Parkinson’s disease is a complex constellation of symptoms. As reported in the August 30, 2011 issue of Neurology, neurologist care of Parkinson patients greatly improves their quality of life and long term clinical outcome. Parkinson disease affects approximately 1 million Americans. It is only second to Alzheimer’s disease as a common neurodegenerative illness. Early diagnosis, recognition of associated symptoms and comorbidities as well as comprehensive care are necessary if a Parkinson patient’s long term clinical outcomes and quality of life are to be maintained.

Neurology has commonly not been taught in the detail that is necessary in most medical schools. Medical students graduate, generally with a limited understanding of neurological diseases and the treatment required for each. Neurology has a vast scope of illnesses, each requiring intimate knowledge and understanding of the disease process as well as the treatment required to optimize patient well being and life quality. It is beyond the scope of medical school, internship and even family medicine or internal medicine residencies to train the young physician sufficiently in the details of neurological disease.

Across the United States, 15-20% of all visits to a primary care doctor’s office (family physician or internal medicine) involve a neurological complaint. While simple problems such as back or neck pain can easily be treated, more complicated illnesses such as Parkinson’s disease, migraine headaches, seizures and multiple sclerosis should be managed by a neurologist – particularly a sub-specialist neurologist in the disease process needing treatment. Surveys in the United States, Europe and Asia show that both medical students and general physicians do not feel as comfortable in managing neurological problems as they do other common medical problems.  The article in Neurology clearly shows that Parkinson patients, managed by a neurologist, have overall better outcomes than those managed by family physicians.

Parkinson patients managed by  a neurologist have  an earlier diagnosis. This leads to starting treatment earlier. With early intervention, patient functioning can be maintained and optimized. This allows for the patient and their families to enjoy more quality time together with an increased ability to engage in social activities and travel. The study reported in Neurology, looked at over 138,000 Parkinson patents. The finding of this study showed that about 20% of patents with Parkinson’s disease never see a neurologist. These patients had a higher rate of falling, hip fractures, nursing home admission and death at an earlier age.

Parkinson patents cared for by a neurologist, by contrast, significantly had fewer hip fractures. Hip fractures are a major cause of disability and death in the elderly. Inherent to Parkinson patients is gait instability and a tendency for stumbles and falls. Falling prevention is a main goal in all elderly patients, but particularly those with Parkinson’s disease. Unfortunately, many who suffer a hip fracture may become wheelchair confined, even with successful hip fracture repair.  One third of all patients who suffer a hip fracture will die within a year of their fracture! The annual cost of managing a patient with a hip fracture is $20,000 per person – not including medical costs. With detailed care of all of a Parkinson patients symptoms, a neurologist can better prevent these patients from falling and suffering fractures.

The second finding of this study was that Parkinson patients getting state-of-the-art care by a neurologist had a lower probability of being admitted to a nursing home. While most Parkinson patients do not need nursing home care, those with more advanced disease, Parkinson related dementia or complications such as hip fractures frequently need skilled nursing facility placement. Parkinson’s disease is complex condition. Not only are the motor symptoms a major problem, but so are the cognitive and psychological problems that go along with this disease. Depression and anxiety occur in over fifty percent of Parkinson patients. Early recognition and treatment  is critical for improved patent and caregiver quality of life. Dementia is also a common problem. It can start as mild memory loss but will progress. Neurologists are sensitive to these problems and there are medications as well as dietary supplements that help to improve these problems.

The final finding of the Neurology study was that there was a statistically significant increase in the six year survival of patients with Parkinson’s disease managed by a neurologist. There are multiple reasons why this may be the case, including earlier use of the many types of medications used in Parkinson management, treatment of coexisting psychiatric problems and addressing the multitude of other medical problems that are frequently associated with Parkinson’s disease.

