Author: Integrated Neurology Services

FLUENT Study Enrollment Closing — Act Now!

The FLUENT study will be closing enrollment at the end of the month, on June 30, 2018! Those diagnosed with Multiple Sclerosis (MS) who are interested in trying Gilenya (fingolimod) for the first time may be eligible to participate. The study simply asks for a few questionnaires and a blood draw at baseline and at the standard 1m, 3m, 6m, and 12m follow-up office visits to help learn more about how this medicine affects the immune system.

Neurology Advisor reports patients who have previously tried one or more injectable therapy (iDMTs) may still see improvement with a switch to a Gilenya pill once a day! Read it here.

Need more information? Check out this website or this one to learn more about these studies. 

If you or anyone you know are interested in learning more about this trial, feel free to call our Research Director, Lindsay, at 703-313-9111 ext. 107, or email her at Lindsay@integratedneurologyservices.com.

 

Safety Awareness

 

wear a helmet

Every year National Safety Awareness is observed in June to minimize injury and death on the road, at home, and at work. Injuries are the leading cause of death for Americans ages 1 to 40. The good news? Everyone can get involved to help prevent injuries. 

This June, we encourage you to learn more about important safety issues like preventing poisonings, transportation safety, and slips, trips, and falls.

  • Poisonings: Nine out of 10 poisonings happen right at home. You can be poisoned by many things, like cleaning products or another person’s medicine.
  • Transportation safety: Doing other activities while driving – like texting or eating – distracts you and increases your chance of crashing. Almost 1 in 6 crashes (15%) where someone is injured involves distracted driving.
  • Slips, trips, and falls: One in 4 older adults falls each year. Many falls lead to broken bones or a head injury.

Raising awareness about safety issues can reduce the risk of injuries by being better prepared. Check out some of these resources to learn more about safety preparedness:

Take some classes to learn skills like CPR and first aid

Get downloadable material about safety awareness

Julie- Best of Luck!

a picture with our med student intern.

 

We had the honor and privilege of having Julie work with us for two weeks for her neurology rotation. We wish her the best of luck in her pursuit of higher education and know that she will be an amazing doctor. We will miss you and hope you’ll come to visit us! 

 

 

Dear Dr. Fishman,

Let me start out by saying what a fantastic 2 weeks I had with you! With sincere honesty, out of all 3rd and 4th year clinicals, this was by far my favorite rotation. I certainly had an interest in neurology coming in but your passion for the specialty and dedication to your patients, along with your teaching, were really inspiring. As you noted, a preceptor can shape a student’s perspective….and I am now thinking about possibly pursuing neurology further. 

Thank you for being such a wonderful role model. You are talented when it comes to teaching–your passion and great degree of knowledge were so impressive to me. But perhaps what was even more impressive was your respect for and commitment to your patients. (Having a brother with MS, this especially hit home.) I enjoyed partaking in your interactions with them in that you demonstrated the kind of relationship, a therapeutic alliance, that I hope to one day have with my patients. You not only shared your expertise but also listened compassionately each time to their thoughts and concerns–something that makes a great physician. When the pre-med student came in concerned his headaches represented a malignancy, for example, you put him at ease with reassurance and ordering of a scan.

I feel truly privileged to have had these 2 weeks with you. I have a tremendous level of respect for you and the amazing work you do every day. Thank you for all that you have taught me–whether it be neurology or just clinical pearls of medicine. 

I look forward to staying in touch, and will certainly send your way all those I know in search of a great neurologist.

Warmly,
Julie

Ps. Thank you for my FAVORITE new tool–my reflex hammer! I have been testing all the reflexes in my household and will now (at least look like I) know what I am doing on my neuro rotation at UVA…! 🙂

Stroke—You Have To Act FAST

Learning the signs and symptoms of a stroke and knowing how to act FAST can be life-saving. This month is marked by National Stroke Awareness month.

