Instead, diagnosis permitting, we use non-invasive treatment and medication to get patients past the initial trauma, and then physical therapy to re-train their muscles to support the spine and prevent re-injury. This is a case where our physical therapists contribute directly to RNI’s original research efforts. You can read more about pain and other neurological symptoms around the spine on our page about “Back Pain & Neck Pain Relief for the Long Term.”

Unfortunately the statistics suggest that more and more patients are receiving aggressive therapy for back and neck problems right out of the gate, in the form of surgery. Surgeries of many types – to remove bulges from discs, remove bone from vertebra, and fuse vertebra together – are all necessary in some small percentage of cases. However, there is a clear trend toward patients getting surgery where conservative approaches would work. In many cases they are probably not aware of the long-term consequences of surgery. Our new article “7 Reasons to Get Your Back or Neck Diagnosed by a Neurologist Before Seeing a Surgeon” addresses the pitfalls of going straight to a surgeon when you experience acute back pain.

In order to better inform the Kansas City community, we have added a new section on Back and Neck Pain to our website, and we hope that visitors will be able to use and share this information. There is already an article there explaining the use of EMG for diagnosis of nerves affected by spinal issues, and we hope to add more informational articles in the future.

In the meantime, if anyone you know experiences back or neck pain, we hope you will direct them to this site in order to learn about their alternatives.

The post New Back & Neck Pain Articles Discuss Avoiding Surgery appeared first on Rowe Neurology Institute.

Watch this video on YouTube.

The post Clinical Trial: Central Neuropathic Pain and MS appeared first on Rowe Neurology Institute.

Researchers are conducting a study to evaluate an investigational drug for spasticity in people with MS. View more information about this clinical trial.

As one of the MS centers participating in the study, Rowe Neurology Institute is now enrolling patients. To learn more about the study and to inquire if you are eligible, please contact Shannon Cone at (913)894-1500 ext. 138.

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She ended up grateful to RNI, both for curing her back pain and for diagnosing and treating her sleep disorder. But along the way she exhibited the kinds of denial, frustration, and stubbornness that we all feel from time to time, especially when we’re suffering. And we are grateful to her for sharing these feelings with us and our visitors.

This first excerpt from her story is the “headline” testimonial that we might have used on its own:

Back Pain Patient Tried Other Physical Therapists, Only Got Relief at RNI

First, just watch the 30 seconds where this RNI patient really makes getting better at RNI sound really easy:

But that’s only a bit of the story. We feel that her story will help patients more if they can see all of the emotions she felt at different points in the journey.

For one thing, she didn’t like it when her doctor told her that she needed to see RNI’s physical therapists to solve her back pain. She wanted to go somewhere more convenient. She may have even felt that RNI was trying to make extra money off her case. Fair enough, we all feel that way sometimes. And the only other places that offer as many services as RNI does for neurology patients are hospitals, with their inflated charges plus additional “facility fees.”

RNI uses a very original approach to neurology care, and it sometimes confuses people. We’re okay with that.

Here’s a headline you don’t expect to see on a doctor’s office website:

Patient Angrily Agrees to RNI Physical Therapy When RNI Doctor Refuses Surgery Referral

So you can see that her case was complicated. After the physical therapist she chose failed, she went through pain medications, spinal injections, patches. Using a walker at home, and electric carts at Target. After so much failed therapy, she got frustrated and angry. She called her RNI doctor to demand a surgery referral.

But then, you can see how much it meant to her when finally, in just 2 sessions with a neurology-focused RNI physical therapist, she began to get relief – and after six sessions she began her new, pain-free life.

Remaining Pain-Free Takes a Little Work Every Day

There is one last piece of the puzzle that she doesn’t really talk about, but it’s important. She was diagnosed at RNI with sleep apnea, and was prescribed a CPAP machine. She swears by her CPAP now. But the important thing to realize is that RNI Sleep Clinic’s diagnosis of her sleep disorder was crucial to curing her back pain and preventing re-injury.

The Sleep and Back Pain Connection

Like many people who know they snore, she had learned to sleep on her side to breathe easier. However, there is a risk to side sleeping that was first discovered at RNI’s research branch, MidAmerica Neuroscience Research Foundation. Side sleeping exacerbates nerve problems along the spine, such as nerve root inflammation like this patient experienced (lumbar radiculopathy). In the neck area it can trigger migraine headaches in susceptible patients.

