Friday, April 26, 2024

Peripheral Nerve Disorder Care | UC San Diego Health

Peripheral Nerve Disorder Care | UC San Diego Health


If a peripheral nerve condition is affecting your quality of life, turn to UC San Diego Health.

We are a regional leader in care for nerve pain, nerve compression injuries, nerve trauma, and other disorders of the peripheral nerves.

What are Peripheral Nerves?

Peripheral nerves are an integral part of the human nervous system. The nervous system consists of:

  • Central nervous system (brain and spinal cord)
  • Peripheral nervous system

Peripheral nerves reside outside your brain and spinal cord. They relay information between your brain and the rest of your body.

The peripheral nervous system is divided into two main parts:

  • Autonomic nervous system (ANS): Controls involuntary bodily functions and regulates glands
  • Somatic nervous system (SNS): Controls muscle movement and relays information from ears, eyes and skin to the central nervous system

Nerves in the Peripheral Nervous System

  • Brachial plexus (radial nerve, median nerve, ulnar nerves)
  • Peroneal nerve (foot drop)
  • Femoral nerve
  • Lateral femoral cutaneous nerve
  • Sciatic nerve
  • Spinal accessory nerve
  • Tibial nerve

Nerve Pain and Injury Specialists

Our specialists are able to quickly diagnose and treat nerve-related functional impairments and nerve tumors using leading-edge surgical techniques.

Conditions We Treat

Nerve Sheath Tumors

The nerve sheath is the tissue that covers and protects the nerves. Nerve sheath tumors grow directly from the nerve itself. They usually develop randomly but occasionally can be caused by a health condition or syndrome, such as neurofibromatosis (type 1 and type 2).

Nerve tumors are one of the following:

  • Benign peripheral nerve sheath tumor (e.g., neurofibromas, schwannomas)
  • Malignant peripheral nerve sheath tumor (sarcoma)

Neurofibromas and schwannomas are non-cancerous and are the most common type of nerve tumor.

Also See Acoustic Neuroma

Peripheral nerve tumors usually grow slowly and may be noticed as a lump somewhere in the body. They can interfere with normal activities, causing discomfort, tingling or even numbness, weakness and severe pain.

Patients often consider removing these tumors when they become problematic. Removal can usually be performed without destroying the nerve. The tumor usually can be resected out of the nerve itself without harming the nerve's function.

Cancerous Nerve Tumors

Peripheral nerve sheath tumors are rarely malignant (cancerous).

Cancerous peripheral nerve tumors are more problematic, painful and grow rapidly. If there is any question about whether or not a tumor is cancerous, it is important to get a needle biopsy or special study done to be sure.

If the tumor is believed to be cancerous, surgery is performed to remove all of the tumor, including a large portion of the nerve from which the tumor came. Nerve function, which may be lost with the removal of the tumor, can later be improved with the use of nerve transfers.

Brain Tumor Diagnosis and Treatment

Nerve Pain

We treat nerve pain such as meralgia paresthetica, occipital neuralgia, inguinal neuralgia and neuromas.

Nerve Compression

Surgical treatment to decompress the nerve may be considered for entrapment neuropathies such as carpal tunnel, thoracic outlet syndrome and peroneal neuropathy.  

Nerve Injuries

Trauma and sometimes even other surgical procedures can result in paralysis and disability in particular nerves. Our peripheral nerve experts can treat these nerve injuries (including brachial plexus and facial nerve injuries) and restore function.

Personalized Care Plan

We get to know patients so we can work with you to develop a customized plan that meets your goals and improves your quality of daily living. This can include non-surgical treatments as well as surgery.

Nonsurgical Treatment for Peripheral Nerve Disorders

  • Acupuncture
  • Medication for neuropathy and pain management
  • Physical therapy and rehabilitation
  • Orthotics
  • Injections and stimulators

Surgical Treatment for Peripheral Nerve Disorders

Tumors, Cancer and Inflammatory Conditions

  • Open and minimally invasive nerve tumor surgery (schwannoma, neurofibroma, malignant nerve tumors)
  • Robotic-assisted nerve tumor surgery for thoracic, abdominal and pelvic nerve tumors
  • Nerve biopsy for neuromuscular disease or metastatic cancer to nerves

