Drink Your Milk For Strong Bones and Joints

We remember being told as children to drink milk to have strong bones. The ‘Got Milk?’ campaign centered around milk being essential to healthy bones. As we get older we may replace milk with soft drinks and forget to be mindful of our bones, that is until we notice our joints aching and the looming possibility of osteoporosis.

Around the age of 25, our bones and joints are at the height of their strength. Bone mass decreases and cartilage wears down as time goes on becoming fragile. Joints protect the bones from rubbing against each other but when cartilage is worn away too much it can lead to arthritis. At some point after the age of 50, half of all women and a fourth of men will fracture a bone due to osteoporosis. This condition, that affects women more aggressively than men especially after menopause, continually weakens the bones causing the break very easily.

Good bone and joint health start in childhood often with a tall glass of milk and an active lifestyle. Proper nutrition is imperative to strengthening and later maintaining bones and joints. Calcium and vitamin D are essential. Many kinds of cereal and milk come fortified, making a bowl in the morning, not a bad option (just watch the sugar levels). Dark leafy greens such as kale, spinach, bok choy, and collard greens are packed with calcium — so are edamame and yogurts. For the dairy-sensitive, enriched soy and almond milk can make up your calcium needs.

While there are foods fortified with vitamin D, your body will naturally produce when exposed to sunlight making for an excellent opportunity to get up and go on an afternoon walk. Just 15 minutes a few times a week should produce enough vitamin D for your body to properly absorb calcium.

But don’t let those 15-minute walks be your only source of exercise. Maintaining a healthy weight is imperative to the body’s health. Extra weight can put unnecessary strain on your bones and joints. Research shows that for every extra pound, there’s four times more stress on the knees. Bones become stronger through activity and benefit from muscle building exercises (muscles and ligaments protect the bones and joints too — bonus!), dancing and brisk walking. Change up the types of exercises, though, since weight-bearing exercises can wear out joints. Mix in some aerobic workouts like running or for low-impact options try swimming and cycling. Speak with your doctor before starting any new exercise programs and find a trainer if you need help learning proper form to avoid injury.

Somethings aren’t so helpful to keeping bones and joints strong. Soft drinks and caffeine may not be so bone-friendly so try to limit the intake of these. Alcohol can also hinder bone and joint health so women should have no more than one drink a day, up to seven a week, and men two drinks a day but no more than 10 a week. Not only is it bad for your lungs, but smoking is also bad for the bones. Healthy lifestyle choices can help improve quality of life in later years.strong bones

It’s important to understand what effects medications may have outside of its main purpose as some may have adverse side effects. Prednisone, a corticosteroid used to help arthritis inflammation, decreases the amount of calcium absorbed causing bones to weaken.

Supplements could be an option for maintaining the nutrition needed for bone and joint health. Talk to your doctor if you are concerned about any deficiencies in your diet and if supplements are a good fit. There are new medicines on the market in recent years to help with osteoporosis and more to come. They’re all a little different but increase bone mass either by encouraging new bone growth or slowing the breakdown of the bones.

In a person’s younger years, it’s vital to build up strong bones and joints to set the foundation for their later years. Nutrition and exercise are the pillars of building and maintaining all aspects of a person’s health. So remember, drink your milk.

Join us for World Alzheimer’s Month



This September marks the 6th annual global World Alzheimer’s Month. This year is following the theme “Remember Me” and emphasizes the importance of early detection and diagnosis of dementia.

The Nothern Virginia area will be hosting several walks throughout the month to raise awareness of Alzheimer’s and dementia in communities.

Integrated Neurology Services will be participating in the following walks:

Join us in raising awareness and say hi at our booths!

Juvenile Arthritis – Not Just Your Grandparents’ Disease


We’re accustomed to joint problems increasing as we age into our wisest selves but there is a small population that experiences this at a young age. Juvenile arthritis (JA) is an umbrella term for several autoimmune and inflammatory diseases that can affect children.