The conclusion for Parkinson patients and their family or caregivers is to get that patient into see a neurologist, particularly a neurologist who specializes in movement disorders. Patients want more control over their life, improved quality of life and the ability to remain functional as long as possible. This is true for the Parkinson patient as well. Take control of your life, contact Sarasota Neurology for consultation and management of your Parkinson’s disease. It will most likely be the best thing you could do for yourself – for the rest of your life.

What do you think of when you think of neck or back massage therapy? Most people think of the type of massage you would receive if you went to the spa for the day.  That type of massage therapy is known as a Swedish Massage. Swedish Massage is only one of over 40 types of massage that a person can receive. When you say you went to see your doctor today, what do you think of?  If I went to see my family doctor, my image would be different than if I said I went to see my Cardiovascular surgeon.  They are both doctors, but the exams and procedures that they perform are vastly different.

The field of massage is similar in its sub-specialization within the scope of massage therapy. Swedish Massage is great for relaxation and stress reduction, but if your back just went into spasm and is  locked up, you would be much better served going to a Massage Therapist that specializes in Rehabilitation and back pain relief.   Neuromuscular Therapy, Myofascial Release, Positional Release and Muscle Energy are just a few of the specialized massage techniques that were developed to treat muscle pain and skeletal dysfunction.  These techniques are focused on looking at the role of the soft tissues in causing pain. Soft tissues include muscle, tendon, ligament and fascia. Fascia is the covering over muscles and internal organs that provide stability and strength. Neuromuscular therapy treats fascia and muscle pain. Myofascial Release treats connective tissue disorders, particularly tight fascia which is a painful syndrome that frequently accompanies muscle pain and spasm. Positional Release treats muscle spasms, muscle energy treats joint restrictions.

These techniques are taught to Massage Therapists as advanced, highly specialized postgraduate courses. Just as a doctor can practice medicine after four years in medical school, he/she must first participate in a postgraduate internship and residency program to specialize in his/her specific field of medicine.  A Massage Therapist who is treating patient for acute and chronic muscle and joint pain should have more than just basic, Swedish Massage training. What patient’s want most is pain relief.

In summary, specialized massage therapy for medical conditions, requires advanced training on the part of the massage therapist. Many hours of postgraduate massage therapy education and training is necessary for successful outcomes in the treatment of patients suffering from pain in the neck, back, head or extremities. For more information visit Soar Point Massage or contact Jack Ryan, LMT a 941–993-3339 for an appointment.

In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized expert in stroke prevention, provides an overview of  current techniques for preventing and managing risk of stroke.

Stroke is the third leading cause of death in the United States. This combined with heart attacks and heart disease result in over 2 million deaths a year.

The common underlying cause is vascular disease or hardening of the arteries. Heart attack and stroke can be prevented with simple life style changes and medications. Treatment of high cholesterol, high blood pressure and stop smoking will significantly lower risk of suffering from these devastating conditions. This combined with supplements and simple medications, such as aspirin with have a dramatic impact in reducing risk for stroke and heart attack.

Listen to this report to find out how you can reduce your risk of suffering from a stroke, heart attack or other cardiovascular disease.

If you are concerned that you or someone you love may be at risk for stroke, please call (941) 955-5858 or click here to schedule your appointment today. If you’re outside the Sarasota area and unable to travel here, please locate a neurologist in your area.

A recent report in the Journal of the AMA (De Vos, et al JAMA 2009) reported that platelet rich plasma therapy was no more effective for chronic Achilles tendinopathy than standard, conservative therapy. This study was inherently flawed in its design resulting in incorrect conclusions. Platelet rich plasma is the healing component of blood. It is derived and concentrated from a patient’s own blood and then injected into the affected area. Not all PRP is the same. Blood processing is the key, levels of growth factors are of utmost importance and successful outcomes will vary with the technique, protocol and level of expertise the clinician possesses. Different PRP extraction equipment and how the blood product is handled during this process is also critical.

