By BECKY GILLETTE
Releasing entrapped nerves often keeps patients out of the OR.
Board Certified Neurosurgeon Tim Maryanov, MD, Fort Neuro, Fort Smith, has a focus on using non-invasive techniques to discover and resolve the cause of pain so people can live fulfilling lives without taking medicine that is potentially addictive.
“What I often find is that chronic pain patients have abnormalities in the autonomic part of the nervous system,” Maryanov said. “For example, sweat secreted from the bottom of the feet is part of the autonomic system, and we can draw inferences from that to understand the physiological and psychological symptoms of patients’ chronic pain symptoms.”
He has in house x-rays and sends out for CT scans or MRIs, but he prefers, when possible, to use ultrasound to evaluate muscles, tendons and the soft tissue structure. For example, when evaluating knee pain from arthritis, he can see nerves that are being compressed by various muscular and tendon structures. Some of the techniques he uses to release those entrapments include massage balls, movement and various exercises.
“I really try to appeal to people who want to treat the cause of their pain, not just cover it up with narcotics,” Maryanov said. “Medicines are not as helpful as finding out where the pain is coming from, and what can be done. I also do nerve-blocking injections guided with ultrasound.”
With carpal tunnel syndrome, many patients are older, have lost significant amounts of strength in their hands, and have multiple other medical problems. He can treat carpal tunnel syndrome without surgery using ultrasound and multiple needle punctures to release the entrapments in the nerve. There are no incisions, and he uses anesthetic so the patient doesn’t feel the needles.
“I go right to the point of entrapment, and release it,” he said. “Folks are doing this procedure around the world, but I think I am the only one in this area doing it at this time.”
As anyone who has ever had chronic pain can attest, to have that relieved is life changing.
“It is very rewarding when I explain to someone why they have been having pain symptoms for a long time and am able to resolve that,” Maryanov said. “Some have tried to get it treated before.”
Maryanov had a young patient with chronic pain in his right arm along with infections and swelling after an injury.
“I figured out the cause of his Complex Regional Pain Syndrome,” said Maryanov, who cured it by stimulating the brachial plexus, a collection of nerves between the neck and shoulder. That patient is now free of pain and is weaning off pain medicines.
In another case involving Complex Regional Pain Syndrome of the foot, Maryanov treated it by stimulating lumbar 4 and lumbar 5 nerve roots coming out of the spine.
Both advanced procedures were done at an ambulatory surgery center.
A common problem in today’s society is neck and shoulder pain from too much time at the computer or other strains. Neck arthritis is common especially with older people. In these cases, he uses ultrasound to find the nerves being entrapped by arthritis and uses nerve-blocking shots and radiofrequency ablation.
Maryanov and Mooza
Another patient with spinal stenosis who was more than 80 years old had been on opiates for a long time. Other doctors were reluctant to do anything because of her age and other health conditions, including lymphoedema. Using a minimally invasive procedure, Maryanov inserted the Vertiflex Superion® interspinous spacer in her back to restore the normal space between the vertebrae. He was able to advise her on dietary changes to resolve the lymphoedema, which is nutrition based. After eliminating certain products from her diet, including chocolate, the lymphoedema was resolved and she was able to walk much more freely.
“She is a year out and very happy,” he said.
Maryanov has some groundbreaking equipment that helps him evaluate patients including WAVi, a brain measurement platform which provides objective information about brain function and cognitive resources. It looks for markers of vascular disease often involved in chronic pain and dementia.
“It is a way to evaluate patients that is pretty extraordinary,” he said. “It really helps to treat patients.”
He helps people with lifestyle issues, evaluating their diet and physical activities, and then modifying those to manage chronic symptoms.
“That is a lot better than medications,” he said. “I try to eliminate medications because of the side effects of pain medicine. I also evaluate what medicines people are on. Sometimes people come in with lists of 20 prescriptions. Some are medicines started because of the side effects of other medicines. I have found by evaluating the medications and removing those that are no longer necessary, I can slow down or even reverse cognitive decline.
“When I find out what is wrong and can help a patient, that makes my day,” Maryanov said.
Born in Ukraine, Maryanov was 14 when he moved to the U.S. with his family. While he has no close family members left in the war-torn country, it is difficult to watch the war that has devastated the country and led to millions fleeing as refugees.
He dedicates his Facebook videos to Ukraine and has named one of his patient-exercises the Ukrainian Twist.
Maryanov’s grandfather on his father’s side was a gynecologist and surgeon who died from contracting hepatitis after being incarcerated in a USSR labor camp in Siberia following World War II.
Maryanov, who is the proud father of two children, speaks Russian, and learned Spanish while studying a family medicine rotation at University of California, San Diego, where he earned his MD in 2004.
“My Spanish-speaking patients really enjoy me speaking Spanish because they often can’t communicate with medical providers,” he said.
“Nowadays I try to spend time with my adolescent children and further my skills by attending medical and scientific workshops and conferences.”
His favorite hobby, scuba diving, has been on hold because of Covid. He was doing some kayaking before he had an accident that totaled his truck. Having made a commitment not to buy another gas-powered vehicle, he is trying to find an electric truck. He is encouraged to see some electric charger stations in Van Buren and Fort Smith, and also has solar power at his home.
“I’ve always been an environmentalist, but I realized instead of trying to battle things on a big scale, start by changing the things you do,” he said.
His dog, Mooza, goes with him to the office. She isn’t a trained therapy dog, but patients enjoy her company.
Maryanov completed a surgical internship and neurosurgical residency from 2004-2011 at the University of North Carolina at Chapel Hill hospitals.