Max H. Epstein, MD

My first Basivertebral Nerve Ablation (Intracept) for vertebrogenic low back pain at Intermountain

@NicoleBKatzMD @SpauldingRehab @HarvardSRH_PMR @MGHWomensSports Congrats Nicole!

Honored to have matched at Harvard/Spaulding for my Sports Medicine Fellowship! This achievement is shared with my mentors, family, and friends who have supported me endlessly. Here’s to the next chapter—see you in the clinic, training room, studio, and on the sidelines!

@JayKarriMD @DrJN_SportsMed Much like my case from today with patient presenting with T/L junction area pain on prolonged sitting and prolonged standing, without radicular features.

Patient with 3 months of left-sided pain in L3 distribution but w/o motor/sensory deficits. MRI shows an L3/4 disc herniation...that is anterior, with no central canal, lateral recess, or foraminal compromise. I encounter this once a year. Thoughts and insights? @DrJN_SportsMed

@JayKarriMD Metabolic syndrome discussion is a 1st visit conversation when talking about ANY degenerative msk condition. The art is in how to have that conversation without placing blame or shame

Treating knee OA pain in patients with obesity is challenging. New data on semaglutide shows promising, long-term evidence for pain relief and weight loss - surpassing the data we have for all other non-op interventions. How do we incorporate this into our current algorithms?

@Ryan_S_DSouzaMD Looks good! When image I expect doesn’t show, rotate to point towards the ear

Check out this new infographic🩻 One of my favorite blocks to perform - ultrasound-guided greater occipital nerve block. This graphic shows the important landmarks and ultrasound probe position to perform this block.🧵

@JayKarriMD @Ryan_S_DSouzaMD @C_KenyonDO @nasir418 @NasirKhatriMD Agreed. I’d say I get the view I want 50% of the time, but get very similar results whether it was directly imaged or not. Likely infiltrating the region gets your block rather than needing plane spread.

@Ryan_S_DSouzaMD @C_KenyonDO @nasir418 @NasirKhatriMD Getting a crisp US view in patients with lots of hair is my biggest hurdle! Tips? @Ryan_S_DSouzaMD @MaxEpsteinMD

@JSinghMD @BCM_PMandR

Incredible week at @IPSISMed 2024 with old friends and new

@jonhagedornmd @runliftrunlift Agreed Killens is great! But if you’re staying in Houston proper, The Pit Room is my favorite. Sit on the patio and enjoy the connected patio bar next door

@runliftrunlift Killen’s in Pearland. Goode Company on Kirby Drive is always fun too. Great atmosphere.

Where’s the best BBQ in Houston?

@JayKarriMD @JSinghMD @AbdullahNewaj @Ryan_S_DSouzaMD Focused on the “no-shows” I see 😂

@MaxEpsteinMD @JSinghMD @AbdullahNewaj @Ryan_S_DSouzaMD Nintendo Wii, wii sports, golf club accessory….are what I would get if I had an office.

Furnishing a new office work space. What have been the essentials or some fun additions to your work space? Standing desk is first order of business! @JayKarriMD @JSinghMD @AbdullahNewaj @Ryan_S_DSouzaMD

@Dr_Ankur_Patel @JayKarriMD @JSinghMD @AbdullahNewaj @Ryan_S_DSouzaMD Debating how much to lean into “spine” vs. just keeping it fun

@MaxEpsteinMD @JayKarriMD @JSinghMD @AbdullahNewaj @Ryan_S_DSouzaMD Artwork is a must!

@JayKarriMD @JayKarriMD just wanted to show that he doesn’t bend his needles 😜

#teachingimages The epidural space is likely contiguous with surrounding fascial planes! Shown here is spinal needle placement outside the L5/S1 neuroforamen, but presumably in erector spinal plane, yielding epidural contrast spread.

@Sympathy4TheDr @JayKarriMD @Ryan_S_DSouzaMD @nasir418 @JSinghMD @MihirJoshiMD @VinnyFrancioMD @benjamin_gill @MateuszGraca @DrNvSportsSpine @SounSheen @Dr_Ankur_Patel @NasirKhatriMD @AbdullahNewaj @asterkawi Sure, we both agree that epidural hematoma is a known risk of ILESI. But I fail to see how live/continuous fluoro mitigates this risk

@MaxEpsteinMD @JayKarriMD @Ryan_S_DSouzaMD @nasir418 @JSinghMD @MihirJoshiMD @VinnyFrancioMD @benjamin_gill @MateuszGraca @DrNvSportsSpine @SounSheen @Dr_Ankur_Patel @NasirKhatriMD @AbdullahNewaj @asterkawi No, I have reviewed cases in which this has occurred in patients who are not on anticoagulation.

Do you typically use live (“continuous”) fluoroscopy when performing lumbar interlaminar injections? Why or why not? #painmedicine #proceduraltechnique *rephrased for clarity

@Sympathy4TheDr @JayKarriMD @Ryan_S_DSouzaMD @nasir418 @JSinghMD @MihirJoshiMD @VinnyFrancioMD @benjamin_gill @MateuszGraca @DrNvSportsSpine @SounSheen @Dr_Ankur_Patel @NasirKhatriMD @AbdullahNewaj @asterkawi Of course, but that’s a conversation for AC in ILESI rather than live/continuous fluoro

@MaxEpsteinMD @JayKarriMD @Ryan_S_DSouzaMD @nasir418 @JSinghMD @MihirJoshiMD @VinnyFrancioMD @benjamin_gill @MateuszGraca @DrNvSportsSpine @SounSheen @Dr_Ankur_Patel @NasirKhatriMD @AbdullahNewaj @asterkawi There have been venous hematomas which have caused paralysis.

@JayKarriMD @Sympathy4TheDr @Ryan_S_DSouzaMD @nasir418 @JSinghMD @MihirJoshiMD @VinnyFrancioMD @benjamin_gill @MateuszGraca @DrNvSportsSpine @SounSheen @Dr_Ankur_Patel @NasirKhatriMD @AbdullahNewaj @asterkawi Haha not a bad idea! All the attention goes to TFESI, but rightfully so. To my knowledge, no cases of neurologic injury specifically from intravascular ILESI (excluding direct neural injury)?

@Sympathy4TheDr @Ryan_S_DSouzaMD @nasir418 @JSinghMD @MihirJoshiMD @MaxEpsteinMD @VinnyFrancioMD @benjamin_gill @MateuszGraca @DrNvSportsSpine @SounSheen @Dr_Ankur_Patel @NasirKhatriMD @AbdullahNewaj @asterkawi That’s definitely true! It’s interesting how there’s such a divide on this. We need @MaxEpsteinMD to author a Fact Finders piece on if intravascular uptake/steroid injection during a lumbar ILESI matters.

Incoming and graduating Fellows, join me with @IPSISMed tomorrow night, Tuesday 6/11, 8:30p ET. Registration: ipsismed.org/event/Post-Fel…

@AbdullahNewaj Maybe try shoes next time too 🤷🏼‍♂️

Hike to Lake Blanche. Lesson for next time: Bring a headlamp when you start a 7 mile hike at 4:30PM.

@MateuszGraca We gave my dachshund human gabapentin after spinal cord injury because it was so much cheaper than the doggo brand!

Dachshunds are particularly prone to neuropathic pain from their spines, gabapentin has been a game-changer for my pup. Write it for her! Hopefully she isn’t eating her dog’s treats too…😜

Intraarticular SI Joint injections are the most difficult spine injection. Convince me otherwise!