NeuroNews

MS and Cane Free Thanks to Physical Therapy

  

  

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Cane free and headache free! 

This is a wonderful testimonial to the doctors and physical therapists at MidAmerica Neuroscience Institute.  Another example of how someone's life was  drastically improved simply because a doctor didn't dismiss some symptoms (in this case headaches) as an unfortunate consequences of having multiple sclerosis. 

Headache Information Group of Kansas City

  

  

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Neurologist, Dr. Dana Winegarner, of MidAmerica Neuroscience Institute (MANI) led the first meeting of the Headache Interest Group of Kansas City.  The Group meets on the first Thursday of each month (except January and July) from 6:30-8:00 PM.  The Headache Interest Group of Kansas City is sponsored by KU Medical Center and MidAmerica Neuroscience Institute.  The goal of these monthly meetings is to educate and inform headache sufferers on the resources available to them throughout the Kansas City area (see introductory video below). 

The meeting was held at MANI’s headquarters in Lenexa and featured a short talk by the founder of the Institute, neurologist Dr. Vernon Rowe (video below).  Dr. Rowe spoke to the group about some of the different components that can contribute to headaches.  He went into depth on sleep disorders and their role in chronic migraine and discussed some of the research that he has conducted through MANI’s Headache Center and Sleep Disorders Center.  A future meeting will feature a presentation on sleep issues that relate to headaches as well as the lack of awareness of sleep disorders being a possible reason so many headache sufferers fail to find relief.

Next, physical therapist Shane Jackson, DPT, briefly discussed the impact that the cervical spine has on headaches (video below).  He demonstrated to the group, with a model of the spine, how some motion segments of the neck often become hyper-mobile while others lack mobility.  A future meeting will feature a presentation by a MANI’s physical therapist on some of the methods they utilize and outcomes they have experienced for their patients with chronic migraine.

The next meeting will be February 2^nd at 6:30 and will be held at the Prairie Village Community Center at 7700 Mission Road in Prairie Village, KS.  This meeting will introduce a new tool, “6 M’s of Headache” - Methods, Management, Meditation, Memory, Movement and Medication. 

No RSVP is required but you may call 913-588-0608 with any questions. Stay informed by "Liking" MidAmerica Neuroscience Institute on Facebook.

Stress & Sleep Part II: Coping Skills for Thought-Racing When It’s Time to Sleep

  

  

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In Part I, we talked about how thought-racing can trigger physiological changes called The Stress Response, and that chronic activation of this response can not only fuel insomnia, but can also lead to potentially harmful biological changes in the body and brain that can lead to other medical conditions. So, how can we convince the brain (and of course, ourselves), that we’re under no immediate danger, and that now is the time to sleep? Shutting down thought-racing and worry can be as simple as practicing a few tricks that are used in Cognitive Behavioral Therapy (CBT), which research has shown to help address distressing thoughts as they occur.

Try this coping skill exercise for thought-racing in the next week. See if you notice less thought-racing, and as a result less stress, when you are trying to go to sleep:

1. Get up briefly (turn on only a small light) and get a piece of paper and pen.
2. Make three columns on the paper, labeled: 1) Situation, 2) Negative Thoughts, 2) and Positive Thoughts.
3. Briefly describe the situation(s) you are thinking about, in the first column. An example might be, “I’m worried about my sister’s health…she is going through medical tests to determine a diagnosis for her chest pain”. Though of course you are concerned about your sister, staying up all night worrying is probably not going to help her (or you).
4. For each situation, write down the negative thoughts associated with that situation in the second (“Negative Thoughts”) column. Going with our previous example, this might be, “I don’t know how she is doing.”, “I wish I could help her”, and, “Who is going to take care of her family?”. When thought-racing occurs, many people get stuck in the negative thoughts and never move on to more healthy and productive coping. That’s when the third column becomes useful.
5. Find a more positive thought to counteract each negative thought, and write it in the third (“Positive Thoughts”) column. For each of the negative thoughts above in #4, a few positive alternatives may be, “I’ll be able to get more information about her health in time”, “I can ask her about what ways she needs my help over the next week”, and, “I can see what other resources I have and can offer to her if/when she needs them”.
6. After you have identified some positive alternative thoughts, notice how you feel. Most people feel less anxious, worried, agitated, sad, etc. after going through this exercise. Using this and other techniques can help you feel more relaxed, making it easier to get to sleep.

Many studies have tied CBT coping skills like this one to reduced anxiety, depression, and other negative emotional states that interfere with sleep. One study in the Journal of the American Medical Association (JAMA) found that using CBT coping strategies increased both sleep time and sleep efficiency for those with chronic insomnia (Edinger, et al., 2001). Other CBT exercises can be found in a variety of books on the market today (e.g. Edinger & Carney, 2008).

For additional help in using CBT techniques to aid in sleep, Dr. Carolyn Karr at MidAmerica Neuroscience Institute offers sessions for those who would like help in applying these coping aids to their nightly sleep efforts.

Dr. Carolyn Karr is a neuropsychologist that practices at MidAmerica Neuroscience Institute in Lenexa, KS.

