I am Doug Schell. I am clinical nurse specialist, one of the types of advanced practice nurses, and I am a multiple sclerosis certified nurse. I came into the field of neurology and MS in a round about way. I did a lot of other things before I came here. I started off and got a degree in psychology and I worked at a mental hospital, a psychiatric hospital, as a social worker. Then I went to nursing school, became a nurse, worked in critical care, worked a little bit in nursing education, nursing school, a little bit of teaching and supervising students in nursing school. I have been working at MidAmerica Neuroscience Institute since 2000 and have developed a focus on MS care in those years and have gotten my certification in multiple sclerosis nursing. Although this was not what I set out to do in my professional career, over the past nine years I have really become very involved, committed, dedicated, and focused on MS care and have found it to be a very enjoyable and rewarding area to practice in and work with patients. At MidAmerica Neuroscience Institute, MS is really one of our passions and our areas of focus that we really are dedicated to. Here we have a kind of wealth of resources available to patients with MS. We have providers who are certified in MS care and really spend their time focused in that area learning about the newest developments in that area. Our physical therapists, for example, don't spend their time working with patients who have had hip replacement surgery, knee replacement surgery, although they know about the hip and the knee. They spend a large percentage of the time working with patients specifically with multiple sclerosis and with some of the common problems, especially with walking and balance that MS causes. They are really focused in that area and are really expert in that area more than any physical therapist in any clinic on any street corner. We also have a research department here which conducts research trials in a variety of areas, but the majority of these are in the field of MS and let patients have access to treatments and care that they would not otherwise have and have options available to them that they would not have elsewhere. Just in a number of ways, we have really focused on MS, dedicated ourselves to that area, and are able to offer patients things that would not be available in other clinics. The field of treating MS has really undergone a revolution in the last decade and a half and is going to continue to evolve at probably a very quick pace. We have gone from having really no available treatments to treat the underlying disease of MS in 1992 to having three proven medicines when I started working in the field of MS, we call them the ABC drugs, Avonex, Betaseron, and Copaxone. We have now expanded to having six proven treatments that are FDA-approved for MS and we have a whole wealth of other treatments that can be used in clinical trials that are experimental drugs. Really we have gone from having no treatments to having the ABC drugs to really now facing an alphabet of options for patients with MS. Besides the six FDA-approved drugs that are currently available, many of the drugs and treatments that are undergoing clinical trials now are likely to come on the market and be approved by the FDA for broader use among MS in the next several years. This is going to be a very interesting time. It is going to offer a lot more options and choices, things that might be more convenient or work better than the choices we have now, and it is also going to be more challenging because of those choices in trying to fit the right treatment and right medicine to the right patient and weigh the possible benefits that can come from all of these treatments and the proven benefits that can come from all these treatments with the possible cost, risks, and side effects of these treatments. So we have seen a lot of evolution and we are going to continue to see a lot of evolution in the future. It is going to be very exciting and also a challenging time to deal with MS. MS is a disease that has been described by two key words, unpredictable and variable. That makes living with MS a challenge and it makes treating MS a challenge. Really every patient with MS is unique. MS varies from patient to patient. Within the same person it varies from day to day and year to year. While everybody has good and bad days in their life, people with MS really have good and bad days. Managing all that change and that variability and that individual variation between people with MS is both something that is exciting and challenging like many of the things that have to do with MS. Because of that, we really need to try to develop a close relationship with patients with MS, see them on a regular basis, monitor how they are doing on a regular basis, test their functioning on a regular basis, kind of get to know who they are and how MS affects them so that if their MS changes or starts affecting them in a different way, we are more likely to be able to pick that up and deal with it.