Here are the numbers:

  • About 800,000 people have a new or recurrent stroke every year.
  • That comes down to a person having a stroke about every 40 seconds.
  • It’s the 5th leading cause of death in the US.
  • Every 4 minutes someone dies from a stroke.
  • Up to 80% of strokes can be prevented.
  • It is the leading cause of adult disability in the US.

What is a stroke?

A stroke is either caused by a weakened vein leaking blood or a blocked artery. In either case, blood – and therefore oxygen – are not getting to the brain. These are called hemorrhagic and ischemic strokes, respectively. A temporary block of blood flow is called a transient ischemic attack (TIA) but is also referred to as a mini-stroke. That should not dampen the potential severity of what it is, attention should be sought immediately as a full stroke is likely to occur soon.

What is FAST?

FAST is a simple acronym for signs to be on the look-out for if you suspect a person is having a stroke.

Face drooping – Ask the person to smile and observe if the face droops.

Arms weak – See if the person is able to lift both arms overhead. Does an arm drift down or do they have trouble raising one?

Speech difficulty- Have the person repeat a person phrase. Pay attention to see if they slur or sound odd. They may have some confusion and trouble understanding you.

Time to call 9-1-1 (or your local emergency number) – Call 911 immediately if you observe any of these signs.

Other symptoms include:

  • trouble walking
  • a sudden and severe headache that may be joined with vomiting or dizziness
  • trouble seeing in one or both eyes

Why is it that so important?

In the case of many medical emergencies, stroke included, time is of the essence. Once a person starts having a stroke, it only takes a matter of minutes before brain damage can start to occur. Depending on where and the severity of the stroke, the type of damage can vary but often temporary or permanent disability can be expected. Two-thirds of survivors have some type of disability. These can include:

  • A difficulty with talking and swallowing: sometimes people can experience problems with swallowing, eating, and language due to trouble controlling muscles in your throat and nose. This can include difficulty communicating by talking, reading, and writing. Working with a therapist may help.
  • New sensations may occur in parts of the body affected by the stroke. This could be pain, tingling, or numbness. New sensitivities like to temperature changes could develop.
  • After a stroke, you may lose control of parts of your body or be paralyzed on one side like a side of your face or a leg. Physical therapy may help to return to activities like dressing, walking, and eating.
  • Some memory loss is common as well as changes to your cognitive ability like reasoning and judgment.
  • Emotional problems or depression could manifest after experiencing a stroke.
  • A person may experience behavior changes and their ability for self-care. They may become withdrawn and need help with chores, grooming, and dressing.

The success of treating these complications varies on the person and their situation.

Risk factors

Below are some risk factors that increase a person’s chance of having a stroke. While some of these are unavoidable, working on the ones that are changeable can help lower your risk level and possibly increase your quality of life.

  • Age – being over the age of 55 increases your risk of a stroke
  • Sex – men are more likely than women to have a stroke but women are older when they have one and are more likely to die of a stroke.
  • Race – African-Americans have a higher risk of stroke.
  • Hormones – estrogen-based therapies,  use of birth control, and the higher levels of estrogen during pregnancy and after childbirth increase the risk of stroke.
  • Physical inactivity
  • Heavy drinking
  • Obesity
  • Illicit drugs (cocaine, methamphetamines, etc)
  • Smoking and secondhand smoke
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Cardiovascular disease (abnormal heartbeat, heart failure, defects, and infection)
  • Obstructive sleep apnea
  • A family history of stroke, TIA, or heart attack

 

Implementing simple lifestyle changes can help lower your risk but if you are concerned about your risk, speak to a healthcare professional. If you or someone know has been affected by stroke, therapy may be able to help increase one’s quality of life. Remember, if you suspect someone is having a stroke, act FAST. 

Sleep Apnea – Do You Have It?

What It Is

Sleep apnea, spelled ‘apnoea’ by our friends across the pond, is one of the most common sleep disorders in the United States. People affected by the disorder experience involuntary interruptions in their breathing, lasting at least 10 seconds, as they sleep. The word ‘apnea’ is of Greek origins and literally means ‘without breath’. Some patients stop breathing hundreds of times in the night sometimes for longer than a minute. This can seriously diminish the oxygen levels in a person’s blood and create poor sleep as the interruptions cause the body to awaken enough to breathe. Sources differ in the estimation but it is thought that over 22 million Americans are afflicted with this sleeping disorder. Unfortunately, many experts believe that a large number of people with the sleep disorder remain undiagnosed.

