By Vernon Rowe and Aaron Seacat
Though we are learning about the performance problems created by concussion in sports, we know virtually nothing about the sleep disorders those concussions can cause.
What do we know about sleep and sports? Everyone “knows” athletes tend to do better after a good night’s sleep But what’s the data?
Moughin, in 1991, showed that sleep loss hurt a cyclist’s performance, and it did it by making the cyclist work harder, and get less for the energy expended, by causing more anaerobic metabolism, and increasing lactate production.
Mah et al in 2011 studied the Stanford men’s basketball team, and found that with sleep extension, the time to sprint 282 feet decreased by a full second. Also, free throws and three-pointers increased over 10%, and self-rated performance in practices and games increased by over 10% and 20%, respectively. And these numbers were highly statistically significant.
In 25 years of Monday night football win/loss data clearly favor the West coast teams. (article in Current Biology). This can be explained to some extent by sleep and the clock we all have in our bodies. When the game is played in the West, the percentage of wins is about equal between East and West. But when the game is played in the East, the West coast clearly dominates. This is because reaction time, strength, duration of high intensity exercise, lower pain perception, less joint stiffness and inflammation, and lower perceived effort, all clearly favor the West coast teams. Because they’re all better in the early evening. And when West coast teams play Monday night, they always play, during what for them, is the early evening.
And when the Royals had to play in San Francisco, they realized that a good night’s sleep was more important than an extra practice, and they behaved accordingly. What would have happened if that last game of the World’s Series had been played in the afternoon instead of the evening? That may be the same kind of question as Gordon at third base. We’ll never know!
By Vernon Rowe, Dana Winegarner, and Aaron Seacat
Doctors at the Headache Treatment Center of the Rowe Neurology Institute are using a new device, called the Tx360, for headache treatment in a specially selected group of patients with chronic migraine headache, and certain types of a headaches called Trigeminal Autonomic Cephalalgias, or TAC’s. A recent study showed that the procedure helped patients with chronic migraine, without having to use needles.
“This device helps us deliver a local anesthetic to a group of nerve cells important in the pain pathway of certain types of headache, and it doesn’t require needles or expensive endoscopic procedures, we don’t charge facility fees, and it’s totally an outpatient procedure. But the trick, and that’s true of all patients with headache, is to know what kind of headache you’re dealing with. You need to get to the root causes and real triggers of the headaches a particular patient has. That’s what helps us know which medicine or procedure is likely to work,” says Dr. Dana Winegarner, head of the RNI Headache Center. “Right now, Botox is the only FDA approved drug for Chronic Migraine. RNI has successfully used Botox in patients for several years, but these injections involve needles. The new procedure could be a major step forward in getting patients relief for Chronic Migraine who don’t like needles.”
Data analysis of thousands of patients, at the Rowe Neurology Institute, revealed that several previously unknown factors, like sleep and neck problems, can impact a patient’s migraine severity and frequency. Rather than add yet another drug to a patient’s already long list of drugs, neurology sub-specialists working side by side at the Headache Treatment Center at the RNI, also discovered some of the common things patients do every day can trigger a migraine cascade.
Headaches have many causes and triggers and every patient is unique in some way. We have yet to find a single patient who comes with a ready-made recipe for their headache treatment. The detailed history and physical exam, amplified by appropriate testing for other disorders, must be carefully analyzed for every patient. Only in this way can maximal quality of life be achieved for every patient.
We believe an MRI, just like an EMG, a Sleep Study, an EEG, and nearly every other test we use, is merely an extension of the neurological history and examination. So you need an Open Low Cost MRI that is ordered, interpreted, and reviewed with you by a neurologist and specialist certified in MRI interpretation. Our specialized knowledge insures that any test we order will be performed and interpreted in a way that will help us improve your quality of life. In this way, we can save you thousands of dollars in your evaluation. A test is not just a test, an MRI, not just an MRI. Our specialized certification sets us apart from the faceless alternatives.
—Dr. Vernon Rowe
More Than An Open Low Cost MRI
The Open Low Cost MRI at the RNI is accredited by a national organization that insures its quality, and the quality of every step in the MRI process, from ordering the appropriate MRI sequences, or programs, to MRI maintenance, supervision, performance, and interpretation. RNI has included advanced imaging, including MRI, as an integral part of its practice for eighteen years. Imagers at the RNI know what specialized programs need to be performed to get the answers we need for your care. Only MRI certified technologists perform these scans, and only certified neuroimagers and renowned neuroradiologists interpret those scans.