Well physical therapy is very interesting to me and I have always been involved and excelled in the sciences, so through undergraduate school, that was a natural course of action. It ended up between medicine and physical therapy and I have an older brother that went into medicine before me, so I decided to take a different course of action. We both ended up in neurology, but just through different courses. I enjoy therapy. You get to treat the problem and fix the mechanics. The musculoskeletal field is the biggest draw to me, so that is probably the major reason I came into therapy. Treating multiple sclerosis takes very skilled therapist with patience. I think there are major aspects that we do different. One, we developed our own skill. We are actively working to progress the field. The big thing is not attributing all symptoms to multiple sclerosis. Most people walking around in our society today have movement dysfunctions and they have disuse atrophy from just not using muscles the way they are designed to be moved, I guess. Some muscles, for example like your biceps, work against gravity, where other muscles like your triceps work with gravity. Over the course of living your normal daily life, the biceps is going to be stronger than the triceps so you develop muscle imbalance which leads to faulty movement patterns and eventually pain. MS patients still have the same faulty movement patterns. In a sense we can correct their techniques and get all of the muscles distributing the force loads or getting them out of a chair, however you want to say that, and it helps with energy conservation because more of the muscles are doing their job. You also can improve balance because you get everything in the system functioning to its optimal level. The other thing that we can do is to get the neurological system working efficiently and as efficiently as it can possibly work. We want what is working, working very well. We started an exercise program for our multiple sclerosis patients. I don't want to get too technical, but if you read through research we see that patients who have physical therapy, skilled physical therapy, they progress to a certain level. They will hold that level after discontinuing therapy for six months. You can really see a drop off in that eight months to a year. Typically when we get the patient back a year later or two years later, that we would see a decline in their physical function and their ability to partake in the aspects they enjoy in their life. So we started the exercise program, and we offer that free of charge to our multiple sclerosis patients, to maintain their physical levels. There are different aspects. There is a center-based program so people can come in two or three times a week. We provide encouragement, provide exercise correction, and exercise prescription to get them achieving the goals that they want to achieve. Then there is a home-based program so people who feel they are able to do things well on their own, or if they live a great distance from the Institute, then we can have them come in once a month or once every two months just to refresh their program and we can in the meantime contact them by phone to make sure that they are staying on task and doing the things that we need. We started this last year so hopefully we will see them maintain their physical strength and the balance improvements that they made during therapy. We do have some individuals come into the exercise program that have been with us for a long time and we have received grants from the Christopher Reeves Foundation to get the Moto-Med which is a machine that will help patients exercise. They can do that like a bicycle and there is also an arm attachment as well. That has been a great benefit and we are very appreciative of the grant from the Christopher Reeves Foundation.

I am Dr. Vernon Rowe, head of the MidAmerica Neuroscience Institute. Patients sometimes say to me in disbelief \"I can\'t believe I didn\'t have to wait for three or four months to see you\" or to see someone in our institute. I can’t explain why wait lists for neurologists are so long. I know there is a great need for neurologists in our subspecialty culture of medicine these days. I know there are not nearly enough and there are not enough in the training programs. It seems to me it is more of a scheduling issue and a prioritization issue than anything else why these waits are so long. What we have done at MidAmerica Neuroscience is realize that when a family physician, internist, or other primary care provider decides that a patient needs to go to a neurologist and knows that patient is going to have to wait months to get into a neurologist, we know that is not good patient care. It is not good patient care for the patients themselves and it does not really help the whole system of getting patients fixed and on with their lives. We have set up a different scheduling procedure here at MidAmerica Neuroscience Institute and that is that we always have available slots for experienced clinicians to see patients every day of the week so that patients who have intractable headache or have a new kind of headache or think they might have multiple sclerosis or are worried about a loved one having a memory problem or have been told that they are falling asleep and they or their spouse are worried about a sleep disorder or they have bad neck pain or back pain or a new numbness or weakness that they have not experienced before, we have slots available for those patients to see because we have just planned it that way. I don’t know why everybody else doesn’t do that. I think it probably has to do with just an appreciation of how important it is to see patients who are having these problems in a timely manner. That is at least one thing that we can say about MidAmerica Neuroscience, that we can evaluate patients rapidly with many of the problems that drive patients to neurologists. Now this is not to say that if you have the acute onset of stroke symptoms that you should not go to a hospital, you should go to a hospital. You should seek out a hospital emergency room that has a stroke program, but you should definitely go to a hospital if you even think that you might be having a stroke or if you definitely are having a stroke. You know because you have had one before or someone close to you has had one. Again, those warning signs of a stroke, sudden onset of loss of vision in one eye or the other, sudden onset of double vision, problems walking, sudden onset of weakness or numbness of an arm or a leg, all those things should drive you immediately to a hospital emergency room with a stroke program. The other problems that now have to wait for months to be evaluated in a neurologist\'s office -- we get patients in within three to four days.

