Stellate Ganglion Block (SGB) Specialist

John How, M.D. -  - A Private Medical Practice

The How Clinic

John How, M.D.

A Private Medical Practice & Bioidentical Hormone Specialist located in Encinitas, CA

  

Stella Affiliate

Stellate Ganglion Block (SGB)

We are excited to partner with The Stella Center, whose mission is to provide relief to the millions of people affected by mental trauma-related symptoms. Through a modification of a procedure called the Stellate Ganglion Block (SGB), the treatment targets the brain's fight or flight response. Our partnership allows us to bring SGB to as many trauma victims as we can. 

What is SGB?

SGB is a sympathetic nervous system “Re-Boot” used to improve the functional health of patients suffering from a variety of conditions. SGB has been used to treat military personnel for Post-Traumatic Stress Disorder (PTSD), behavioral illnesses and other disorders following their return to civilian society, as well as shown efficacy in improving symptoms of depression, anxiety, long-term pain syndromes, stress disorders, and sexual dysfunction in the general population. Additionally, athletes have begun to use SGB to synchronize their brain and body to maximize optimal competitive performance. 

How does SGB work?

The sympathetic part of the autonomic nervous system (ANS) is responsible for the body’s emergency “fight or flight” response. It controls our heart rate, blood pressure, skin temperature, and the response of our eyes to light, which are the body’s responses to stress, perception of pain, the ability to relax or focus our thoughts, and to function sexually. When the sympathetic nervous system (SNS) is overwhelmed, generally from extreme stress, it becomes programmed to an inappropriately high set point. This causes the body to remain in a state of extreme, survival-level response. This is a stress injury, in which the brain is inappropriately stuck in a “fight or flight” response and a great solution is to reset that part of the nervous system.  In the same way as rebooting a computer can free the system from an inappropriate or dysfunctional program, SGB works to reset the nervous system and restore it to its normal settings.

Who is a good candidate for SGB?

 An evaluation for the use of SGB therapy is right for anyone suffering from PTSD, depression, stress, anxiety, chronic pain and many other behavioral challenges which prevent them from being physically and emotionally present in their everyday life. SGB may also be a helpful therapy if you routinely struggle with insomnia, fogginess, irritability or decline in sexual function, or if you are an athlete looking to sharpen your mental acuity, heighten your reflexes and improve your competitive edge.

How is SGB performed?

The procedure is done with the patient laying fully clothed on a comfortable table.  An ultrasound is used to visualize the target nerve bundle in the neck and to guide a needle into the correct position.  Once the correct needle position is confirmed, a small amount of local anesthetic is injected into the area and the needle is withdrawn.  After an injection is completed, the patient is observed for a time to ensure safe recovery.  The procedure takes approximately one hour and for many patients the relief is immediate.

What are the possible complications associated with SGB?

 There are several other nerve bundles in the same area as the one we are targeting with the procedure, and interruption of these often result in a droopy eyelid, blood shot eye, changes in the size of the pupil on one side, hoarseness of the voice, and mild difficulty swallowing.  The symptoms listed above are expected and are actually used to gauge the likely success of the procedure.  Uncommonly, some patients report some difficulty breathing.  All of these conditions are temporary and resolve within a few hours of the procedure. In a vanishingly small number of patients, the anesthetic can be placed in an unintended place such as a blood vessel. If this happens, the function of the brain or heart can be affected which may result in seizure, pathological heartbeat or cardiac arrest. As an extra precaution we use a medication that is more specific to the sensory nerve fibers over motor or the nerves affecting the heart. While theoretical, we hope that this will further improve the safety profile of this procedure. Bleeding deep in the neck that can form a swelling and close off your windpipe and result in death. If the lung is hit with the needle, a life-threatening condition called a tension pneumothorax can develop.

What are the possible benefits of SGB? (results vary)

 ✓   Restoration of emotional and mental clarity

 ✓   Improved sleep, reduced insomnia

 ✓   Improved symptoms of Post Traumatic Stress Disorder (PTSD) and Injury (PTSI)

 ✓   Improved memory and concentration

 ✓   Decreased irritability

 ✓   Restored autonomic function to the Nervous System

 ✓   Enhanced sexual function and intimacy

 ✓   Improved ability to interact socially

 ✓   Reduced “on edge” feeling or other forms of social anxiety

What should I do before the SGB procedure?

  • Schedule an appointment with us to learn about the risks and benefits of SGB

  • Complete a PTSD Checklist (PCL) with us.

  • Inform us of your medications and allergies

  • Continue to take regular medications

  • Prepare to have a driver after the procedure