During REM sleep, the muscles of the body completely relax, letting the body sag against the bed. A body on its back rests evenly, aligning the spine properly and allowing space between the vertebrae for nerves to pass easily. But the spine of a body resting on its side is like a rope bridge, supported at one end by the shoulders and at the other by the hips, and bending unnaturally sideways. The spaces between vertebrae on the “top” side pinch closed, pinching nerve roots and causing inflammation and pain. The pinching initiates a self-feeding cycle, in which the swollen nerve is pinched even worse, which aggravates the nerve and causes more swelling. The only way to break the cycle is sleeping on the back – something patients with sleep apnea can’t do without the aid of a CPAP.

Not every patient comes to RNI with such aggressive pain. And certainly not every patient ends up with a sleep study. But RNI has come to know, from seeing thousands of patients and carefully studying their medical records that when one system breaks down, we must treat the whole patient. Back pain and side sleeping tend to travel together. Patients who come in for migraine headaches might have sleep-related headache triggers. And RNI often approaches problems, successfully, through physical therapy. Not everyone understands at first. But with success comes acceptance, and hopefully stories like this will help the knowledge spread.

The post The Best Example of the RNI Patient Journey, Frustrations Included appeared first on Rowe Neurology Institute.

The analysis of our electronic medical records data, merged with our digitized sleep center database, showed that sleep disorders can lead to cervical radiculopathy. However, when we began looking for an association between lumbar radiculopathy (pinched nerve in the back), we didn’t find sleep disorders as a major underlying cause. Yet we did find a striking relationship between Restless Legs type movements (a sleep disorder) and back problems.

Webster’s Online defines radiculopathy as: irritation of or injury to a nerve root (as from being compressed) that typically causes pain, numbness, or weakness in the part of the body which is supplied with nerves from that root.

Patients with Restless Leg Syndrome (RLS) and/or Periodic Limb Movement Disorder (PLMD) had a high incidence of lumbar radiculopathy.

Put simply, we found that patients with lumbar radiculopathy (LR) tended to be awake more throughout their sleep study than those without LR, and many had abnormal leg movements that corresponded with the side of their radiculopathy.

The implications of this finding could be substantial to those suffering with RLS or PLMD who are commonly treated with powerful dopaminergic agents (like ropinerole or pramipexole), drugs used to treat symptoms of Parkinson’s disease and cerebral palsy. These drugs may be heavily overused in patients with Restless Legs Syndrome secondary to other causes, like problems with the nerves going from the back into the legs.

Evaluating a possible lumbar radiculopathy

Low back pain is the second most common symptom-related reason for seeing a physician in the United States, affecting up to 85% of adults at some point during their lifetime. There are many causes of low back pain and most resolve with rest and time. In any case of acute lower back pain we suspect a radiculopathy, and this diagnosis is especially likely if they also have one-sided numbness and tingling in a leg, foot, or toes.

With this type of patient the questions we try to answer are:

1. Exactly where is a nerve being affected?
2. How severe is it?
3. What likely led to this?
4. What is the best option to fix it?

MRI, or magnetic resonance imaging, is ideally suited for determining exactly where the nerve root(s) are being irritated. For instance, a herniated disc between the 4th and 5th lumbar vertebrae would show up beautifully on MRI films. The next thing we would like to know is how bad is it? The MRI is very specific to pointing out where the problem is, but it does not give us great information about how much a bulging or herniated disc is affecting the nerve that passes nearby. Nor is MRI good at ruling out other causes of nerve involvement. Electromyogram (EMG) is a more sensitive study for showing how severe the damage is to these nerves that branch away from the spinal cord. Now the pieces of the puzzle start coming together to help answer questions number three and four from above.

At RNI we believe in physical therapy

The solution to low back pain is never an easy process, but with an exact diagnosis and all the information in front of us we can begin to make a treatment plan based upon solid information. Physical therapy is often a good place to start, once you know what you are treating. Physical therapy is a broad discipline covering nearly as many aspects as there are specialty physicians. That is why Rowe Neurology Institute has a P.T. practice with three DPT’s that are highly skilled and passionate about working with neurologically impaired patients.