I am Dr. Rowe, head of the MidAmerica Neuroscience Institute. I am also head of our MS Center. Today I would like to talk with you about if you’re an MS patient why I believe you should be followed and treated in an MS center with no disrespect to my colleagues who also treat MS patients. There are approved drugs that they can use. At our institute, we have tried to combine both the diagnostic capabilities for MS along with treatment modalities so that we optimize care for our patients. Remember there are three things you need to do, but you need to do all of these things when you are taking care of MS patients. One you need to be very picky about the diagnosis. Secondly you need to follow patients actively and not just tell them to come back if they have problems. The third thing is you cannot blame everything on MS. Part of our center, though, is a fourth element and that is active research in both the basic science of MS as well as the clinical trials in MS. We started offering patients enrollment in clinical trials to be able to keep them abreast of the very cutting edge therapies in MS and to make available those therapies to them even before they are approved by the FDA, if they meet the very rigid criteria for most of these pharmaceutical industry studies. But only in that way can you hope to keep abreast of everything that is going on in MS and optimize treatment. We at MidAmerica Neuroscience Institute have done phase I studies, phase II studies, phase III studies, pharmaceutical industry study sponsored studies, and we have considerable experience with five clinical care coordinators, all attuned to responsive and empathetic patient care. Patient care, even in these research studies, always comes first. No one is thought of as a guinea pig in these studies. If we need to stop a study because the patient needs something that is out of the study, we do it. If a patient cannot really ethically be involved in a study that would involve a treatment that we do not believe would be best for that patient, we do not enroll in that study. Again, those three things, to be very picky about the diagnosis of multiple sclerosis, follow your patients actively, and do not blame everything on multiple sclerosis in an MS patient, are critical. That fourth element of being able to offer patients cutting edge therapies and being able to offer them the opportunity to participate in the development of new therapies for others is extremely important. Those are the things why I think patients with multiple sclerosis should be followed in an MS center such as ours.

Time: 2:18
If you have ever had a health concern and your family doctor told you to see a specialist, then it is likely that you have experienced the long wait to get that first appointment and diagnosis. I am Dr. John Hunter of MidAmerica Neuroscience Institute in Kansas City. We have intentionally structured our practice so that when you come to us with a suspected neurological symptom, you receive an expert diagnosis and cutting edge treatment. This includes access to the latest research information about your condition, information that is typically only found at large academic centers. At MidAmerica Neuroscience Institute, we provide the highest quality neurological care in a comfortable clinic setting. You will be seen within two to three days of your call, and unless your insurance company requires it, you do not need a referral. Because we are not tied in with a hospital system, our physicians spend the majority of their time seeing patients in our outpatient clinic. They also engage in basic science research and clinical trials research to stay abreast of the latest advances in our areas of expertise which are headache, sleep medicine, multiple sclerosis, and memory loss. I invite you to hear from our physicians themselves by clicking on the videos below. See for yourself what makes us different.