There are 7 different types of juvenile arthritis:

  • Juvenile idiopathic arthritis – This includes several different subtypes: oligoarthritis, polyarthritis, systemic, enthesitis-related, juvenile psoriatic arthritis, and undifferentiated.
  • Kawasaki disease – An inflammatory disease that affects the blood vessels. This can lead to heart complications without proper or delayed treatment.
  • Juvenile scleroderma – Causes the skin to harden.
  • Juvenile dermatomyositis – Causes a skin rash on knuckles and eyelids, and causes muscle weakness. It is an inflammatory disease.
  • Juvenile lupus – Affects the joints, blood, kidneys, skin, and other areas of the body. It is an autoimmune disease.
  • Fibromyalgia – A chronic pain syndrome that is an arthritis-related condition. More common in girls but rarely is diagnosed before puberty.
  • Mixed connective tissue disease – This can include features of the other diseases.

Almost 300,000 children in the United States have some form of juvenile arthritis and 50,000 of those suffer from the most common, juvenile idiopathic arthritis. These diseases present themselves in children as young as 6 months old. Some children may have no symptoms at all and symptoms can vary depending on which type of disease they have.

Some of the more common symptoms include:

  • Joint pains and swelling
  • Stiffness, especially in the morning
  • Rash
  • Fever
  • Weight loss
  • Eye redness, pain, and/or blurred vision
  • Fatigue
  • Irritability

Unfortunately, diagnosing for juvenile arthritis can be difficult. There are no specific tests for JA but doctors can use tests to eliminate other options or even help determine which type of arthritis the child may have. A careful physical exam and a thorough medical history will help with determining a diagnosis. As with most diseases, early identification and treatment are important to deterring future complications.

Cause and Treatment

The cause of juvenile arthritis is still unknown. It is possible that genetics could cause a predisposition for the disease. There is no data to suggest that it could be caused by toxins, foods, or an allergy.

There’s no known cure for juvenile arthritis but treatments can help lessen symptoms. Some goals for treatments include reducing swelling and pain, preventing joint damage, and improving joint mobility and strength. There are a variety of options for medication, including IVIg. While it may seem counterintuitive, exercise is actually a vital part of treatment. Diet is another component of maintaining proper nutrition is important to a child’s natural development and to encourage an active lifestyle.

Children with juvenile arthritis are still able to lead active lives along with their friends and family. With the care of a trained physician, families can work together to improve a child’s chance of maintaining an improved quality of life, maybe even gaining remission.

The Lowdown on Myasthenia Gravis

What is Myasthenia Gravis (MG)?

Myasthenia Gravis is a chronic autoimmune neuromuscular disease that causes weakness in skeletal muscles. The name translates from Latin and Greek origins to “grave, or serious, muscle weakness”. This disease targets muscles that are responsible for breathing and moving body parts, like arms and legs, and is worse after active periods but improves with rest. Often, muscles that control talking, chewing, swallowing, facial expressions, the eyes, breathing, limb movement, and the neck are affected.

Over half of MG cases, eye problems were the first sign. These include ptosis, which is the drooping of one or both eyelids, and diplopia, double vision that improves if one eye is shut. Throat and face muscle symptoms are the first sign in about 15% of those who develop myasthenia gravis. These are the most common symptoms seen in myasthenia gravis patients.

Other symptoms include weakness of the neck, arms, and legs. These don’t usually present themselves without the above symptoms. Legs are less often affected than arms but may cause patients to waddle. More seriously, breathing can be affected and can be a critical issue.

Continue reading “The Lowdown on Myasthenia Gravis”

Alzheimer’s and Brain Awareness Month

June is Alzheimer’s and Brain Awareness Month.

Alzheimer’s disease is an ever growing field of research where there are still many hidden mysteries. It is an irreversible and progressive disorder that affects 5.2 million people in the United States. Interestingly, two-thirds of Alzheimer’s patients are women. It is the 6th leading cause of death in the states and afflicts up to 50% of those 85 years old. Unfortunately, there is no cure but modern treatments help to temporarily slow brain deterioration.

Symptoms of Alzheimer’s disease include:

  • Memory loss
  • Difficulty thinking and concentrating
  • Trouble making judgments and decisions
  • Mood and behavior changes
  • Disorientation
  • Difficulty with speaking, swallowing, and walking

While some loss of memory and certain cognitive functions is a normal part of aging, sufferers of Alzheimer’s disease experience these at a greater amount.