We see many folks starting to get better after just a few sessions of physical therapy, when months or years of chiropractic only alleviated their symptoms temporarily. Similarly, we have found other PT programs don’t always arm patients with the knowledge they need to continue keeping themselves out of trouble for the rest of their lives.

Most patients with lumbar radiculopathy could benefit by losing excess weight. This is a societal problem affecting more than just those with low back pain. Ironically, if back problems are causing sleep problems, as our research shows, overweight patients are facing an uphill battle, since increased body mass indicates a higher risk of both back pain and sleep disorders. More and more scientific research is finding that poor sleep quality hampers the body’s ability to regulate insulin, and this inevitably leads to obesity. It can be a vicious cycle that will only be remedied with a multidisciplinary approach that accounts for all of these factors. Stay tuned to this blog for more on the impact of poor sleep quality.

Besides having board certifications in both neuroimaging and Electrodiagnostic Medicine, Dr. Vernon Rowe is also board certified in sleep medicine. These qualifications are unique among neurologists in this region and it is why his team is the first to discover this relationship between lumbar radiculopathy and RLS/PLMD.

This series originates from a Grand Rounds presentation to Neurology and Neurosurgery residents and staff at the University of Kansas Medical Center. Adjunct Professer, Vernon Rowe, MD, presented his research and experiences as a neurologist and sleep medicine physician, to impress upon those in attendance, the underappreciated connection that sleep disorders have on many common neurological and neurosurgical diseases.

The post RNI Discovers Connection Between Restless Leg Syndrome and Bulging Disc in Lumbar Spine appeared first on Rowe Neurology Institute.

Journalist Steven Brill’s lengthy piece in Time Magazine, which lays the rising cost of healthcare squarely at the feet of fee-inflating hospitals, continues to stir debate this week. If you haven’t read it, it is a gripping read and well worth your time.

As we have detailed previously here on this blog, the story of hospitals acquiring private practices has had a tremendous impact on medicine for patients. Rowe Neurology Institute’s independence from hospital chains lets us provide better outpatient services to Kansas City, and at prices that aren’t inflated like those of hospital chains.

Read more about how hospitals have acquired the power to rip off patients and insurance companies alike.

The post Hospital Fees Drive Rising Cost of Health Care appeared first on Rowe Neurology Institute.

Falling asleep

If you can’t get to sleep, rather than trying harder and harder to fall asleep, try getting out of bed and doing something else. Preferably, move to another room and return to bed only when sleepy. If you have trouble getting to sleep, establish a routine for an hour or so each night before bedtime, such as reading, taking a warm shower or bath, light exercise, or resting quietly.  Avoid too much mental stimulation during the hour or so prior to bedtime. Read a light novel or watch a relaxing TV program; do not finish office work or discuss family finances with your spouse, for example.

Stress

Almost everyone experiences an occasional night of lost or disturbed sleep. It is a natural, perhaps adaptive, response to acute stress.

Naps

If you are having troubles falling asleep at night avoid naps in the early afternoon or early evening.

Getting up

No matter how poorly you have slept the night before, always set your alarm to arise at the same time each morning.

Exercise

Regular exercise can be an effective aid to sleep. It releases energy and mental tensions. It is better not to exercise strenuously just before bedtime.

Noises

Occasional loud noises from aircraft, streets, or highways disturb sleep even in people who do not awaken and who cannot remember the noise in the morning. These sleep disturbances can reduce restful sleep. People who sleep near excessive noise should try heavy curtains in their bedrooms or earplugs to protect the amount of restful sleep they get.

Hunger

Hunger may disturb sleep. A light snack, especially warm milk, seems to help people get to sleep.

Food

Various foods stimulate the body and disturb sleep. Avoid coffee, tea, and cola drinks near bedtime. Avoid late heavy meals.

Sleep patterns

Everyone has a unique sleeping pattern. Some adults need 10 hours a night. Other adults need only 5 hours a night. Many people function best with approximately 8 hours of sleep. Your requirement for sleep is unique. What is effective for your husband, your wife, or your friends is not what may be helpful to you. If you need only 5 hours of sleep a night, do not worry about it, or try to force longer sleeping hours. Instead, learn to use your extra waking hours for something you would like to do or get done.

Quality and quantity

Everyone’s sleep needs change. The amount and quality of sleep varies in the course of each person’s life. The infant may require 16 hours of sleep each day; an elderly person may sleep 3 to 4 hours at night with frequent naps during the day. Changes in the length and depth of sleep are a normal part of life. Within limits the quality of our sleep is more important than quantity.

