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Scott Schlesinger 

A surgeon who says surgery should be 'last resort.'

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An electrical shock to the face. An unrelenting stabbing pain in the chin, like a "hot poker up the nose," triggered by something as inconsequential as wind. Tic douloureux, says neurosurgeon Scott Schlesinger, causes such pain that it's been nicknamed the "suicide disease."

So imagine, after Schlesinger has poked into the brain stem and teased a spongy cushion between the trigeminal nerve and artery to insulate the nerve, a sufferer's relief.

"There's no patient that hurts worse," Schlesinger said, "and no more grateful patient" than his patients suffering from the venous malformation, more properly known as trigeminal neuralgia. Not only does the disease make lives miserable, it is too often misdiagnosed. Many of his patients have been to dentists for jaw pain, even oral surgeons, because the real cause has gone undetected. Schlesinger said more public education on the disease is needed to get people to the right place; his seminar on the disease and the surgery to alleviate the pain can be found on the St. Vincent Health website (the final image in the slideshow on the site is Edvard Munch's "The Scream").

Though he's a surgeon, Schlesinger, 50, who grew up in Hot Springs and went into practice 18 years ago with now-retired surgeons Ron Williams and Ray Jouett, says he is not quick to cut. "My philosophy is doing the most conservative approach," he said, with "surgery as a last resort."

As is the case with most neurosurgeons in private practice, spinal surgery forms the bulk of Schlesinger's cases, though he operates on brain tumors as well and is on call at St. Vincent Health Center's emergency room once every six weeks. Schlesinger's clinic includes outpatient surgical and physical therapy; he says procedures — like a spinal fusion — that would have required a two-week stay in the hospital when he was training at Parkland Hospital in Dallas right out of medical school at UAMS can now be done outpatient, thanks to real-time computer-assisted imagery and other technological advances. Such advances have made back surgery safer and improved outcomes.

During the health reform debate, Schlesinger and ob/gyn Dr. Scott Bailey created the physicians group ardocscare.com, a group that advocated for more doctor involvement in the debate and expressed concern that the House and Senate bills would lead to a single-payer, government-run health care system.

Schlesinger and his colleagues in his practice accept Medicare and Tri-Care, the military insurance plan, "even though the economics don't work so well. It's our philosophy to take care of people."

Because of the hassles involved in getting reimbursement from the government — especially under Tri-Care — Schlesinger believes the health care reform law Congress eventually passed will significantly decrease access to care rather than increase it. You may require people to get health insurance, but "you can't legislate to make people stay in practice," he said. "Who's going to go into the difficult fields?" Schlesinger is trying to recruit a neurosurgeon now for his practice. "It's hard enough to find someone who'll move to a rural state like Arkansas," he said; he believes health care reform will make it worse.

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