Time: 6:38
At MidAmerica Neuroscience Institute, we have a memory loss center. Why do that, why have a dedicated center or a dedicated area within a practice to deal with memory loss. The answer is quite simple. Memory disorders are very common and it is often confusing for families and patients who are experiencing memory disorder or other thinking problems about what they should do, so they may wander from physician to physician. They may call the Alzheimer’s Association. They may go on the Internet and look for things, but what is really needed is a diagnosis. Do you really have a memory problem or are you just distracted and anxious; are you multitasking too much; and if you have a memory problem, what is the cause of it. The cause is important because there are treatments for most memory disorders, cures for a few, but treatments for almost all. Learning which memory disorder you have is very important. We used to think that as we got older some of us got senile. That was a word that was used in the past, but in the 1970s and 1980s, for the first time investigation was carried out to find out what causes senility, why do people become senile, as it were. The answer was quite startling. It turned out that almost all of the people who had been diagnosed with senility, once they passed away and an autopsy was done, their brains revealed straightforward Alzheimer’s disease, so it was not until the 1970s or 1980s that we realized that almost everything we had been calling senility was simply Alzheimer’s disease, which kicked off an avalanche of research into that disease which is just now coming to fruition. There are several treatments for Alzheimer’s disease, all of which we are well versed in at MidAmerica Neuroscience Institute, and there are a number of treatments still under research just on the cusp of becoming available to the general public. We are heavily involved in that research. Currently we have several trials of different treatments and medications for Alzheimer’s ongoing. Eventually within the next 5-10 years, we hope to see a cure for Alzheimer’s, so it is very important to treat people now and keep them as sharp as possible for the contingency that there may turn out to be a cure in the very near future. Now, how common is Alzheimer’s disease alone? Well, it is estimated that 5-10% of all Americans by age 65 have a diagnosis of Alzheimer’s disease. By age 85, almost half of all Americans have a diagnosis of Alzheimer’s disease. Therefore, this is one of the most common disorders that exist and it is very likely to touch many families. I am often asked, \\\\"Do you inherit the propensity to get Alzheimer’s or other dementias?\\\\" They answer is there is a little bit of increased risk if you have a lot of relatives with Alzheimer’s and slightly decreased risk if you do not, but the fact is that it is a very common disease. Alzheimer’s is one of several diseases that cause what we term dementia. Dementia is a scary word which simply means you do not think now as good as you used to think. Alzheimer’s can cause this problem, but so can a number of other issues. Hardening of the arteries is an old term for something that we now call vascular dementia. It turns out that it is really not all that common, but it is important to diagnose correctly and at our memory disorders center we are well versed in that. It turns out that just because you have a few strokes on your MRI does not mean that you have vascular dementia or hardening of the arteries. There are certain other criteria that have to be met and through our participation in research, we feel like we are well placed to make that discernment for a patient. Besides vascular dementia and Alzheimer’s, there are many other causes of dementia, frontotemporal dementia, primary progressive aphasia, Lewy Body disease, Jakob-Creutzfeldt disease, limbic encephalitis, etc. The diagnosis is important and to arrive at this we use very specialized MRI sequences at MidAmerica Neuroscience Institute looking at certain areas of the brain that are of high

Time: 2:54
I have headaches myself which is one of the reasons I am very passionate about treating headaches and seeing headache patients. It is not an arena a lot of doctors want to get involved in. It can be challenging, but through my own experiences, I have come to realize that you really need to study headaches. You really need to develop a program to approach headaches and you really need to apply some expertise. There are a lot of armchair experts out there who will give you advice when you get a headache. "Oh take this, it always works for me or my grandmother always told me to strap a poultice on my head that that's work great." If those things work, that's fine, but I know in my own case I've had headaches since I was 5 or 6 years old and they were misdiagnosed as sinus problems and dental problems and eyeglass problems. In fact, this persisted right through college and medical school. Nobody picked up on the idea that I had migraine headaches. It wasn't until I was in a neurology residency program at the University of Oklahoma and the director of the program was the President of the American Headache Society and a member on the board of the International Headache Society. He pointed out to me, "Dana, the headaches that you're having meet all the criteria for migraine headaches." Then a light bulb went off and I said "Wait a minute, if that's true, I've been treating my headaches all wrong all this time" throwing over-the-counter medications at the headaches, when actually there are much better prescription medications. I had been doing things such as sleep deprivation and too much caffeine that would trigger migraines that I needed to modify. Once I knew the diagnosis, then I knew a logical approach to address my headaches and now I'm in charge of my headaches instead of the other way around. Migraines are not the only type of headache people experience, but they are by far the most common. In fact, of all people who go to see their doctor or go to an emergency room with the complaint "I have a headache", over 90% of those individuals have migraines. None have sinus headaches and very few have other types of headaches such as exertional headaches, trigeminal vascular headaches, cluster headaches, and so forth.