Since our Open Low Cost MRI has an "Open" configuration, patient comfort is rarely an issue. And since MRI is a part of our practice, NO FACILITY FEES are charged, unlike hospital-owned MRI's. An advanced PACS system stores and manipulates the images, so they can be reviewed with you in your exam room, and any questions you have about the study answered. And those images can be sent anywhere in the world for second opinions.
Brain and Spine MRI's and X-Ray's are carried out daily, and the critical questions regarding any need for hospitalization and further treatment can be answered quickly. For instance, in the case of someone with worsening headache, decisions can be made quickly about brain imaging, and whether contrast or blood vessel imaging, is needed. If an appropriate headache-relieving infusion can be given, we can help patients avoid the additional delay and exorbitant cost of an Emergency Room visit.
Get the benefit of cutting-edge research
We don't just read research papers. RNI has generated our own cutting-edge research, documenting links between migraine, pinched nerves in the neck, and sleep disorders. We understand the links between sleep position, migraine triggers, and back pain. We are able to "connect these dots" thanks to our sub-specialization expertise in these areas of neurology, and thanks to our commitment to understanding each patient as a whole, a complex and unique person. A carefully designed MRI examination, chosen after a detailed neurological history and examination, is frequently a critical part of our evaluation process.
RNI is independent from hospitals, but we work with all hospital systems and doctors. This independence from hospitals does mean freedom from inflated fees and "facility fees," which can add thousands of dollars to outpatient services -- many of them paid for by the patients themselves.
Seeing is believing: We go over your MRI with you, so you can understand the results
We believe it is extremely important for a patient to view their MRI in detail, to know specifically why it was done, and to understand what it showed, or did not show. For us at the RNI, this is a critical step in the evaluation and patient education process.
Doctors who order expensive tests like an MRI should be able to go over the images with their patients. It's not good enough for someone to just read from the report of another doctor who never sees patients. Also, mistakes are made in our healthcare system, and sometimes reports of testing bear no resemblance to what that testing actually showed. And worse, sometimes reports mention irrelevant and frightening diagnoses obtained from a laundry list of diagnoses just "for completeness." Sometimes these "diagnoses" have a profound effect just by their mention in a medical report. Also, further useless tests are often suggested in reports, just "for completeness," again in a laundry list fashion. Ordering MRI's in anticipation of a visit to us, neurologists who can actually treat patients, is unnecessary and oftentimes wastes many thousands of dollars.
Our Open Low Cost MRI can acquire images of any other part of the body if necessary. Those images undergo the same rigorous review that all our MRI exams undergo, by experts in the field.
So insist on the RNI for your MRI--You'll be glad you did.
Parents concerned about ADHD should not only be attentive to the AMOUNT of sleep their child receives but also to their QUALITY of sleep.
A medical study highlighted in the NY Times revealed that children with sleep breathing disorders were 40 to 100 times more likely to exhibit behavioral problems like ADHD.
Sleep medicine is one of the fastest growing fields in health care today and researchers are discovering new health implications from poor quality sleep in nearly every field of medicine. With recent discoveries into sleeps’ implications, health care providers of all specialties are beginning to view sleep on the same level as nutrition as a component to good health.
In the medical study, one of the study’s lead authors said, “It’s incredible that we don’t screen for sleep problems the way we screen for vision and hearing problems.”
Children with sleep apnea and even milder forms of sleep breathing disorders (SBD) are not likely to “outgrow” their condition as they mature. In fact, it will likely become worse. Poor quality sleep due to sleep breathing disorders has been proven to increase calorie consumption (study) and weight gain which is correlated with increased risk of sleep breathing disorders. The weight of excess tissues around the neck causes the airway to narrow or collapse. The problem begins to spiral out of control in this manner:
Poor sleep –> Increased calorie consumption –> Weight gain –> Occluded airway during sleep (apnea or SBD) –> Poor sleep…….
The article reveals that the drugs used to treat ADHD, like Ritalin, Adderall or Concerta, can cause insomnia. Dr. Vernon Rowe, board certified neurologist and sleep medicine physician Rowe Neurology Institute has long contended that children who snore or experience poor sleep become wired, not tired. “Unfortunately, you can add kids with ADHD to a long list where medical professionals, by using drugs to treat symptoms, may be doing more harm than good because they are not addressing the root cause of the problem.”
As the medical director at the Institute’s Sleep Disorder Center, Dr. Rowe recorded this video message for parents who are concerned with their child’s sleep and or behavior.