Nerve Injury

  • Nerve transfer surgery for improved function
  • Nerve decompression, repair and nerve grafting to repair the injury directly
  • Nerve surgery for spasticity with brain or spinal cord injury
  • Phrenic nerve stimulation for diaphragm paralysis 

Peripheral Nerve Pain or Weakness

  • Nerve decompression surgery (such as carpal tunnel, ulnar nerve, peroneal nerve, tarsal tunnel, thoracic outlet, etc.)
  • Nerve removal surgery (neurectomy) for pain (such as meralgia paresthetica)
  • Regenerative peripheral nerve interface or targeted muscle reinnervation for neuroma treatment

Meet Our Specialists

  • Image of Katharine Hinchcliff, MD

    Katharine Hinchcliff, MD


    • Plastic Surgeon
    • Assistant Professor of Surgery

    View More

  • Image of Nikhil K. Murthy, MD, MS, MBA

    Nikhil K. Murthy, MD, MS, MBA


    • Neurosurgeon
    • Assistant Professor of Neurological Surgery

    View More

 

Friday, April 19, 2024

Executive Rewards  | Costco


Executive Rewards  | Costco


Upgrade to an Executive Membership and receive an annual 2% Reward. The Executive Membership upgrade fee is an additional $60 a year for Business or Gold Star Members (plus sales tax where applicable). We will prorate the upgrade amount based on the months remaining in your current membership. Purchases made prior to upgrading are not eligible for the 2% Reward. At your next renewal, you will be billed a total of $120 for your Executive Membership. To upgrade, visit the membership counter at any Costco warehouse.

*Executive Membership 2% Reward

Costco Executive Members receive a 2% Reward on qualified purchases (see calculation of 2% Reward below). Reward is capped at and will not exceed $1,000 for any 12-month period. Only purchases made by the Primary and active Primary Household Cardholder on the account will apply toward the Reward. The Reward is not guaranteed to be equal to or greater than the Executive upgrade fee paid. Limit one membership per household and business. Costco reserves the right to treat businesses with the same or similar addresses or with identical, similar or related ownership as a single business and as such, limited to a single membership. Costco reserves the right to refuse, decline, or cancel a membership at any time. Purchases made prior to upgrade do not qualify for the 2% Reward. If, at any time, the Primary Household Cardholder is removed from the account, their purchases will not apply toward the Reward.

The 2% Reward is issued approximately three months prior to the member’s renewal date, in the Renewal Statement, and reflects the Reward earned up until the issue date. A member must be a current, paid Executive Member at the end of the membership year to be entitled to the Reward. To receive a refund for the current Executive upgrade fee, the membership must be canceled or downgraded to a Gold Star or Business Membership. Any 2% Reward issued or accrued will be subtracted from the refund and forfeited to the extent it exceeds the amount of any refund. Any additional savings and services exclusively for Executive Members will be discontinued.

Calculation of 2% Reward

Reward is approximately 2% of pre-tax purchases (less refunds) of most merchandise purchased through: front-end registers, most ancillary business registers at Costco warehouses and Costco websites in the U.S. and Canada by U.S. and Canadian residents and qualifying purchases made directly from Costco Travel once travel is completed. In the U.S., Rewards are not calculated: 

  1. (i) on purchases of cigarettes or tobacco-related products, gasoline, Costco Shop Cards, postage stamps, alcoholic beverages in certain states
    (including Alabama, Arizona, Arkansas, California, Connecticut, Georgia, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Mississippi, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Dakota, Tennessee, Texas, Utah, and Vermont),
    prescription purchases in certain states (including Arkansas, New Jersey, and New York), and
    at food courts
  2. (ii) on membership fees; 
  3. (iii) on purchases not recorded through Costco's front-end registers and transactions done on or through websites not hosted by Costco even if accessed through Costco.com, including all business, consumer, and insurance services, the Online Photo Center, and the My Publisher website; 
  4. (iv) on miscellaneous fees, deposits and taxes, including sales tax and shipping; 
  5. (v) where prohibited by law or regulation; 
  6. (vi) on purchases made by anyone other than the account's Primary or Primary Household Cardholder; 
  7. (vii) as to travel purchases: surcharges, gratuities, trip protection, travel purchased through a third party, upgrades, rental car equipment, resort charges and port charges; and 
  8. (viii) on certain other categories as determined at Costco's discretion, which may change without notice.