There are three types of sleep apnea.

Obstructive sleep apnea (OSA). This type is the most common form of sleep apnea and is caused by a block in the airway that is physically stopping the ability to breathe. It is often due to soft tissues and muscles relaxing at the back of the throat as a person’s body relaxes. A person with this type of sleep apnea may sound like they’re choking or gasping for breath. For the purposes of this article, we will focus mainly on this type of sleep apnea.

Central sleep apnea (CSA). Patients with this type of sleep apnea do not have a blocked airway but the brain fails to send signals to the body to breathe. This insinuates an instability in a person’s respiratory control center.

Mixed sleep apnea. As the name suggests, this is a combination of both obstructive sleep apnea and central sleep apnea.

Why It’s Bad

Untreated sleep apnea can lead to a plethora of consequences for the sufferer. These include:

  • Disturbed sleep
  • Fatigue
  • Daytime sleepiness
  • High blood pressure
  • Stroke
  • Heart disease
  • Heart problems: failure, arrhythmia (irregular heartbeats), heart attack
  • Diabetes
  • Memory problems
  • Depression
  • Headaches
  • Worsening ADHD
  • Weight gain
  • Mood problems
  • Impotence
  • Drowsy driving and motor vehicle crashes
  • Poor performance, impairment, and underachievement in activities such as work and school

Risk Factors

Anyone can have sleep apnea, even children, but certain risk factors increase your likelihood:

  • Men are more likely than women
  • African-Americans, Hispanics, and Pacific-Islanders are the more likely than others
  • Overweight
  • Over 40
  • Large neck size (greater than 17” for men and 16” for women)
  • GERD
  • Having large tonsils or tongue, or having a small jaw
  • Nasal obstructions: deviated septum, allergies, sinus issues
  • A family history of sleep apnea
  • Smoking
  • Drinking alcohol

Do I Have Sleep Apnea?

Sleep Apnea can present in a variety of different ways but below are some of the most common. 

Symptoms:

  • Loud snoring
  • Waking up with a dry or sore throat
  • Choking or gasping while sleeping
  • Daytime sleepiness and fatigue
  • Difficulty concentrating
  • Morning headaches
  • Irritability and mood changes
  • Depression
  • Sexual dysfunction
  • Learning and memory difficulties, forgetfulness

Epworth Sleepiness Test

This is a short self-evaluation of a person’s daytime sleepiness. This is not a diagnosis but an assessment. You can take one by clicking this link

STOP-BANG 

Another self-assessment questionnaire for sleep apnea. This is just an assessment and not a diagnosis.

 

If you think you might have sleep apnea speak to your doctor or a sleep specialist. The only way to definitively confirm sleep apnea and the severity of it is through a sleep test called a polysomnogram (PSG).

At Integrated Neurology Services, our patients start with a clinical consultation. It is a critical first step in evaluating the patient. Based on the consultation the doctor may recommend a sleep test. We offer several types of diagnostic testing depending on the type of study needed.

Treatment

There are several options for treatment of obstructive sleep apnea depending on the severity and a patient’s situation.

Lifestyle Changes – Patients may benefit from some simple lifestyle changes but results may vary depending on the severity of their OSA. This can include things such as:

  • Lose weight
  • Exercise & maintain a healthy diet
  • Stop smoking
  • Avoid alcohol and sedatives
  • Changing sleep positions and not sleeping on your back

Continuous Positive Airway Pressure (CPAP) – This is the most form of treatment is considered the gold standard. The patient wears a mask that allows for a continuous airflow to keep the passageway from being blocked while sleeping. Machines have gotten quieter and a wide variety of masks are available including full face masks and ones that just cover the nostril openings. Another type of similar machine is called a bi-level, or BPAP, where the airflow changes with a person’s breathing. These machines are most effective when consistently used and Integrated Neurology Services has a comprehensive compliance program to ensure our patients’ comfort and application of their treatment.

