About

Services We Offer:

• Evaluation and Medical Management: This is the most important service any physician can offer a patient because a proper evaluation is a prerequisite to selecting the appropriate treatment.  Even with known diagnoses, there are subtleties to treatment that depend on the patient’s comorbid conditions and general health.  We strive to know you-the patient- and tailor your treatment to achieve the best outcome.  Your first encounter with our practice is ALWAYS with a board-certified physician who has expertise concerning your problems.  You are paying for expert care and will never have an initial assessment with a physician extender such as, a nurse practitioner or a physician’s assistant.
• Osteopathic Manual Medicine (OMM): Doctors of Osteopathy learn that structure governs function and that when there is dysfunction, pain and illness can ensue. Triggering events can be trauma, post-surgical scarring, poor nutrition and unhealthy lifestyle habits, stress and toxins. Osteopathic physicians do not reject traditional medical and surgical treatments but in addition, we are able to look at normalizing body mechanics with manual techniques. Often, this non-traditional approach corrects a condition that the patient had been told cannot be corrected. Dr. Shapiro is skilled with most forms of manual therapy including cranio-sacral release, facilitative positional release and counter strain, myofascial release and muscle energy and high velocity low amplitude manipulation (HVLA).
• Interventional Pain Techniques: Epidural Steroid injections, Medial branch blocks, Sacroiliac Joint injections, and Facet Injections are performed in a surgical suite using fluoroscopy to guarantee “good needle placement”. These procedures can be diagnostic or therapeutic. When properly used for the correctly selected patient, they can help decrease the amount of time that the patient is impaired, help the patient avoid surgery and often return the patient to normal function. Often this is combined with exercise instruction or formal physical therapy and other modalities.
• Diagnostic ultrasound and ultrasound guided interventional techniques: Ultrasound is an office-based procedure that can often provide greater resolution than MRI. It is ideal for visualizing blood vessels, nerves and connective tissue. It can visualize structures at rest and as they move, allowing subtle details to be seen. Often, we can see if a nerve is tethered or if “pinched” by a bulging muscle or bone during its arc of motion. It is also a fantastic modality for needle guidance during joint injections or nerve blocks and makes for greater safety during invasive procedures allowing more accurate medicine placement during procedures, such as PRP.
• Electrodiagnostic evaluation: EMG is not a new diagnostic but it is ideal for diagnosing certain types of nerve and muscle disorders and differentiating and active problem when there are multiple injuries and insults along the path of a nerve. For example, is a patient’s hand pain numbness and tingling coming from carpal tunnel syndrome or a pinched nerve in the neck. EMG also often allows accurate prognostication and gauging the severity of a nerve or muscle disorder. Where ultrasound often allows a fine-tuned appraisal of anatomy, EMG often allows a fine-tuned assessment of physiology, that is, how well the nerve and muscle function.
• Regenerative medicine: this was once called stem cell therapy but that term is really not accurate. The injectates are not stem cells that develop into new tissue. Rather, they are concentrations of blood products that contain growth factors that reduce inflammation and thereby facilitate healing. These growth products can be harvested from fat, bone marrow or concentrated from whole blood. When whole blood is taken and centrifuged, plasma can be separated and the platelets can be concentrated in a layer of the plasma. This layer is known as platelet rich plasma or PRP and contains growth factors that reduce inflammation and accelerate tissue healing and promote pain reduction. PRP can be performed for arthritic joints and damaged tendons and ligaments all over the body. PRP treats the underlying problem whereas cortisone and other steroids reduce inflammation but can weaken tissues over time. PRP therapy heals and strengthens tissues leading to long-term relief but most insurance companies feel it is still experimental and will not cover it, and it can be prohibitively expensive. We will work with patients to help spread out the cost.
• Neurotoxins for pain, spasticity or aesthetics: Neurotoxins such as botulinum toxin have been used since the 1990’s to treat advanced spasticity after traumatic brain injury, stroke or spinal cord injury, dystonia and other rare but debilitating neurologic conditions.  It is also used for certain dental conditions such as bruxism and TMJ pain, facial spasm, hyperhidrosis, sialorrhea, migraine and as part of an aesthetics regimen.  Shapiro has been trained to use botulinum toxic for these neurologic and painful conditions and is currently receiving training from the International Academy of Facial Aesthetics for cosmetic uses of these drugs.
• Peripheral nerve stimulation: Peripheral nerve stimulation is an advanced technique for treating refractory low back and neck pain, joint pains, post amputation pain and refractory pain after failed spine surgeries and total joint replacements or, for people who cannot use opioids, or who are too medically unstable to undergo corrective surgeries. In many instances trials can be done as an office procedure.  However, definitive placement of most system must be done in the operating room.
• Subscription Practice Advantages: We are currently looking into developing a subscription-based practice in order to defer large out-of-pocket costs associated with uncovered services such as PRP or cosmetic Botox.  In addition, this will allow greater personal attention during office visits and easier access for these uncovered services.  As the details develop and emerge, we will provide updates.

 

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