IVIg Infusion Therapy Helps Many Medical Conditions

Infusion Therapy, IV
By Harmid (Own work) [Public domain],
via Wikimedia Commons

Infusion therapies are treatments received intravenously, as in, directly to the veins, of a patient. Most often a needle or catheter is inserted into the arm but alternative placements are possible based on a patient’s needs. Infusion therapies are beneficial for treating many chronic and immunosuppressive diseases including Crohn’s, Parkinson’s, MS, Common Variable Immune Deficiency, and Rheumatoid Arthritis, among many others. For all the diseases that are treatable through infusion therapy, there are just as many drugs including IVIg, Remicade®, Tysabri®, and Reclast, just to name a few.

IVIg is one of the most common infusion therapies that patients receive as it is able to help with a variety of diseases.

The average person has lots of things floating around in their bloodstream: red blood cells, white blood cells, plasma… we remember this from Bio 101 or at least The Magic School Bus. One of the parts of the bloodstream is something called antibodies —they’re part of the white blood cell group and help fight off infections. Without getting too technical these antibodies are called immunoglobulin and there are a lot of different types: IgM, IgG, IgA, etc. If you’ve ever given blood or at least seen someone give blood, you might have noticed a machine used on some donors to separate the blood, which are given back to the donor, from the plasma. The plasma is taken, combined with other donors’ plasma, and purified for the IgG. This is our ‘Ig’ in the ‘IVIg’ and it takes hundreds of donors to make just one dose. During the purification process plasma from 10,000 – 50,000 carefully screened individuals are used.

Fun Science: Using IgG to boost immunity is called passive immunization. It occurs naturally from mother to fetus or via IVIg and antiserum. IgG is the smallest of the immunoglobulin which is one of the reasons why it can pass to the child.IgG molecule

Ig was initially used during World War II to fight off infectious diseases and in 1952 was given as a primary immunodeficiency treatment. It was originally given as a deep injection into the muscle until the early 1980’s. While those who may need an immunity boost due to being in an area with high risk of disease, like measles, are still given intramuscular shots, we benefit from modern medicine and most patients receive IVIg intravenously (this is the ‘IV’ of our ‘IVIg’).

IVIg, unfortunately, does not stimulate the patient’s immune system into creating its own Ig but just replaces what the body is not able to make. Antibodies must constantly be replenished as they are “used up”. This is called being metabolized and about half of infused Ig are metabolized in 3-4 weeks. For this, a person in need of IVIg will need continual, regular treatments for their lifetime. Patients may notice that around their next appointment they are feeling weaker due to the lower Ig count. Dosage and time vary with each individual but infusion times are typically 2-4 hours. Most people tolerate to Ig very well but a low fever, achy muscles or joints, or a headache are not uncommon. Most side effects can be treated with common medicines if need be but patients should call their doctor if they experience hives, tightness in their chest, wheezing, or if their headache does not go away after taking medication.

At Integrated Neurology Services our Infusion Suite is set up to handle any of your IV needs. Our treatment center is equipped with reclining chairs, state of the art infusion pumps, TVs, and free WiFi. Your care and comfort are our priority to our trained staff. We treat a wide variety of diseases with various types of infusion medications. Treatment for IVIg includes anyone suffering from:

  • Common Variable Immunodeficiency (CVID)
  • Guillain-Barre
  • Dermatomyositis
  • Lambert-Eaton Syndrome (Stiff-person syndrome)
  • Kawasaki Syndrome & Dermatologic Conditions
  • Chronic Inflammatory Demyelinating
  • Polyneuropathy (CIDP)
  • Myasthenia Gravis

Contact us to set an appointment or learn how we can help take care of your infusion needs.

Pains Got You Down?

back pain spine

Back and neck pains are some of the most common ailments for adults. 85% of adults below the age of 50 report back pain in at least one occurrence and most will have at least one more. Lower back pain is becoming more prevalent possibly because we are becoming a more sedentary society. A 1990 study showing the rankings of “…the most burdensome conditions in the U.S. in terms of mortality or poor health as a result of disease put low back pain in sixth place; in 2010, low back pain jumped to third place, with only ischemic heart disease and chronic obstructive pulmonary disease ranking higher.” Most neck and back pain is a temporary condition but lower back pain is a leading cause of disability worldwide, according to the National Institute of Neurological Disorders and Stroke (NINDS) in 2014.