Using The 2% Reward Certificate

The Reward certificate is mailed with the Executive Member's annual renewal notice and mailed to the Primary Member. Rewards totaling less than $1 will not be sent. The Reward may be redeemed toward purchases of most merchandise through the front-end registers (not currently available at self-checkout) at Costco warehouses in the U.S. Reward certificates may not be used: 

  1. (i) toward purchases that are not recorded through Costco's front-end registers, such as purchases at gas stations, Food Courts, and online at Costco.com; 
  2. (ii) as payment on credit card accounts; 
  3. (iii) on purchases of services, such as travel and auto; 
  4. (iv) where prohibited by law or regulation; or 
  5. (v) on certain other categories as determined at Costco's discretion, which may change without notice. 

Reward certificates may not be redeemed for cash. Reward certificates will not be replaced if lost or stolen. Regulatory restrictions on Rewards subject to change at any time.

Canadian program rules are available at Canadian warehouses. Costco reserves the right in its discretion and without prior notice to discontinue or change the 2% Reward program at any time, or to disqualify or cancel members' participation.

Updated January 20, 2023.

What is an Executive Membership?


It pays to be a Costco Executive Member:

Executive Members earn an annual 2% Reward on qualifying purchases at Costco, Costco.com, and Costco Travel. Plus, additional benefits are available on our suite of Costco Services. We offer a 100% satisfaction guarantee and will cancel and refund membership fees at any time if a member is dissatisfied.

Additional values are available to Executive Members such as lower prices on check printing, auto buying, roadside assistance included at no charge for vehicles covered through the Auto Insurance program and additional travel benefits. View our full list of Costco Services. Executive Members also receive a monthly edition of The Costco Connection magazine.

Costco membership is $60 a year. An Executive Membership is an additional $60 upgrade fee a year. Each includes a free Household Card. Please include sales tax in all applicable states. (Business Members also pay an additional $60 for each additional cardholder - purchases made by the additional cardholders do not contribute towards the 2% Reward.) Members who upgrade for a partial year will be charged a prorated upgrade fee.

The Primary Member or Account Manager of an existing membership may upgrade to the Executive membership one of the following ways:


When to expect a 2% Reward Certificate:

The 2% Reward Certificate is mailed with the renewal notice approximately two months prior to the member’s annual renewal date. A member must be a paid Executive Member at the time the Reward is issued to receive the certificate. Members who reverse their Executive status will lose all rewards accumulated. Rewards are not prorated.

Eligible purchases:

Only purchases made by the Primary and active Primary Household Cardholder on the account will apply toward the Reward. Most U.S. warehouse purchases apply to the 2% Reward. Please see below for a list of ineligible purchases. Eligible purchases made in Canada, Puerto Rico or on Costco.com also contribute to the annual 2% Reward. For eligible Costco Travel purchases, Executive Members will earn a 2% Reward after travel is completed (must be an Executive Member when travel starts).

In most cases, pharmacy and over the counter (OTC) purchases apply to the 2% Reward. Only the amount not covered by insurance (co-pay) is calculated as part of the 2% Reward.

Refunds of eligible purchases will be deducted from the 2% Reward.

Ineligible purchases:

Purchases made in Australia, Japan, Korea, Mexico, Spain, Taiwan, Iceland, China, France and the U.K. will not be applied to the 2% Reward.

The following purchases do not apply to the 2% Reward:

  • Alcohol in AL, AZ, AR, CA, CT, GA, HI, KS, KY, MA, MI, MN, MS, NH, NC, ND, OH, OK, RI, SD, TN, TX, UT, and VT
  • Auto Purchasing
  • Battery Fees
  • Bottle Deposit
  • Costco Shop Cards/Gift of Membership
  • Children’s Miracle Network Hospital Balloons and other charitable giving Costco.com
  • Shipping Fees
  • Costco Services
  • Food Court
  • Gasoline
  • Home Delivery Services (Delivery Charges, Installation)
  • Membership Fees
  • Misc. Taxes & Fees
  • Oil Disposal Fees
  • Optical Exams
  • Stamps
  • Tire Balance & Installation Fees
  • Tire Disposal Fees
  • Tobacco
  • Websites not hosted by Costco.com including online Costco Photo Center
  • 3rd Party Insurance Payments
  • Prescription drug purchases in certain states (including Arkansas, New Jersey, and New York)