Q: Where on the body is the injection given and why?

A:  The injection is administered into the side of the neck. The reason for this is that at this precise location on the side of the neck lies a grouping of nerves called the Stellate Ganglia. These particular nerves perform important functions such as regulating blood flow and sweating. When these nerves are over stimulated, above and beyond normal activity, the result is a sharp rise in the body’s temperature creating what we know as hot flashes. Though for some women, hot flashes are mild, for others they are so severe that they become unbearable. The remedy used by Dr. Lipov is actually a nerve block injection. When administered into the Stellate Ganglia, it has the affect of numbing this area, much like a dentist’s use of a Novocain shot, thus reducing its level of over activity. This, in turn, reduces the quick escalations of blood flow and sweating, thus reducing hot flashes.

Q: How long does the procedure take?

A:  The procedure is typically completed within about five minutes. It is a very short procedure.

Q: How is precision determined and achieved when the injection is given?

A: Precision of location of the injection is not only important for safety, but for overall efficacy of the treatment as well. Therefore, to ensure complete precision of where the injection needle is placed, Dr. Lipov insists on always performing this procedure through X-Ray machine guidance. Through X-ray guidance, Dr. Lipov can easily locate the proper and precise location of where to administer the injection. To do so without this type of guidance would not be as simple or safe. With this “fool-proofing” technique, however, and the years of experience Dr. Lipov has had not only in giving this treatment, but also in teaching fellow physicians how to administer it safely, he has never had one incidence of performing it incorrectly. He has a solid track record of having done this procedure safely and satisfactorily over his entire tenure in pain management medicine.

Q: Does the injection hurt?

A: The injection does not cause pain. It creates a sensation of pressure during the brief time that it is being administered. It can also produce a brief flush of warmth in the arm on the side where the injection is being given. Though not necessary, some patients request that the injection be given under a momentary dose of anesthetic, in which case, patients do not feel anything and are “out” for only a matter of minutes.

Q: What are the immediate side effects and how will I feel afterward?

A: Patients report that the side effects they experienced immediately following the injection include a droopy eyelid on the side that the injection was administered and a bit of numbness of the throat on that side. For that reason, it may be preferable to wait until several hours after the procedure to plan anything social or to eat your next meal. Please note that these side effects always reverse and typically disappear within a matter of six to eight hours after the procedure. Many patients go home and take a long nap and awake with the side effects greatly diminished or completely gone.

Q: What should I expect on the day of my appointment?

A: When it is your turn to see the doctor, you will be given a typical hospital gown to wear to preserve your clothing. You will then be given an IV for use of either mild sedation or a requested anesthetic, to be administered during the procedure. You will be asked to lie on a medical bed with your neck over a small pillow. When the doctor begins the procedure, he will at this time administer the anesthetic, if requested, in which case you will awake within approximately 5 minutes and the procedure will already be over. If an anesthetic is not used, you can expect that thedoctor will proceed by using the X-ray monitor to help him to determine the exact location of the injection site. He will begin to administer the injection and you will feel pressure upon application at the site of the injection. Throughout the procedure, your blood pressure and vital signs are closely monitored. Within a short time the procedure will be completed.
             
Once the procedure it complete, whether sedation or anesthetic is used, you will be guided to gently get up and move to a recliner to rest for a short time, before you leave the office. You will be fully awake; the doctor simply wishes to ensure that are not too “woozy” before leaving. If you have chosen to use an anesthetic, you may wish to have someone come with you to drive you back home or to arrange to take public transportation to get back home. This is only precautionary. You will be awake; however, your reflexes may be a little slower if you have any residual grogginess. If you do experience grogginess, it typically is only for a very brief time  after the procedure. You should feel back to your normal state of alertness within a couple of hours if not sooner.        

Q: How soon will the injection start working to oppose hot flashes?

A: Patients often experience an immediate change in their “body thermometer.” It can take anywhere from a matter of hours to a few days to experience the full effect.

Q: How much does the injection actually reduce or eliminate hot flashes?

A: This can vary somewhat from person to person, but on average, hot flashes are reduced significantly or eliminated altogether.

Q: How long does the effect on hot flashes last after the injection?

A: After the initial injection, relief from hot flashes usually last for weeks or months. It is common for a follow-up shot to be needed at some point to continue relief. With each subsequent shot, however, the duration of the benefit derived from the injection is greatly increased. So, a subsequent injection will last many times longer than the previous treatment.

Q: How many subsequent injections are typically required for the long-term management of hot flashes?

A: Studies of this treatment have demonstrated that, typically, a series of two or three injections will be all that is needed to achieve long-term benefit, with some patients requiring a yearly injection, for several years, to maintain optimal results.  Results can vary from patient to patient, but on average, the benefits from the first injection will usually last for a month or more. A second injection will often yield relief for many months and a third injection, if necessary, can be given and will typically provide long-lasting if not permanent relief from the hot flashes.

Q: Is any follow-up care required?

A: A band-aid will be placed on your neck at the site of the injection. No further follow-up care to the procedure site is required.

Q: What is the cost for the procedure?

A:  Please contact the doctor’s office for all pricing information. Pricing can vary depending on the choice of sedation or anesthetic for use with the procedure.

Q: Will my insurance cover this procedure?

A:  Please ask the doctor’s office for assistance in dealing with your insurance company. Some insurance companies have paid for this injection, though not alldo. Payment arrangements can often be worked out.

Q: Can I get this type of injection at any doctor’s office?

A:  No. It is important to note that this is a procedure which, while new in relation to its shift in use from pain management to the use for hot flash management, is a procedure that has been practiced safely at pain management facilities for over 25 years. The nature of this type of injection necessitates that it must be given only by a physician experienced in administering such nerve block injections, widely- used in pain management clinics.

Q: What are the risks involved in this procedure?

A:  With any medical procedure, there are potential risks associated. The risks  involved with this injection include possible seizures, infection, epidural block, or the injection striking a blood vessel or surrounding organ. Done properly, through use of X-Ray guidance, those risks are minimized dramatically and the likelihood of developing such risks is remote. Again, in the seventeen years Dr. Lipov has administered this treatment, there has never been one case with such an outcome.

Q: How exactly does the injection work to oppose hot flashes?

A: The injection works by impairing the activity of the group of nerves that the nerve block agent is injected into. These particular nerves are the Stellate Ganglia nerves, which can send temperature impulses, or hot flashes, through the body, if over-stimulated. The injection acts to counter this effect by numbing these nerves.          

Q: What is the best way to ensure that the optimal effect of eliminating hot flashes is achieved?

A:  While a marked improvement has been documented in all patients who have participated in Dr. Lipov’s study of the use of the Stellate Ganglion Nerve Block, the understanding is that optimal results will occur if the patient seeks this treatment as close to the onset of hot flashes as possible. Those who are several years into their menopausal hot flashes can certainly obtain benefit as well, though it may require additional treatments to reach the optimal therapeutic effect.

Q: Is there anything else I should know? 

A: You should know that Dr. Lipov employs exacting standards for care and safety in his practice. His credentials includes Board Certification in Anesthesiology and Pain Management and he earned his medical degree at Northwestern University in 1984. Since that time, he has spent the last 22 years making his life’s work a mission to help others cope with pain. He now is recognizing the need for and pioneering a remedy for helping patients cope with quality-of-life impairing hot flashes.