Dr. Rowe recorded this video message for parents who are concerned with their child’s sleep and or behavior.
By Elizabeth S. Rowe, Ph.D., M.B.A.
MedPAC finds High Hospital Charges and Costs, NOT Higher Volume, makes US Healthcare more expensive than the rest of the world.
This year’s agenda for MedPAC (The Medicare Payment Advisory Commission, which advises Congress on Medicare Policy) includes an analysis of the high hospital charges and costs in the US compared to other countries, and what policy changes in Medicare can be made to ameliorate these high costs. The presentation by staff at a recent public meeting (MedPAC Presentation)included the results of their research, which showed that American high hospital charges and costs for Medicare are 50% higher than those of the closest comparable country, as a percentage of GDP. Commercial hospital costs are 100% higher in the US. However, the reason was traced to higher costs, NOT greater utilization; in fact the average length of stay and number of admissions per capita are lower in the US.
The analysis only considered hospital costs, and it includes costs of hospital employed physicians. Since private physicians are paid less than hospital employed physicians for comparable services, this data suggests that private practice independent physicians in the US are NOT overpaid compared to these other countries.
The presentation listing of possible actions that could be taken to correct Medicare payment policy include introducing site neutral payments which “removes incentives to move lower priced services to hospitals where overhead is higher.” Site neutral payments policy for hospital employed and private practice physicians was officially recommended last year also (see March 2014 Report, at www.medpac.gov). A second possible action would be to simplify quality reporting, since “complexity” was one of the reasons identified for US hospitals having higher overhead than the compared hospitals.
This meeting is the first of several public meetings where this topic is being discussed by the Commission, and the data details and resulting official positons and recommendations will be presented as a chapter in the March 2015 Report to Congress. The presentations and transcripts of the discussions for all of the MedPAC public meetings are posted online at www.Medpac.gov
By Vernon Rowe, MD
This article takes for granted that you are already aware what a slippery slope spinal surgery for back pain and neck pain can be. Put concisely, one bad thing leads to another. Surgery is not the “final answer” for back and neck pain. Just as injury begets weakness which begets another injury, one spine surgery frequently leads to more spine surgeries. It’s a complex topic, but at RNI we feel very strongly that the fault for this lies in the weak tissues surgery leaves behind, rather than surgery patients having worse conditions to begin with. Click to read a fuller discussion of the risks of back surgery. At RNI we consider it our mission to move you from the slippery slope to solid ground with the most conservative and effective therapy possible.
Why diagnosis by an independent neurologist is crucial in back pain and neck pain
Here are just a few reasons why you need an independent neurologist for your back pain and neck pain, like those at the RNI,–the only independent neurology institute in Kansas City.
We have tried to capture the value of RNI’s approach by sharing a woman’s story (and video) of going from wheelchair to pain-free walking, and we hope that you will check it out. It’s quite a story, hopefully you find some inspiration in it.
Many Surgeons have an inherent “lean” toward surgery. They do order diagnostic tests like MRIs and x-rays, just like a general or family doctor can. But surgeons can’t help seeing every patient through the lens of their most powerful tool: “Can surgery help this patient?” The problem is, patients don’t want surgery if they can possibly avoid it. Thus, even the best surgeons see your case through a different lens than you see it yourself.
Any neurologist is highly specialized in diagnosing back pain and neck pain, and in assessing risks and treatment options. Every back pain and neck pain patient is unique, with different degrees of problems associated with a bone or disc abnormality. A neurologist is trained to discover the causes of symptoms, as well as using EMG testing to assess the injury to nerves and whether it is reversible in the short and long term. But if a neurologist sees a patient sent by one of his or her surgical friends, and they both work in the same hospital system, then that neurologist is conflicted in his or her assessment. On the one hand he/she has a primary duty to the patient to provide the best care possible. On the other, the neurologist’s salary might be paid by the hospital system, which receives compensation, as does the surgeon, when surgery is done. So we at the RNI believe it’s best for a patient to see an independent neurologist, or at least one in another hospital system, to have a true and unbiased second opinion about whether surgery is necessary. In most non-emergency cases, a conservative approach is both possible and optimal.
You need the most informed and trustworthy referral to a surgeon. An independent neurologist who has seen thousands of cases can find the best surgeon for your case. Unfortunately, some patients can’t be helped by even the best physical therapy. Disc herniation can be too extreme, bone can build up around nerves to the point where they no longer fit through. Neurologists at the RNI know fine surgeons they can rely on if surgery is necessary, no matter which hospital system that surgeon is in, so the RNI can frequently give a patient multiple options should they need surgery. We have a great deal of experience with all major hospital systems in the KC region, though we’re independent from hospitals, so you can trust there’s no financial motive at play.