Time: 1:43
The headache center at MidAmerica Neuroscience Institute provides something that you cannot get at the office of your local neurologist, internist, or family practitioner. As good as they may be the headache care we provide is more in depth. We have in place programs and protocols to treat headache patients in ways that are not done routinely by other physicians in other offices. We have infusion center capabilities so that instead of going to the emergency room because you have an uncontrollable headache to get something intravenous, there is a possibility that you could come to our offices and have your headache treated as an outpatient without having to wade through the indignity of the emergency room where headache patients are often unfortunately treated as drug seekers. We typically have no need to use narcotics or controlled substances at MidAmerica Neuroscience Institute because almost always headaches are controlled without addicting medications, and once successful treatments are found, the patient typically is not going to be on these treatments for the rest of their life. Once we correct the headaches over the course of a few months, one could anticipate that you will remain headache-free then for many months to years before treatment is again necessary.

Time: 2:18
I'm Dr. Rowe, head of the MidAmerica Neuroscience Institute. People ask me sometimes why I wanted to become a neurologist and I tell them "Well, I wanted to find out how the nervous system works so I could help patients with nervous system disease." You treat people and you don't treat tests, but the tests are important too in our day and age. Neurology is a fast moving field. For instance, an MRI is just a fancy computer. You can program it to do anything you want to, but it is really important that you program it to do the right things to find out exactly what is wrong with the patient. It is important that someone with special training in neuroradiology and MRI interpretation be looking at those films so that they know what they actually show. It is important that they design sequences or programs for the MRI to determine exactly what patients have. The same thing goes for sleep medicine. An accredited sleep center is extremely important. The technicians that perform those tests need to be registered polysomnographers. The physicians that look at those tests finally need to be board certified in sleep medicine. Only in that way can you put all the information together to help make the right diagnosis in the patient. The same thing with neurophysiology and all the things that we do here are MidAmerica Neuroscience Institute. Neurology is a fast moving field. You cannot be a jack-of-all-trades and treat patients with neurologic disease in a modern way, so we have decided to focus on four different areas of subspecialization in neurology. We see patients with neck pain, back pain, and other problems that other neurologists see patients for, but where we are different is that we have special certification and training in MRI interpretation and relating that to the patient's problems and in sleep medicine, polysomnographic, and sleep study interpretation relating that to the patient's problems. Neurophysiology and interpretation of tests like EMG and EEG and relating that to the patient's problems, so that translates into better care for the patient with multiple sclerosis, sleep disorders, problems with headaches, and problems with memory loss. We think we are equal to the best around and we would love to give you a chance to evaluate us in person.

Time: 0:52
I was fortunate to go to Duke Medical School and to Johns Hopkins where I was trained in neurology. I spent time at the NIH in research and was in academic medicine for several years before I decided that I could probably have a little more hands on, have a little more control over the quality of care that is given than I actually could in academics. Through that training, I developed a deep appreciation for the importance of research, ongoing clinical research as well as basic research to keep your mind and your ability to help patients up to date and sharp. I think we give that approach to patients at our Institute that is maybe not available in other nonacademic centers.