Dental Device – Patients with mild to moderate sleep apnea may consider having a specially trained dentist fit them for an oral appliance. This pushes the lower jaw forward opening the airway while one sleeps at night.

Surgery – Several types of surgery are available to help with obstructive sleep apnea. Nasal surgery corrects the problem of a deviated septum which may contribute to OSA. Uvulopalatopharyngoplasty (UPPP) cuts out the extra soft tissue to help free space in the airway. Mandibular maxillomandibular advancement surgery fixes some facial and jaw problems or throat blockage. Surgery can, however, be expensive and may not always lead to a permanent solution.

Inspire – A new device on the market that creates a mild stimulation to nerves that keep the airway open. It is inserted near the upper chest with wires that lead to the lungs and neck and it learns your breathing patterns. A trained doctor is able to program it externally and the patient has a remote to turn it on before bed.

 

It’s important to get a full night’s rest every night. If you feel that you may be suffering from any sleep disorder it’s best to discuss your concerns with your doctor and seek treatment, if diagnosed. 

Connecting Your Heart With Your Brain

heart health = brain healthYou know what they say, ‘what’s good for the heart is good for the brain’. Ok, it might not actually be a saying but maybe it should be. There is increasing information that steps to prevent heart disease may also prevent or slow dementia.

A rising public epidemic is railing brain health. In a person’s 20s, the brain naturally starts showing signs of cognitive decline and an estimated 3 out of 5 Americans will, in their lifetime, have some type of brain disease. However, the rate of Alzheimer’s, dementia, and stroke cases seems to be increasing and by 2030, these conditions are expected to exceed 1 trillion dollars.

There have been a number of studies that show that factors that affect heart and vessel health also affect the brain. Considering the brain uses 20% of the body’s oxygen and is surrounded by hundreds of vessels, it makes sense that poor cardiovascular health would, in turn, affect the brain’s health.

There are overlapping risk factors for both cardiovascular disease (CVD) and dementia. A few include type 2 diabetes, high cholesterol, obesity, and especially high blood pressure. These can have some effect on the vessels in the brain, cause the brain to shrink at a faster rate, cause changes to white matter, or lead to a stroke. In fact, according to  Ralph Sacco, M.D., chief of neurology at the Miller School of Medicine at the University of Miami and past president of the American Heart Association (also the first neurologist to be president of the AHA), high blood pressure is the “strongest predictor of brain health.” Some research indicates that the presence of these risk factors in middle age may have a greater effect on brain health than if they were in old age, however, specifics as to why are yet to be determined.

The American Heart Association has developed a system called Life’s Simple 7 as a means to keep a person’s health in check.

  • Blood Pressure Management
  • Cholesterol Control
  • Blood Sugar Regulation
  • Being Active
  • Eating Balanced
  • Weight Loss
  • Quit Smoking

Some studies have followed participants following this guideline for many years (30 years in some cases) to see how their health progressed. They awarded how well a person abided by each guideline with points between 0-2 and researchers found that every point missed seemed to correspond with about a year’s worth of age-related brain shrinkage. Similarly, other researchers found that with each increase of a point, the participant’s risk for heart failure was lowered by 23%. The research, however, does have some limitations and requires more data.

The earlier a person takes their health seriously the better, but starting now is better than never starting at all. Take steps and actions to take control of your health. Assess your health and speak with a physician if you have any questions or concerns. Simple actions can go a long way such as taking daily walks, incorporating more vegetables, or cutting out something high in sugar. A healthy heart can lead to a healthy brain, which could lead to a multitude of other positive life and body changes. Take charge of your health today!

 

Hygge: Find Your Coziness

hygge: creating togetherness with others

Think about the last time you were wrapped in a blanket drinking a cup of hot cocoa as a snowstorm rages on outside. Or cuddling on the sofa with a loved one as you watched the latest blockbuster. Or the joy of having a summer-time barbecue with your friends. What do these have in common? How do these things make you feel? The Danish would call these things hygge.