Neurologists make a long-term connection with patients. Surgeons don’t generally care for patients with back pain and neck pain over the long term. The last time you see a surgeon is likely at a post-op follow-up visit a month or two after surgery, long before you are fully recovered. There are a plethora of cracks to fall through later on, the most important being a return to the same posture and muscle conditioning that led to the injury in the first place.
RNI coordinates all aspects of your treatment, from diagnosis to recovery and prevention of re-injury. We at the RNI are a tightly coordinated team of caregivers, diagnostic equipment, and facilities in order to deliver the best possible outcomes for neurology patients. This includes an imaging center with both MRI and x-ray, and a physical therapy team that gets the majority of back patients better without surgery. These outstanding individuals deserve their own paragraph:
Highly specialized physical therapists who follow your case from your first visit. RNI’s physical therapy team gets the majority of RNI back patients better without surgery, by re-training the muscles of the hip and abdomen to support the back the way they were intended. What these physical therapists accomplish can seem like a miracle to the patients they help.
If a surgeon refers you to physical therapy at all, he’ll leave it up to you to pick a physical therapist off the internet. Not only will the therapist you find be a generalist, they will have little more to go on than a few words about the type of surgery you had.
A good neurologist will support you in the long term. Back injuries are a long-term problem, and to fix them a great deal of commitment is required of the patient. That commitment can keep you healthy and out of surgery, but you can’t do it on your own. RNI nurses, physicians, and physical therapists support you all along the way.
by Vernon Rowe and Aaron Seacat
Healthcare and Baseball are alike in many ways, and this similarity was driven home when the Kansas City Royals, against all odds, won the American League pennant.
Healthcare and Baseball are ponderous institutions, with tremendous inertia doing things the way they have always been done. But occasionally, disruptors can change the way things are done and induce a paradigm shift in the way the game is played for the better.
Jonathan Bush, in his book Where Does It Hurt: An Entrepreneur’s Guide To Health Care, makes this point about healthcare when he says “Health care is starving for efficiency experts, customer service geniuses, retail mavens, people who have created thriving and modern businesses in other industries [disruptors.]”
In the famous Moneyball example in baseball, a paradigm shift occurred when Jonah Hill showed Brad Pitt (as Billy Beane) the most important part about winning was getting on base. In the movie, John W. Henry, of the wealthy Boston Red Sox , tells Billy Beane: “The first one through the wall…is threatening the way that they do things…and every time that happens–whether it is the government, or way of doing business or whatever it is …the people who are holding the reins, have their hands on the switch, they go [expletive deleted] crazy.”
As the Royals won the American League pennant and gave Royals fans their first postseason appearance since 1985, they did something never before done in the history of the game—8 straight wins to begin the postseason. They did this with a small market payroll uniquely void of high priced sluggers. In an era where home runs are a valued (and expensive) resource, the Royals success has introduced another paradigm shift in thinking to MLB: the ability to run and disrupt the rhythm of the game can be as important as hitting.
As in the baseball industry prior to Billy Beane, and now the Kansas City Royals, our hospital-centered healthcare system is ponderous, overly expensive, and obsolete. Like the automobile industry of the 1970’s, with its cars gulping gas at the rate of 7 miles per gallon, the healthcare system will need to be re-engineered. The industry itself is sorely in need of disruption.
Most health care is outpatient care, yet most of our healthcare dollar is spent on hospitals–far more than the rest of the world, due to higher rates, not higher volume. MedPAC Study
Independent outpatient centers, like the Rowe Neurology Institute, can be designed to deliver high quality, cost effective care at a fraction of the cost of hospital-based care.
These centers are light on their feet and fast, without facility fee overcharging and the weighty infrastructure of overbuilt hospitals dragging them down. They can eliminate long waits and overpricing. Their only loyalty is to their patients. They are disruptors, and in this sense, are game changers and paradigm shifters.
Outpatient centers like these are perfectly poised to disrupt the healthcare system for the better. Just as the ability to steal bases and disrupt the rhythm of the game of baseball, can be a major addition to the arsenal of hitting and pitching. In the now famous words of Jarrod Dyson, a player for the Royals, “That’s what speed do.”