Time: 4:15
Multiple sclerosis is a tough disease, but there is basically three things that you need to do when you are taking care of patients with multiple sclerosis. We have learned this in our MS Center through extensive research and follow-up of patients over many years. One, you need to be picky about the diagnosis. Two, you need to follow up patients actively to make sure that what you are doing is working or to see whether or not it is not working. Three, you cannot blame every single symptom that a patient with MS has on MS. Those three are absolutely critical. You need some examples here. One is that every year we see five or six patients who are on the shots for MS and who turn out not to have MS. They turned out to have another disease that caused their symptoms. For instance, the most common one that we see is sleep disordered breathing or sleep apnea, fatigue, and either neuropathy or a problem with carpal tunnel with entrapped nerves as they go through the wrists. The second one is that you have got to follow your patients actively and aggressively. We try to see our patients with multiple sclerosis every three months. We are able to get them in either the day or the next day after they begin having problems. We put them on a little graph that is called the Multiple Sclerosis Functional Composite Graph that looks at their thinking, their ability to manipulate their hands and fingers, and their ability to walk. In this way we can assess whether or not they are staying the same, whether or not we are treating the multiple sclerosis adequately and stabilizing the disease. There is not a cure, but we have many things that we can pull out of the quiver to treat that disease. The third thing is, do not blame everything on MS. We are the ones who found a number of years ago that patients with multiple sclerosis have a markedly increased incidence of sleep disorders. A lot of them have sleep apnea, a lot of them have increased motion of their limbs at night that disrupt their sleep, and a lot of them have spasms at night. You treat these all very separately, very differently, and what I always say to patients is that you can treat MS until you are blue in the face, and if you are missing something else like a urinary tract infection, sleep apnea, carpal tunnel symptoms, or a pinched nerve in the neck, then you are not doing everything that you can to maximize the quality of life of that patient. At our Institute we try to live by those three principles and I would say \\\\"How\\\\'s that different from the rest of medicine?\\\\" It\\\\'s not. That\\\\'s the way that medicine should be practiced in every single discipline. It is nice that we have five clinical care coordinators and certified nurses that take care of research studies. We are doing 12 to 14 of those studies at all times trying to give our patients access to cutting pharmacological treatments in multiple sclerosis. Cutting edge kind of therapy that is not available yet. It is nice to have a certified and accredited imaging program. It is nice to have a couple of Ph.D.\\\\'s masters level type people who do basic research using animal technology and other kind of cell culture technology in multiple sclerosis. It is nice to have all those things, and we have them, but the critical elements here are: One, be very picky about the diagnosis of MS because you can do something about it if you make the right diagnosis. Two, you need to be able to follow your patients actively and change what you are doing if it is not working. Three, you cannot blame everything on MS.

Time: 1:23
You know that it is fun to practice neurology and to see patients in the setting like ours. We are a fully integrated neurologic care facility. We emphasize the four different areas, but in order to do that, you have to understand imaging, you have to understand neurophysiology, you have to understand sleep medicine, and all the research studies that go along these areas. In being fully integrated, we are not tied to a hospital system and it is a much more inexpensive and cost efficient way to practice medicine if you have physicians who are treating the patients, determining which tests are necessary, and being able to completely control the quality of those tests. That way you do not end up with unnecessary testing, repeating MRIs, repeating neurophysiology tests, repeating sleep studies, and other kinds of inefficiencies that are endemic really in our healthcare system. This is a model that has been shown many places to reduce healthcare costs and we are proud to be a part of that tradition while maintaining excellence in patient care.