Pain can be caused by an array of problems. These can include irritated nerves, muscle strain, or damaged bones, joints, or ligaments, among other origins. The symptoms and severity present themselves very differently person to person so it is important to identify the main cause to work towards proper relief treatment.

The subspecialty of interventional pain management uses minimally invasive techniques for the treatment of acute and chronic pain. Physicians trained in pain management work to improve a patient’s quality of life and functional activity by utilizing pain-blocking techniques. For the most effective and fastest reduction of pain, treatment is a combination of resources – not just prescribing a medicine or referring to a physical therapist – with a focus on a finding the main source of the problem.

Pain management can help alleviate pain on a range of levels and durations and even help pain related to headaches, bone pain, neuropathy, back and neck pain, muscle pain, and epilepsy, among others. If you find that treatments aren’t working or the pain is impacting your day-to-day life, it is time to seek the help of a professional pain management specialist.

Integrated Neurology Services offers a variety of pain management options for our patients including those who suffer from back, neck, and spine pain, headaches, multiple sclerosis (MS), and Parkinson’s disease. If you are interested in setting up an appointment or learning more about this service give us a call at 703-313-9111 or email us at info@integratedneurologyservices.com.

6 ways to sleep better

Sleep hygiene is the concept of implementing a variety of habits and practices to get a good night’s sleep and be alert the next day. As we discussed in the last post, sleep is very important and many people suffer from some type of sleep disorder. Even those that do not have a sleep disorder can benefit greatly from having good sleep hygiene.

Naps. Limit naps to 30 minutes. Naps can actually be disruptive to sleep so avoid them if you can or at least
4 hours before bedtime. Coffee naps are a way to feel refreshed in the day since it takes about 20 minutes for the caffeine to hit your system.

Exercise. Exercise is great to help you sleep soundly but be careful of when you pump iron. Too close to bedtime and you may find it difficult to catch those Zs.

Coffee. Avoid stimulants like caffeine and nicotine close to bedtime. Try to avoid coffee after 3 pm since lingering caffeine can hinder your ability to fall asleep.

Light. Natural light to be specific. Exposure to sunlight and darkness at night helps keep a healthy sleep-wake cycle. A perfect excuse to get yourself outside.
A regular schedule and routine. This includes going to bed at the same time every night, waking up every day (within 30 minutes), and the process of getting to bed. Take a hot shower, read in bed, journal, or any peaceful activity that helps you wind down. Avoid using your phone, computer, or TV close to bedtime or consider installing an app that negates the blue light like Twilight or f.lux. As you go through your routine, it tells your body that it’s time for sleep.

Food. Certain foods like dark chocolate and anything fried can be disruptive to your sleep. Avoid high-fat foods, things with hidden caffeine, and spicy foods before bed. If you’re hungry and need a snack try foods with tryptophan like turkey, something whole grain, or foods high in magnesium which may have positive effects on your sleep too. Try turkey slices wrapped in a slice of whole grain bread, an egg with a few crackers, or an avocado half. If you have a handful of cherries around, they are a natural source of melatonin and great to munch on.

Bedroom. Have a good sleep environment. 60 to 67°F is an ideal temperature to sleep in and make sure your bedroom is quiet and dark. If you need sound stick with something consistent like a fan or a white noise maker. Alternatively, if you are in a loud or brighter environment consider buying earplugs and an eyemask. Place phones and any other blue light emitting devices (laptops, TVs) out of sight as it can be disruptive to your sleep – even just the charging light can be bothersome.

We hope you find this list helpful and your sleep more restful. Do you have anything that helps you to sleep?

Are You Getting Enough Sleep?

It’s something everyone does every night and yet we don’t totally get it—sleep. Sure, we know we should sleep a certain amount every day but it’s something many seem to avoid. When was the last time you slept a solid 8 hours? Many are lucky to meet the National Sleep Foundation’s minimum recommended time of 7 hours. According to the 2013 Gallup poll, Americans were getting an average of only 6.8 hours of sleep. That’s a full hour less than what was reported back in the 1940s. More recently, in February 2016, the CDC reported that more than ⅓ of American adults are not regularly getting enough shut-eye.