 

Hygge
HEW-gə

Hygge is a concept deeply rooted deep in Danish culture. It’s hard to give it a direct translation but a popular one is ‘cozy’. It’s more about a feeling or atmosphere than anything in particular. To be hygge or hyggelig (hygge-like), it’s about creating comfort and safety. There’s often a togetherness aspect of spending time with family and close friends. Enjoying coffee together, eating a meal and having conversations, playing games, all these things are considered hygge. Hygge is often thought of as candles, cozy sweaters, and fuzzy socks – and it is (per person Denmark uses the most candles compared to any other nation) – but it is so much more and it is what each person makes it to be. Popular hyggelig activities include cooking together and enjoying the meal, making homemade sweets or treats to share with friends, or even watching a movie at someone’s house. Anything that creates togetherness or homeyness. While hygge often centers around creating intimacy with others but it can also be enjoyed alone. Enjoy a book with coffee, sit outside with the sun warming your face, or whip up your favorite comfort food. Whatever lets you feel grounded, connected, comforted, and safe – that is hygge.

hygge: fire, cocoa, and slippersThe Danes have been developing hygge since the 18th century when the word first appeared. It is thought that it may have come from the Norwegian word hugga which means, “to comfort” and where the English word “hug” is derived from. This concept of coziness and self-kindness envelopes their way of life. Perhaps it’s no coincidence that they consistently rank as one of the happiest countries in the world.

What’s important is that hygge isn’t a new set of rules to add to your life. It’s really about giving yourself a break. So to start, put the phone down and slow down for a second. A huge part of hygge is not just being present but appreciating and living in the moment. Enjoy a cup of coffee with friends or a co-worker. Have a slice of cake or that piece of chocolate. Drink tea while reading a book in a comforting corner. A hygge life is about little indulgences that let you escape from the busy day or stress, not bingeing or being gluttonous. Balance.

hygge: pools of light and plants

While indulging in that extra sweet or taking comfort in curling up makes hygge seem like an indoor activity it works outside as well. The Scandinavian countries experience a lot of darkness during the winter months and the weather isn’t always pleasant but that doesn’t stop them from getting outside or exercising. They don’t believe in bad weather, just unsuitable clothes. Partaking in outdoor activities that you enjoy is also hygge, especially if you do it with friends or family. Walk the dog, play games while waiting for the barbecue, enjoy a picnic. At this point I’m sure you’ve noticed the trend, almost anything can be hyggelig and it isn’t confined to a particular definition. You can enjoy it indoors or outdoors and it is all year round.

Meik Wiking, author of The Little Book of Hygge and the CEO at The Happiness Research Institute, sums it all up really well in this VICE Interview:

The art of coziness that is hygge has been gaining popularity in the last few years around the world. In 2016 it was the U.K.’s second most popular word (after Brexit) and that was just the beginning of its momentum. There are Pinterest boards beyond Pinterest boards about hygge and dozens of articles like this one talking about its spectacular ability to help you find happiness. But it’s important to remember that hygge is about how things make you feel not the actual things. It isn’t about spending lots of money to buy a concept of coziness. In fact, spending lots of money isn’t hygge at all. The saying, “home is where the heart is” is related to a similar essence; “coziness is when you feel comforted” could be something to keep in mind as you create your hygge journey.

What makes you happy? How can you incorporate self-kindness into your life? What is cozy to you?

Discover your hygge.

 

New Website Launch

Happy-new-year-2018

It’s a new year and we thought we’d start it off with a new site. We are proud to announce the launch of our new website. It has all the same great information as our old one; click around to learn more about our services. 

If you have any questions or wish to learn more about anything please do not hesitate to call us at 703.313.9111 or email us at info@integratedneurologyservices.com

Cheers to an amazing 2018 from all of us to you!