Symptoms of a mental problem

Sleeping problems may signal a medical condition such as anxiety, depression, and other disorders. It is important to get a proper diagnosis and treatment of the underlying cause of a chronic sleep disturbance.

Pregnancy

Excessive sleepiness the first 3 months of pregnancy is normal don’t worry about it. Pregnant women also tend to sleep about two more hours at night.

Medications/alcohol

An occasional sleeping pill may be of some benefit, but chronic (nightly) use of sleeping pills may actually hinder good sleep. Natural sleep is the best sleep.  Sleeping medications should be used with caution and only upon the advice of a physician by the elderly, pregnant women, people with respiratory disease, kidney disease, or a liver impairment.  If your doctor prescribes a sleep medication, ask for clear directions and information about the particular drug you are to take. Some sleeping pills have a prolonged effect, and can impair your coordination and driving skill the following day.  Sleep medications should be used only for the short term management of a sleep complaint. Do not self-medicate or increase the dosage yourself. If you feel that your medication is losing its effect, report this to your doctor. Although alcohol may help to induce sleep, the chronic use of larger quantities of alcohol causes disturbed sleep and dependency.

The post Myths and Truths About Bedtime Habits and Insomnia appeared first on Rowe Neurology Institute.

The test is often given to people older than 60 years of age that are suspected of mental decline or are manifesting some signs of dementia.

But the mini-mental test should never be used as the sole test for dementia, because it ignores factors only a neurological examination and more thorough neurocognitive testing can accurately evaluate.

What is the mini-mental test?

The MMSE is the most widely used standardized cognitive screening test. Folstein first described it in 1975 as a “practical method for grading the cognitive state. In about 10 minutes, it samples various functions, including: orientation, short- term memory, ability to follow instructions and object recognition.

It is called “mini” because of its brief nature and its easily administered initial screening of a patients cognitive status. The test does not assess mood or thought disorders. Originally, it was intended to assist psychiatric residents in the cognitive part of the mental status test.

Limitations of the mini-mental test

The MMSE is a useful screening test for cognitive impairment. But it should never be used as the only criterion for making a diagnosis of dementia. No one should ever be told they have Alzheimer’s or any other dementia based solely upon the MMSE findings.

The test is a useful tool in initial screening and assessment as well as the ongoing follow-up of patients with a dementia, but only a complete neurological examination, formal patient history, neuropsychological testing, lab tests, CT or MRI of the head can accurately diagnose or rule out various forms of cognitive dysfunction. Further, the MMSE is not a test of personality, mood or behavior, and does not by itself determine competence.

The MMSE is not always sensitive enough to pick up early dementia and can be influenced by the educational background and gender of the person who takes it. It is also less helpful in forms of dementia where there are early and severe language problems.

The post Diagnosing Dementia: Is the Folstein Test Reliable? appeared first on Rowe Neurology Institute.

Other sleep posts that may interest you:

The post Sleep Test: Check Your Sleep Quality with a Short Quiz appeared first on Rowe Neurology Institute.

Can we reduce cost, thus increasing access without affecting the quality of care? The answer is certainly “yes.” — Dr. Stephen Kunz, Overland Park Radiologist

Insurance companies are trying to protect patients, believe it or not, and it’s borne out in these examples.  You’ll see in Dr. Kunz’s piece that the hospital tried to charge $7,000 for an emergency room visit, including an unnecessary CAT scan, but the patient’s insurance company only allowed them to charge around $4,000.  Even that amount would, if we could see the details, include a whopping “hospital facility fee,” which as we have detailed in another postis often charged in outpatient clinics (doctor’s offices owned by hospitals) as well.

Insurance companies can’t fight facility fees because hospital chains are too powerful.  These chains have achieved monopoly or duopoly power in many regions, and they can bully insurance companies into accepting these abusive practices.  Bloomberg News published an excellent investigation into the methods large hospital chains use to inflate medical costs.

Unfortunately, hospital chain power is only growing in Kansas City.  Two major hospitals are up for sale and will undoubtedly be swallowed by large chains.  This follows the purchase last month of a major independent hospital in Kansas City by HCA, the biggest hospital chain in the country.

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