De Vos et al commented “A limitation of the study was that the amount of platelets and quantity of activated growth factors that were present in the PRP injections were unknown.” This introduces several variables that would invalidate the data and the study’s conclusion:

1. What PRP processing system was used?

2. Were the levels of Growth Factors therapeutic? Therapeutic level ranges  are usually 4-5  times the baseline.

3. No levels or PRP concentrations were taken or reported.

All of these are significant study design flaws that will result in invalid study conclusions. Additionally the study stated “Platelets are slow to activate by exposure to tendon collagen, but it might be that therapeutic pressure within the tendon, a large amount of PRP diffused rapidly out of the tendon thereby reducing its effect.” Additionally thrombin – a critical component in PRP therapy – was not used to activate the platelets. PRP and growth factors will not activate or be as effective if thrombin is not used in this procedure.

Perhaps most significant study design error was that only one PRP injection was given. The study patients, by design criteria, were required to have chronic Achilles tendinopathy that had responded poorly to prior therapies. Chronic tendon injuries, particularly those in the Achilles tendon, heal poorly due to inherently poor blood circulation. The standard PRP technique in this type of injury would be a series of three injections over a period of 3-4 months. A study that specifies treating a patient with a chronic tendinopathy with a single PRP injection is setting up the patient unnecessarily for failure. Lastly, the study had a low number of subjects in it to make any clinically significant conclusions. Only 27 subjects were treated, each with a single PRP injection and there were 27 control subjects.

Regenerative medicine – Platelet rich plasma – has been FDA approved for medical use for 20 years. It has been used widely in dental, cardiac, orthopedic medicine to assist in and improve medical outcomes. The professional horse racing associations widely use PRP therapy to heal leg injuries in their million dollar race horses. Major league sports such as the NFL and MLB consider platelet rich plasma therapy an important treatment option to get their elite athletes “back into the game” in as short of time as possible. PRP healing typically takes six weeks, particularly when combined with rehabilitation. In conclusion, PRP is a highly effective medical treatment for ligament, tendon, muscle and other knee/shoulder injuries as well as lower back pain. Even patients with post-operative knee pain or shoulder pain can benefit from PRP therapy.  Outcomes are entirely dependent on the preparation and handling of the blood, equipment used and experience as well as skill of the treating physician. Additional information on PRP can be found at PRP Stops Pain. Excellent clinical study references can be found by clicking here.

As a neurologist who sees many patients with neck, back and various joint pains, I practice an area of medicine known as neuro-orthopedics. As such, I treat patients for their pain without surgical intervention. Many patients with neck, back and joint pain (knee pain, shoulder pain, elbow pain, etc.) can be successfully treated without invasive surgery and the many risk that go along with this. With surgery there is also a prolonged recovery time and need for extensive rehabilitation. The area of medicine that applies to successfully treating patients without surgery or use of narcotic medications is known as regenerative medicine. In this field, platelet rich plasma is injected into the affected joint, tendon, ligament or soft tissue area that has pain and is failing to heal completely. Tendons attach muscle to bone and ligaments attach bones to bones. Platelet rich plasma (PRP) is the concentrated healing components of the blood. Only one percent of the blood contains the bioactive proteins and platelets that are involved in healing. Through a specialized process, we can take the patient’s own blood and concentrate the platelets and bioactive proteins up to 500%. This small amount of concentrated PRP is then injected into the joint or other body area, that needs regeneration, after local anesthetic is administered. The PRP graft is then activated with thrombin and the healing process begins. Using the patient’s own blood eliminates the risk of transmitting disease and prevents graft rejection. PRP also has the benefit of being antimicrobial, killing off bacteria thereby limiting the risk of infection. David Crane, MD published an excellent overview of platelet rich plasma.

Platelet rich plasma works by first being injected into the affected area and activated. The activated platelets attach themselves to the damaged tissue, whether that be tendons, ligaments, muscle or bone. The platelets release alpha granules and dense particles. The small packets contain powerful bioactive proteins that begin the healing process. The alpha granules contain clotting factors, growth factors, cytokines and adhesion molecules. These substances allow the PRP graft to attach to the damaged tissue and start recruiting other healing cells to migrate into the area. The dense particles contain proteins that allow the platelets to clump together, forming the structural matrix of the PRP graft.