Time: 3:37
Sleep medicine is one of the most prevalent, most common problems in our country. We have seemed to develop a macho kind of culture around being able to perform without sleep, even though we know that from all kinds of psychology experiments that if a person does not get enough sleep, even cut down by an hour a night, then they progressively develop a sleep debt and progressively have problems with their thinking and memory. As a matter of fact, if a patient comes in to us for memory loss and they are 30-45 years of age, probably the most common thing we find is that they have a sleep disorder that is taking away some of their memory. The most common cause of sleep problems in our country is inadequate sleep, so you cannot be macho about this thing. You have to get enough sleep so that you feel rested in the morning. If you don\\\\'t feel rested, then you may have one of 80 sleep disorders that can disturb your sleep at night. Another common problem is sleep disordered breathing. Snoring is common, but it is not normal. It is always abnormal in infants and children and preadolescent children as well as teenagers. It is critical that these little folks get sleep in order to produce the hormones that allow them to grow. It is never normal in a 30-year-old, 40-year-old, or 50-year-old, and in that age group, it tends to produce cardiac problems with coronary artery disease and stroke as well as automobile accidents. If you have one ounce of alcohol and you are sleep-deprived, that is the equivalent of having six ounces of alcohol, so it is a major public health problem. Sleep loss, sleep deprivation due to just inadequate sleep, not trying to get enough sleep, or to one of the many sleep disorders that are out there is a major public health problem in this country. It is important in being able to treat patients with sleep disorders that you depend on the quality of your testing. Our sleep laboratory is nationally accredited. It is staffed by registered polysomnographers and people in our sleep center are seen by board certified sleep specialists who know how to interpret the tests and who participate in research trials for patients with various kinds of sleep disorders. So, sleep disorders are a pervasive problem that can lead to headaches, automobile accidents, premature death with stroke and coronary artery disease. They are not to be taken lightly, should always be evaluated completely, and treated appropriately.

Time: 4:54
One of the things that we have learned over time is that headaches are best treated in the context of a headache clinic or a headache program. This brings together multiple disciplines including radiology, physical therapy, and other areas of expertise that can be brought to bear to treat whatever kind of headache that someone has. The first thing to do if you have a headache and simple measures, over-the-counter medicines are not really working, and chiropractic intervention really has not helped you, the first thing to do is to get into a headache center and get the type of headache properly diagnosed. Certainly it is true that brain tumors, aneurysms, and various other scary things can cause headaches, but typically that is not what is going on. It is important to investigate to rule these things out with appropriate types of MRI, appropriate studies otherwise, and not just any MRI or any blood work, but blood work and MRI specific to the diagnosis of headache type. Once the headache type is pinned down, and sometimes an individual may have more than one kind of headache, then we know about a number of interventions which may help that individual. It may be physical therapy that they need or perhaps they have headaches induced by sleep apnea or some sleep-related disorder that simply needs a CPAP mask or something simple. There are certainly a lot of medications that can be given on a daily basis or an intermittent basis to help with headaches. Depending on the headache type, the treatment would be very, very different for individuals. If you go into a headache center, the expectation should be that there is a 70% chance you will get rid of your headaches or get them under your control. There is a 30% chance that you may not get complete control of your headaches, but you can certainly get some control and improve your lifestyle. It is only the rare patient that cannot gain control of their headaches through the simple startup measures that would be applied when they first come to a headache center. Those individuals we have to go deeper and look at more options, but I will tell you a lot of patients come in and they tell me \\\\"Doc, I had an MRI done 10 years ago and they didn\\\\'t see anything. I\\\\'ve had all this blood work done and I\\\\'ve been on every medicine there is\\\\", but when we start interviewing them, we find out that in fact the MRI they had was a more or less generic MRI. Sometimes if we repeat the MRI and do it a slightly different way, we find something that was missed on the previous MRI. Nobody asked them about their sleep and sometimes that is critical. Perhaps certain blood work was not checked for. Certain inherited disorders can cause headaches and we can rule those out. When patients are given a list of all the available treatments for headache, even the individual who says \\\\"I\\\\'ve been tried on everything, there\\\\'s nothing left\\\\", is usually amazed. They have usually been tried on less than one-tenth of what is available and that is why in a headache center such as ours we have such a high success rate because we know of treatments that have not been applied. The average physician, the family practitioner, has one or two really good treatments for headache up their sleeve. They will try these. If they are successful, that is great. If that does not work, then the primary care physician has a lot more to worry about than headaches. At our center on the other hand, we make it our business to worry about headaches, and since I am a headache sufferer, I take it very personal. We try to keep up with all of the literature. We investigate new therapeutic approaches for headache and we involve ourselves in research in the headache arena, which is not something that you can get from just any neurology office or your primary care doctor. If that is the type of headache treatment and the depth of headache treatment you need, we do provide that.