The Whirlybird Anthology of Kansas City Writers
Edited by: Vernon Rowe, Maryfrances Wagner, David Ray, Judy Ray
Cover Photograph by Elizabeth Rowe
The Whirlybird Anthology of Kansas City Writers presents poems, stories, and memoir selections from 95 writers who have lived or worked in the Kansas City area, many of whom have earned widespread recognition in this country and internationally.
“In some of the selections Kansas City itself is subject or backdrop, for example when Richard Rhodes and Hilary Masters recall specifics of their childhood, or when David Owen returns to explore remembered odors, or when poets respond to the influences of jazz. But also found in these pages are subjects and styles as varied as can be imagined—and imagination is not bound by place.” – from the Preface to the Anthology
Other regional collections have been published in previous years. This work stands on their shoulders, highlighting some of the finest examples of widely published authors, but also introducing new voices to the Midwest medley. In addition to a note of biographical information, many of the authors also provide a personal sound-bite observation about Kansas City.
The Anthology will be launched at a celebratory Reading on November 30, 2012 at 7 p.m. at The Writers Place, 3607 Pennsylvania, Kansas City, MO 64111. 816-753-1090
Dr. Vernon Rowe answers a reader's question about sleep disorders:
Question: I am looking for information for a friend who snores loud and stops breathing in their sleep. How should they even start getting their treatment? I don't even know where to begin.
Answer: Your question is a very important one and your friend is very lucky to have someone like you watching out for them. What your friend needs to understand is that snoring is NEVER normal. There can be different reasons why people snore and some reasons are more serious than others but you have clarified that your friend snores loud and stops breathing which is a hallmark sign of sleep apnea.
Of course the only way to truly know is to have a sleep study at a sleep lab (at this time I don’t recommend "at home sleep testing" because of the equipment deficiencies; mainly reduced sensitivity that can result in a false negative polysomnogram). You can find an accredited sleep center near you by entering your zip code at this link.
Schedule a new patient visit with a physician who is board-certified in sleep medicine. While any physician can write an order for a sleep evaluation, a physician board certified in sleep medicine is much more intimately familiar with how various sleep disorders are identified and treated. At the initial visit, a short evaluation will ask many questions about the patient’s sleep habits, medical history and symptoms that may indicate if a sleep disorder is present. If deemed necessary, a polysomnogram (sleep study) will be ordered.
If scheduling at Rowe Neurology Institute's Sleep Center: Our schedulers will verify insurance coverage for the sleep study and review the details with your friend. Once the sleep study has been completed, a board certified sleep medicine physician will review and interpret the data, make a diagnosis and discuss with your friend what the next steps should be. PAP therapy is the most common treatment for sleep apnea (because it is simple and it works) but there are other options that can be discussed as well. The important thing you can do now is not let your friend continue to go undiagnosed and untreated.
Sleep apnea is a real health risk with links to heart disease, stroke, diabetes and other serious health problems. The good news is that sleep apnea is treatable and your friend will wish he/she had done something sooner. Good luck.
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The Headache Center at Rowe Neurology Institute has said over and over that there is no single cure for migraine, because every patient is unique and must be evaluated and treated individually. However, there is a pattern developing of satisfied (former) migraine sufferers that all seem to be singing from the same hymnal. In recording their testimonials, like the one below, a common migraine story is developing.
• Had regular or daily headaches
• Currently on or tried multiple medications with little improvement or bad side effects
• Evaluated at Rowe Neurology Institute
• Found previously undiagnosed sleep disorder (like sleep apnea or RLS)
• Usually a side-sleeper or sleeps on their stomach
• Pinched nerves in the neck (possibly triggering migraines)
After a comprehensive neurological evaluation these migraine sufferers receive an individualized treatment plan developed to fix the root cause(s) of their migraine. Patients are most appreciative that they are not simply getting another drug to treat their symptoms. The common treatment “formula” that has emerged.
- Physical therapy to correct the mechanics of the neck and shoulder complex and to strengthen weaker muscle components to correct movement patterns
- Sleep study to diagnose and properly treat the sleep disorder
- Learning to sleep in a “neutral spine” position that was previously difficult or impossible due to undiagnosed/untreated sleep disorder
- Unparalleled expertise in medication management to eliminate or pare down medications to a bare minimum
This model of care at Rowe Neurology Institute (RNI) is unique in that the care provided from RNI's accredited sleep center, the clinical neurologists, electrophysiologist, neuro-radiologists and physical therapist are all coordinated together. Communication happens seemlessly and easily between the different departments so that ultimately, the patient experiences the most effecitive and cost-efficient care possible.