~The Integrated Neurology Services Team

Don’t Be A Grinch. Get Some Sleep!

sleep to keep stress at bay for the holidays

It’s no mystery that sleep (rather, lack of) and stress can go hand in hand. Being overstressed keeps you awake at night and leads to unrestful sleep, while being sleep deprived causes things to stress you out easier and less able to handle the tasks of the day, inevitably becoming a cranky person. It’s a vicious cycle to be in. The holidays, full of cheer and merriment, are no stranger to stress either. Between holiday parties, pageants, gift buying, family visits, and who knows what else is on that to-do list how is anyone supposed to actually find time to rest? Here are a few tips to help guide your way to a fun and well-rested holiday.

Stay organized

Even if you don’t usually keep a calendar, agenda, or task list, do it for this time of year. Print out a calendar, draw your own, or fire up that calendar app and write down every event, task, and person you want to see, or thing you want to do. Staying on top of your daily and holiday to-dos will keep you from getting blindsided by anything and help you to not procrastinate on tasks. Get your shopping done, clean the house, wrap the gifts, and when you get to have some fun you won’t have to be worried about ‘the next thing’. The last thing anyone wants is for everything to snowball into an overwhelming mess preventing you from enjoying your time with friends and family.

It’s OK to say ‘No’

Saying ‘no’ can be really hard but it can also be empowering. Think about yourself and what you can give, or want to give, in terms of your time or commitment to something or someone. Maybe you can’t get out of volunteering for the school pageant, but you can minimize the time you spend this holiday with people that stress you out or you find unpleasant. Your time is limited so don’t feel too bad about prioritizing people, sometimes you can’t see everyone or do everything. You could try getting everyone together for one event rather than go to 4 different ones to see everyone on your list. This one might take some reflection and thought, but staying organized can help you put your time in perspective.

Go easy on the food and alcohol

Without getting too much into how to manage your diet (there are tons of articles that do that already), just be sure not to eat too close to your bedtime as it can cause sleep disruptions. Watch out for sugars since they’ll make you crash and pay attention to your coffee intake since too much or too late can mess with your sleep schedule. While we’re on the subject of sleep schedules, mind your alcohol too. While alcohol may seemingly help you fall asleep, as your body processes it, it will interfere with your proper sleep cycle leaving you feeling groggy the next morning—and possibly hungover.

Don’t stop working out

With an increase of other things to do it’s easy to knock exercise to the bottom of the list but that shouldn’t be the case. If you can get into your usual routine, fantastic! Exercise helps you manage stress, feel better (thank you endorphins), and sleep easier—all things that are pretty important right now. If not, try modifying your work out. Maybe find a HIIT routine so that you spend less time but still get a good work out, find time to stretch between activities or tasks, take the stairs if you can, or even park further away from the store to get some extra steps in (it might even save you time getting in and out of the lot). And, bonus points for getting sun exposure while doing any of this. You’ll soak up some vitamin D and help keep your circadian rhythm regulated.

Keep your regular sleep schedule

Do your best to stick to your normal sleep schedule. Going to bed and waking at the same time will help you get the rest you need to tackle your busy days. As mentioned before, sleep is important for managing stress but it also keeps you alert, balances your hormones (like the stress one, cortisol, and the one that makes you hungry, ghrelin) and mood, and helps your memory. You don’t want to have fun things planned but then be too tired to enjoy them or snap at anyone during a holiday party. If you need to, schedule a nap in your day to help with your alertness but remember: keep it to 20-30 minutes and try not to have it after 3 pm.

Stick to your nighttime routine—or create one!

If you don’t have one yet this is a great time to start. At least an hour before bed, it’s time to put all your blue-light emitting devices away and get ready for sleep. Your routine can include a variety of things but the point is to do it consistently so your brain recognizes that now is the time to mellow out. Reading, a hot bath, listening to relaxing music, drawing, or journaling are some options you can try out. Anything that helps calm you down and doesn’t require bright lights. Whatever your takeaways from this are, the important thing to remember is to have fun and enjoy your holiday season. Get some sleep, take care of yourself, and don’t be a grinch!  

 

We wish you the happiest of holidays!

The Integrated Neurology Services Team