Time: 3:06
I am often asked who should come to a memory disorders center and why should they bother. The answer is that if you have a family member, a spouse, a parent, who you feel is not thinking the same as they used to, something has changed that you do not like about their behavior, their ability to remember, their ability to perhaps handle the checkbook or finances, or their ability to drive, perhaps they are getting in more unexplained wrecks, all of these things can be signs of dementia and the earlier that you look into these issues, the more likely you are to be able to initiate treatment at a stage where it makes a difference. If you have a dementia that is caused by say Alzheimer’s and you are going to get worse and worse over time, it is better to get a diagnosis first of all and to start treatment early, because the treatments currently available for Alzheimer’s disease simply slow the disease process down. So if you are slowing something down, you would like to start while you are still pretty sharp and not wait until you have lost a great deal of ability and begin slowing the disease process down at that point. We found that through judicious application of medications we can delay the loss of certain abilities for up to two years in a disease, for instance, like Alzheimer’s. If someone was going to forget how to operate the microwave or the television remote or the phone, we might push that back by two years with use of certain treatments and medications. As far as nursing home placement, which unfortunately happens in a number of individuals once they get far enough along with dementia, certain treatments in Alzheimer’s can push nursing home placement two years further out into the future. With all the new treatments about to become available and the possibility of a cure on the horizon, that is really critical. If you can remain at home and still operate the microwave and the phone for two years longer than you would have otherwise, that is very, very helpful to other family members. Also, it is helpful to understand why someone\\\\\\\\\\\\\\\\'s behavior may change. If someone is becoming more aggressive, confrontational, or argumentative, it may not be because of something they have personally against you, it may be a dementing process and that can sometimes be addressed and make life more normal. It can restore relationships to a more normal footing if everybody understands what is going on.

Time: 2:05
You should never depend on your primary care physician to pick up on subtle changes in your loved on and make a diagnosis of dementia in a routine office visit. My wife is a primary care physician and her time is so limited that she must focus on the complaint brought before her in an individual visit. So unless you go to your regular family doctor with a complaint of memory difficulty or behavior change, it is unlikely they will have the time to pick up on what is happening and refer you to appropriate care. Most primary care physicians know how to initiate care for many memory disorders and dementias, but meanwhile it is important to get referred in to MidAmerica Neuroscience Institute Memory Disorders Center or a similar memory disorder center where you live and begin the appropriate workup to really prove what the cause of the thinking issue is. We do not always require that you be referred in by your primary care physician if you have not been in to see them in awhile or you have changed physicians. If you are concerned right now about a memory problem, you should call and make an appointment yourself at MidAmerica Neuroscience Institute and let us take a look at your loved one. If you yourself feel that you have memory issues or thinking problems, then let me reassure you that often that turns out not to be anything serious if you yourself are realizing it, but occasionally we do find something that we are glad we caught. We would evaluate you the same way we would if you would bring a loved one in. It is important to get those issues resolved and stop worrying about having Alzheimer’s if you really do not.

Time: 2:11
One of the cool things about the memory disorders center at MidAmerica Neuroscience Institute is that we are involved in clinical research. We are the first kids on the block to get our hands on brand new medications which may turn out to be amazingly beneficial to certain disease processes such as Alzheimer’s. We are on the cutting edge of being involved in research to prove or disprove theories about why diseases such as Alzheimer’s may be occurring. We are also well positioned to take care of the other issues a patient may have which can impact their thinking decline or their dementia such as strokes, sleep disorders, headaches, medication interactions, and other things which if corrected can improve thinking in and of themselves. Being involved in research at MidAmerica Neuroscience Institute, we are privy to the latest cutting edge information about the various dementing illnesses and we are in communication with thought leaders around the world in the area of dementia. In terms of meetings, phone calls, and communication through letters, we are on a first name basis with many thought leaders in the realm of dementia regardless of what part of the country you are from. As such, we feel like we do not miss anything when it comes to evaluating dementia, and if there is anything that is not available in the Kansas City area, we are going to refer you to the specific place where you can get the testing done that needs to happen and then we will continue to follow you here locally with those results.