep projects moving forward.

With Tippett on board and dedicated to the cause, Salcedo expects the IDEA Council to gain and maintain momentum on projects such as improving the health system’s interpretation and translation services. At the same time, he cautioned against expecting one person to shoulder all of the work.

“We’ve identified her as a person to lead this effort, but that doesn’t mean it’s completely on her to do it. That’s not representative of an organization that’s equitable,” he said. “It’s on all of us to show up and do the work.”

Tippett is intent on gaining traction, however. One of her primary goals in her new role is to increase what she calls the health system’s “belonging score,” which measures how much caregivers feel like they are welcome at St. Charles, that they are heard by leadership and that their ideas are valued. Toward that end, she and her team are developing programs to educate managers and physicians on inclusivity, incorporating IDEA concepts into the health system’s orientation for new caregivers and annual education requirements for all caregivers, and investing in IDEA training for key roles within the organization.

“We’re doing more than just talking about this stuff,” Tippett said. “We’re taking action.”

Saffert said he’s excited not only that St. Charles has someone on board to lead IDEA work, but also about what Tippett brings to the position.

“Her clinical psychology background, her experience as a behavioral health provider, her lived experience within Central Oregon and her passion for inclusion and equity make her the ideal person for this role,” he said. “Also, her desire to learn and to be an inspirational activist makes her the perfect candidate to help with this ongoing, worthy journey of creating a welcoming and inviting place for all.”

That’s a journey supported by St. Charles’ top leadership, the Executive Care Team, including President and CEO Joe Sluka.

“More than a century ago, the women who founded St. Charles promised Central Oregon that this organization would care for all people, or it would care for none,” Sluka said. “I am proud of the work we are doing to be a health system that is inclusive, diverse, equitable and accepting, and I believe it’s our next step toward upholding that commitment to care for all.”

Thanks to Valentine’s Day, the month of February is closely associated with hearts – more precisely, the well-known heart shape, usually in hues of pink or red.

But did you know February is also officially American Heart Month, according to the Centers for Disease Control? This time we’re talking about the actual heart – the muscular organ inside our chest that pumps blood throughout the body, carrying oxygen to our cells.

That’s important work, which is why the CDC sets aside February as a time for all people to focus on their cardiovascular health.

At St. Charles, we have a talented staff of cardiologists and caregivers at our Heart and Lung Center who provide cutting-edge and life-saving care every day to people with heart ailments. We are thankful for the incredible work they do.

I’d also like to use this opportunity to highlight the St. Charles Foundation’s Children’s Heart Fund, which offers a wide range of support services to families of children with congenital heart disease. Those services may include simple but vital help such as gas cards, food and lodging through the Ronald McDonald house, or it may mean complex assistance, such as providing the family with a case manager to help with care coordination and community services, or coordination of neurodevelopmental follow-up for at-risk children.

That’s a mouthful, so let me state it clearly: The Children’s Heart Fund helps families of kids with congenital heart disease when they need it most. By alleviating other stressors, it frees up parents to focus completely on their top priority: the health of their child.

The Children’s Heart Fund does tremendous work year-round, but February is when it makes its major fundraising push, and I believe it deserves your support. I would encourage you to watch the video below, then visit our Children’s Heart Fund fund web page to learn more about how you can help.

I wish you a very happy (and healthy) heart month.

Sincerely,
Joe

DAISY Award winners honored for extraordinary nursing

Four St. Charles Health System nurses have been honored with The DAISY Award for Extraordinary Nurses®, recognizing the outstanding, compassionate nursing care they provide patients and families every day:

• Bend: Page Ogden, Lactation
• Madras: Emily O'Hearn, Family Birthing Center
• Prineville: Jennifer Lewis Welch, Float
• Redmond: Jessica Aragon, Medical Services

Nominated by patients, families and colleagues, the award recipients were chosen by a committee at St. Charles.

The nurses—who represent all four St. Charles hospitals in Bend, Redmond, Madras and Prineville—were recognized with a ceremony on their respective units and presented with a certificate, a pin and a "healer's touch" sculpture by their hospital’s chief nursing officer. The DAISY honorees will also receive ongoing benefits, such as special rates for tuition and ANCC certification. 

The DAISY Foundation is a not-for-profit organization that was established in memory of J. Patrick Barnes by members of his family. Patrick died at the age of 33 in late 1999 from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease. (DAISY is an acronym for Diseases Attacking the Immune System.) The care Patrick and his family received from nurses while he was ill inspired this unique means of thanking nurses for making a profound difference in the lives of their patients and patient families.

"When Patrick was critically ill, our family experienced first-hand the remarkable skill and care nurses provide patients every day and night,” said Bonnie Barnes, FAAN, president and co-founder of The DAISY Foundation. “Yet these unsung heroes are seldom recognized for the super-human, extraordinary, compassionate work they do. The kind of work the nurses at St. Charles are called on to do every day epitomizes the purpose of The DAISY Award.”

This is one initiative of The DAISY Foundation to express gratitude to the nursing profession. Additionally, DAISY offers J. Patrick Barnes Grants for Nursing Research and Evidence-Based Practice Projects, The DAISY Faculty Award to honor inspiring faculty members in schools and colleges of nursing and The DAISY in Training Award for nursing students. More information is available at http://DAISYfoundation.org.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

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Effective for dates-of-service beginning Jan. 1, 2022

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. 

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. 

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.”  This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. 

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service. 

You’re protected from balance billing for: 

Emergency Services 

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.  

Certain services at an in-network hospital or ambulatory surgical center 

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. 

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. 

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network. 

Under Oregon’s balance billing law, health providers cannot balance bill a patient for health services provided at an in-network health care facility.  Balance billing occurs when an out-of-network health care provider you did not choose, such as an emergency room physician, anesthesiologist or radiologist, bills you for more than the allowed in-network charges when you are at an in-network facility. Please contact the Oregon Division of Financial Regulation for more information (888-877-4894).

When balance billing isn’t allowed, you also have these protections: 

• You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly. 
• Generally, your health plan must: 
  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”). 
  • Cover emergency services by out-of-network providers. 
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits. 
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact the Department of Health & Human Services  at (800-985-3059), or contact the Center for Medicare & Medicaid Services (www.cms.gov/nosurprises/consumers) for more information about your rights under federal law.  Visit the Oregon Department of Consumer and Business Services to file a complaint (dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx).

Your Rights

You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost

Under the law (effective Jan. 1, 2022), health care providers need to give patients who don't have insurance or who are not using insurance, an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate, in writing, at least one business day before your medical service or item.

You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-888-703-8401 or 541-706-7750, option 1.

Service Estimates

Patients are encouraged to use our self-serve estimates tool for certain common procedures. You can access the tool by clicking the button below.

Financial Estimates