Stress and Sleep Part I: Thought-Racing and The Stress Response

  

  

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We’ve all had those nights when we are worried about some big event the next day, and the worry and anticipation keep us from going to sleep right away. Maybe it’s an important appointment, an anticipated stressful day at work, or worrying about a friend or family member who is ill, but whatever the reason, we’re tossing and turning instead of catching some ZZZs. The process of worrying and thinking about the same thing over and over is called “thought-racing”, and it’s just how it sounds: thoughts seem like they’re out-of-control and are buzzing through your mind, going 200 miles an hour. And, since this isn’t the Indy 500, that type of racing is a barrier in reaching our goal of consistent sleep.

If thought-racing is the vehicle, then adrenaline is the gasoline. When thought-racing occurs, we’re not only keeping our mind occupied when it should be resting, but we’re also stirring up nervous energy that can be further fueled by adrenaline. Adrenaline is a hormone that is released by the adrenal glands when we are under real or perceived stress—a part of “The Stress Response”. It spurs the heart rate, contracts blood vessels, and dilates air passages, all in preparation for “flight or fight”, an innate response where we are called on to act quickly to save ourselves (“fight”) or to get out of a situation (“flight”) as soon as possible. In other words, we are wide awake at these times, because our brain and body think there is a physical threat that needs addressing-- even though no true physical threat exists. The emotional threat is enough to trigger our body to use The Stress Response to help us survive.

When we are trying to get to sleep, and need to relax to do so, adrenaline has a nasty way of putting our body in the worst possible state to allow that to happen. Compounding the problem, some research now suggests that long-term sleep deprivation can activate The Stress Response trigger more easily, as it may cause biological changes in the brain response system over time (Meerlo, et al, 2008). Currently, this line of research has used animal models only, but other research indicates that chronic activation of The Stress Response may play a role in the development of medical conditions as well, such as coronary heart disease (Vitaliano, et al., 2002) and type II diabetes (Black, 2003).

Part II will provide an exercise for how to cope with thought-racing at night.

For help in applying coping strategies to sleep issues, Dr. Carolyn Karr at MidAmerica Neuroscience Institute offers sessions for those who would like help in using positive behavioral changes to decrease insomnia.

Physical Therapy and Pain Management

  

  

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After an accident with a ladder, this patient sought the help of various physicians and therapists but found little relief for the pain in his arm.
It wasn’t until he began working with Shane Jackson, DPT, at MidAmerica Neuroscience Institute that he discovered the real origin of his pain.  With the correct information about his injury in place, a plan of therapy with physical therapist, Dr. Jackson brought him the pain relief and healing that had escaped him for so many months.

Physical Therapy and Multiple Sclerosis

  

  

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Rule number 3 in Dr. Rowe’s philosophy of treating Multiple Sclerosis is, “Don’t blame every symptom on MS”.  People with Multiple Sclerosis, just like everyone else, can develop problems with their bodies that have nothing to do with their MS.  Those problems should be addressed independently of their MS and not looked upon as another complication of MS that the patient will have to overcome. 
Physical therapy can be a huge component in keeping a person with Multiple Sclerosis actively functioning at optimal levels - as the patient in the video below describes.

Doctor of Physical Therapy, Kelli Wong practices at MidAmerica Neuroscience Institute in Lenexa, KS, a suburb of Kansas City.

Multiple Sclerosis Center Advances Knowledge of MS

  

  

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One of the benefits of a multi-disciplinary Multiple Sclerosis Center is the knowledge and expertise that is accumulated and shared with others.  MidAmerica Neuroscience Institute’s MS Center has operated in the Kansas City area for over 15 years and has approximately 1,000 MS patients in its care.  The Institute provides many services to people with Multiple Sclerosis (MS), their family members, as well as other health care professionals involved in treating MS.  On the front lines of educating patients, the public and medical providers is Doug Schell. Schell is Clinical Nurse Specialist and MS Certified Nurse at the Institute and his knowledge and experience of Multiple Sclerosis is increasingly in demand.

In December Schell traveled to Wichita, KS to meet with a group of people with MS and their family members. Schell presented them with information about MS and the MS medicine Avonex, followed by an extensive question and answer session.  Also in December he presented a talk to local health care providers about the experimental medications Rituximab and Ocrealizumab.  The Institute was part of a preliminary study on Rituximab and is currently conducting two research studies about Ocrealizumab.  Interested patients can contact our research foundation for more information.  In January, Schell presented local MS patients with information about Mulitiple Sclerosis and the first oral drug approved for MS, Gilenya, at an evening meeting at a local restaurant.  The Institute plans to continue to reach out to the community to provide education and information to help people with Multiple Sclerosis.

All MRI's are Not Equal

  

  

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There are many elements that contribute to the quality of an MRI scan.  The first thing people generally think of is the size (strength) of the magnet but just as, if not more critical for an MRI to be useful in making a correct diagnosis are these factors; given from a neurological perspective.

