Getting It Right:
On the Road Again


Jeannie Malik is the type of woman people call when they need to get things accomplished. The San Luis Obispo County resident is a non-stop force of positive energy, who likes to take on big challenges. Athletic and active in the community, the 54-year-old is equally at ease competing in a triathlon as she is in leading a school fundraising campaign.


Unfortunately a spine injury in 2008 threatened that active lifestyle. The surgical treatment she received resulted in rare complications, leaving her with constant pain and the loss of mobility and strength in her legs, predominantly on the right. After extensive rehabilitation, her condition did not improve.


In the summer of 2009, Jeannie's doctors at that time gave her depressing news.


Jeannie Malik


"They basically told me 'this is how you will be now' and they couldn't do anything more for me," she said. Jeannie had not been able to drive for almost a year and she had trouble walking without assistance.


But Jeannie refused to give up hope and was determined to find a doctor who could help her.


Friends and others recommended that she contact Dr. Thomas Jones, a neurosurgeon in Santa Barbara who is also the medical director of the new Santa Barbara Neuroscience Institute at Cottage Health System.


"Cottage is a tertiary referral center for certain conditions. We have expertise beyond what you find in a community hospital," Dr. Jones explained. "And, unlike the big academic university hospitals, here patients have immediate access to experienced clinicians."


One of the advantages, from the patient's perspective, is that the clinicians are not separated from the patients by layers of physician assistants, residents and fellows.


Jeannie confirms how easy it was to get an appointment with Dr. Jones.


"I called him and he saw me within two days," Jeannie said, thinking back on her first meeting with Dr. Jones in October 2009.


On the same day of her appointment, Dr. Jones was also able to schedule a 3-Tesla MRI scan and an intrathecal contrast CT scan for Jeannie at the Cottage Center for Advanced Imaging, located in the same building as his office.


Jeannie was impressed that Dr. Jones stayed after office hours to discuss the findings so that she and her husband would not have to wait until after the weekend to get the results.


After spending 45 minutes talking with Jeannie about her medical history, and then almost two hours reviewing her previous MRIs and the new scans, Dr. Jones concluded that Jeannie's problems were due to either scar tissue or an acquired arachnoid cyst. Because of the complications from her previous spine surgery, Jeannie had developed scarring around her spinal cord, and that was causing partial paralysis and abnormal reflexes in her legs.


This type of cyst formation can be congenital, meaning a person is born with it. Or, as in Jeannie's case, it can develop as a result of trauma, or from surgical complications. Dr. Jones felt that it would be beneficial to re-explore the abnormal area in her thoracic spine to attempt to untether the spinal cord.


"We had total faith in Dr. Jones," Jeannie recalled. "He is such a knowledgeable man and also very conservative. He told us that he would only do the surgery if he felt strongly that it would be successful."


Two days before Thanksgiving in 2009 Dr. Jones performed a thoracic laminectomy and explored the spinal cord. He removed scar tissue and then placed a shunt in the space, to alleviate pressure.


"In Jeannie's case, the scarring was tethering the spinal cord and causing 'traction myelopathy.' If you are aware of this possibility, then you can look for it," Dr. Jones explained. "But you need to know to be on the lookout for it, or you will miss it."


Jeannie was amazed by the results: "When I woke up from the surgery, I threw my leg out of the bed and said, 'I can feel my leg again, all the way down to my toes!'"


"There was a pretty dramatic improvement in her right leg immediately, and she started to recover quite quickly," Dr. Jones confirmed.


On New Year's Day in 2010, Jeannie started driving again.


Dr. Jones stated that conditions like Jeannie's are quite rare, and he sees only about a handful of similar cases per year.


"When you're dealing with a relatively rare condition, it's important to get as much history as possible," he emphasized.


"You need to take the time to listen to patients. If their condition can't be explained by what they've been through, then you need to dig to find what else is going on.


"How do we do that? We listen and we don't over-operate. Fifteen minutes is not enough time in a case like Jeannie's to determine what is wrong. You can't do assembly-line medicine," he stated.


He recalls Harvey Cushing (1869-1939)-widely regarded as the greatest neurosurgeon of the 20th century and often called the father of modern neurosurgery.


"Harvey Cushing said that the operative part is the least part of the work,'' Dr. Jones said. "That's because the most critical part of a surgeon's job is knowing when, where and whether to operate.


"The goal for the Neuroscience Institute at Cottage," says Dr. Jones, "is to be diligent and thorough, and to practice appropriate use of our assets, working with state-of-the-art imaging technology and the expertise of our exceptional neurologists, and neuroradiologists."


There are four neurosurgeons at Cottage:  Dr. Jones, Dr. E. Scott Conner, Dr. Richard Chung and Dr. Alois Zauner, who is a neuroendovascular surgeon.


"We're here not just to do surgeries," Dr. Jones emphasized. "Our goal is to solve problems."




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Mar 2011