Many people in modern day society are sleep deprived. But what happens when we don’t get enough sleep? Our body and mind go through a whole host of consequences when running short on sleep. The most obvious ones that you may have noticed after a bad night of sleep is that we are groggy and sluggish, maybe it’s a little bit harder to focus, we reach for caffeine to keep us going but we tend to be unmotivated and might even skip out on gym time. You’re likely to be more forgetful, emotional, in severe cases delirium and hallucinations may be present, and your brain might even be shrinking! Poor sleep contributes to feelings of hunger which may cause someone to eat more which could lead to weight gain. It’s also associated with increased heart rate, blood pressure, aging skin, trouble conceiving, diabetes and other organ issues. Getting a good night’s rest is essential to a properly functioning body and mind.

The National Institute of Neurological Disorders and Stroke reported, “about 40 million people in the United States suffer from chronic long-term sleep disorders each year and an additional 20 million people experience occasional sleep problems.” There are over 70 different sleep disorders someone could suffer from. Let’s look at a few of the more common ones:

Sleep apnea is a disorder when a person’s breathing is interrupted during sleep. The most common type is Obstructive Sleep Apnea (OSA) that affects an estimated 22 million Americans. It’s often characterized by really loud snoring and gasping or choking sounds. OSA is commonly treated with a CPAP machine, lifestyle changes, and surgery. There are new devices coming out onto the market as technology advances.

Insomnia is when a person is unable to fall asleep, stay asleep, or wake up too early and is unable to fall back asleep. Roughly 60 million people suffer from insomnia. Women and those over 65 are disproportionately likely to suffer from this disorder. Many people have experienced acute insomnia at some point in their lives but those who suffer from chronic insomnia experience it at least three times a week for at least three months. Treatments often include CBT-I, medication, and alternative techniques like yoga.

Narcolepsy is a “sleep  disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter).” Unfortunately, there is no cure currently but medications and behavioral treatments are implemented to improve symptoms.

Restless Legs Syndrome (RLS)is a nervous system disorder that causes a need to move the legs (or another body part) and is often disruptive to sleep. The feeling may be described as ‘itchy’, ‘creepy crawly’, or ‘pins and needles’. Treatment for RLS includes lifestyle changes to manage symptoms and a special leg wrap.

Bruxism is when a person clenches or grinds teeth during sleep. About 8% of adults grind their teeth at night and ⅓ of parents report their children having it. Chronic bruxism could cause dental damage, muscle pain, and disturbed sleep. It may have a variety of causes like stress, smoking, caffeine, or from another sleep disorder like sleep apnea. Often sufferers get a mouth guard fitted by their dentist.

Parasomnia is an umbrella term to cover abnormal events while sleeping other than suffering from sleep apnea. This includes nightmares, sleepwalking, night terrors, REM sleep behavior disorder, and many others.

With any potential disorder, it is best to seek consultation with your doctor. Try keeping a sleep diary and jot down notes like your habits or symptoms that are particularly bothering you. If you think you may be suffering from a disorder or would like to learn more, contact us today!

Parkinson’s Disease, Depression, and Anxiety

Parkinson’s Disease is known for its effect on motor functions, it also contributes to nonmotor symptoms that may reduce the quality of life for patients. Depression and anxiety are often undiagnosed and untreated for patients which can have an even more negative impact on the disease itself.

The disease can cause a deficiency in dopamine, serotonin, acetylcholine, and norepinephrine in the brain which can lead to depression. This can happen“‘…even several years before the onset of motor symptoms; hence, depression is not just reactive to the diagnosis of [Parkinson’s Disease],’” according to neurologist Pinky Agarwal, MD. Depression and anxiety can co-occur and findings have found patients with Parkinson’s Disease to have rates of 17% and 31%, respectively.

According to neurologist and Mayo Clinic College of Medicine’s associate professor, Julie A. Fields, PhD, LP, these effects can go beyond mood impairment. Motor functions decline, cognition can worsen – even more rapidly –  and dementia risks increase.

It is important to identify these disorders in patients but overlapping symptoms can make it difficult. Assessment and treatment should be done by a trained professional that can recognize true depression and anxiety as well as understand the effects medicine can have on patients that suffer from Parkinson’s Disease.