• Choosing the correct type of imaging.  Different health issues may require one of, or a combination of MRI, MRI with contrast, MRA, as well as the decisions to use gradient echo sequencing or other variants.
• Determining proper protocols, slices and sequences that will zero in on the specific area to be imaged.
• Imaging the correct body part.  This may sound absurd but in a neurology practice, patients with radiating pain, due to a problem in the spine, routinely show up with a previous MRI of their shoulder, arm or hand.  A complete waste of time and money / insurance.
• Who reads the MRI? Most facilities have general radiologists that read every type and kind of MRI, somewhat a “jack of all trades”.  At MidAmerica Neuroscience, a neuroradiologist or a neurologist with fellowship training in neuro-imaging read all MRIs.

The reasons above are why Imaging Decisions Should Come After, and as a Result of the Clinical Examination.  But with all of these complex decisions, sometimes the outcome is dependent on the kindness and caring of the MRI technologist, as the following letter from a patient (used with permission) describes.

Dear Dr. Moreng
I would like to commend all of your staff that I met.  They were all really good people and that definitely includes yourself and Judy.  However one lady in particular stands out.  Her name is Tammy and I met her on Sept 12th at your Cambridge Circle location.  She is a very caring and professional lady who goes out of her way to make things easy on the patient.  I did not realize how long approximately two hours was in an MRI tube.  I could have had a problem handling it if not for her help.
Thanks again,
John P. Dalbier

Tammy Tubbs is an MRI technologist at MidAmerica Neuroscience Institute with over 10 years of experience.  Her professionalism and commitment to her patients are vital in achieving quality MRI scans that will assist the physicians in making the diagnosis.  Keep up the good work Tammy!

The Art of Medicine

  

  

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Some of you know that I am a writer as well as a doc.  My heroes, in addition to the medical greats, are Keats, Chekhov, Williams, Coulehan, Coles and other physician writers. 
My creative writing is short.  Really short.  If it isn’t poetry, it scans like poetry.  And one act plays.  Some of my recent work is incorporated into a small collection, The Ride, available from Amazon and Whirlybird Press.
I recently took a vacation and was looking for ideas for a long form piece.  Background, inciting event, first-act turn, the back and forth of act two, and the third act, with the climax and conclusion.  Get into a scene late and out early.  Every story has a beginning, a middle, and an end.  Cut the beginning and cut the end.  If you can’t tell a story with nouns and verbs, don’t bother.  That sort of thing. 
I was soaking in the pool when a kid splashed in.  Typical thirteen year old, full of joy.  What was different about him was he had a scar from his tummy to his neck, with a tracheostomy scar at the top.  He offered his hand in introduction, and from his speech I could tell he was deaf.  He was a good lip-reader, though his parents also signed for him.
This kid turned out to be the oldest living patient with his syndrome, which included Ondine’s Curse—whenever he went to sleep he stopped breathing.  He had an electrical problem in his brain.  So he had slept every night of his life with a nurse and a breathing monitor.
No matter what I did, sleep problems were all around me.  The next day I went to meet a guy who made the best musical instrument of its kind in the world.  Turns out neither he nor his number two could sleep.   I told him he had sleep apnea and his number two probably had periodic limb movement disorder. 
I went back to the pool, and in jumped a seventy year old with polymyalgia rheumatica.  I knew his history before he told it.  He was sleepy and his countenance was as bitter as bile.
Lives focused through the lens of medicine will burn your eyes if you look directly into them.  So I look to the side when I’m out of the office.  Still, the lens never turns completely off. 
So where was I?  Inciting event, character…

- Vernon Rowe, MD is a neurologist and Founder MidAmerica Neuroscience Institute

Extra Hour of Sleep and You’re Still Tired?

  

  

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Daylight savings time ends this weekend and along with the reminders to replace batteries in your smoke detectors, you are certain to see and hear the obligatory news stories about getting enough sleep.   

Sleep Quality vs Sleep Quantity
While the amount of time we spend sleeping is important, most of these daylight savings time stories will ignore the health consequences that poor quality sleep plays in lives.  Also, disorders such as sleep disordered breathing, has ill-effects on the heart and the brain.  As a neurologist and sleep medicine specialist, I see people in clinic every day that are getting 7 to 8 hours sleep nightly but are still chronically tired.  There are times when patients need to undergo a polysomnography (sleep study) so that we can understand what is affecting their sleep. 

What is a Sleep Study?
Some of the problems uncovered during a sleep study are obvious ones that a bed partner could have (and probably has) observed.  Snoring, a symptom of sleep apnea is one example.  Other sleep disorders are only perceived by the sensitive measurements of a polysomnogram, read by a board certified sleep medicine physician.  A sleep study is a complex integration of multiple tests that are all related to sleep. 

Some of the key components of a sleep study are:
• Sleep Stages
• EEG (electroencephalogram)
• Oxygen Saturation
• Sleep Position
• Respirations
• Heart Rate
• Respiratory Events
• Eye Movements
• Limb Movements

By observing the interrelated results of the polysomnogram, often we can determine what is robbing the patient of restful sleep and prescribe an appropriate therapy.  With solutions is place, patients return to normal, restful sleep and typically report improved quality of life in just a few weeks.  So while you're checking your smoke detector batteries this weekend, check your quality of sleep… ask yourself if your energy level matches the hours you spend sleeping.

-Kenneth VanOwen, MD