Bioactive proteins recruit fibrinocytes that move into the area, attaching to the matrix. Fibrinocytes begin laying done new collagen. Collagen is the basic building block for soft tissue, tendons, ligaments and cartilage structures in the joint area. Initially after platelet rich plasma is injected there is an inflammatory response where the new cells, including fibrinocytes, white blood cells and stem cells move into the graft. This phase usually lasts about a week and may be associated with slight swelling and mild pain.  As new collagen is being laid down, the proliferation phase begins. During this phase, the collagen is laid down in sufficient quantities to regenerate the damaged tissue. A stem cell is an immature cell that can transform into whatever tissue is needed for repair. This phase can take about 4 weeks. After this the remodeling phase occurs, where the new collagen contracts and becomes much stronger, building stronger tendons and ligaments. The entire process takes about 6 weeks but remodeling can go on for as long as six months.

Regenerative medicine offers patient with hip, knee, shoulder, elbow, neck and back pains the opportunity to have the damaged tissues repaired non-surgically. Injection of PRP results in regenerating the damaged tissue and thus restoring normal function. It also offers patients hope for pain relief, who have failed surgery and do not want to take (or continue to take) narcotics. PRP is also excellent for some patients who have joint problems that would prefer to avoid surgery or are not good surgical candidates. This may be especially true for patients with severe knee arthritis. PRP is safe and effective. It has been FDA approved for 20 years. Platelet rich plasma has the advantage that it can be done as an outpatient procedure and there is virtually no “recovery time.”

Platelet rich plasma has been used many times in professional athletics. Hines Ward, the Pittsburgh Steeler’s wide receiver, sprained his medial collateral knee ligament. It was thought that he would not be able to play in the Super Bowl due to his knee pain. He was given a PRP treatment and went on to play in the Super Bowl. He actually caught the 38 yard pass that won the game! During his knee surgery, Tiger Woods had the additional benefit of having a PRP graft put on the surgical site of his knee surgery. Both the NFL and MLB consider platelet rich plasma a viable medical treatment in the management of their elite athletes. For athletes with intractable tennis elbow, PRP is an excellent treatment modality to avoid surgery. Similar benefits can be found in the treatment of professional baseball pitchers who suffer from pitcher’s shoulder.
Platelet rich plasma therapy can be used in other chronic painful conditions such as plantar fasciitis – a condition characterized by persistent foot pain that is difficult to treat. A PRP graft can be administered to the heel area and frequently provides patients with healing of the plantar fasciitis.  Sacroiliitis, an inflammation of the tailbone where it attaches to the hip bones is a very common cause of persistent lower back pain. It can mimic sciatica (leg pain) and yet has nothing to do with the low back spinal nerves. In patients who fail to respond to standard therapies such as anti-inflammatory agents, physical therapy or a cortisone injection, PRP is a excellent treatment alternative to heal and regenerate the sacroiliac joint ligaments. Patients with persistent hip pain frequently have a condition known as trochanteric bursitis. This is a hip bursitis that is sometimes difficult to treat. PRP repairs the tendon damage, thereby relieving the pain.

In summary, platelet rich plasma and regenerative medicine offer patients an exciting and innovative treatment that has a proven track record of healing patients and regenerating damaged tissues. With an experienced treating physician, success rates of up to 85% can be seen. Depending on the severity of the injury anywhere from 1-3 treatments with PRP may be needed, at 4 week intervals. PRP is an ideal treatment modality as it can be given to patients who would prefer to avoid surgery or it can be given after surgery, in patients who have persistent pain, despite adequate rehabilitation. If you have chronic joint, neck or back pain, you may want to consider getting PRP therapy. PRP therapy clearly can improve a patient’s quality of life. Call today for a consultation and evaluation to see if platelet rich plasma therapy may be right for you. For more information, see Sarasota Neurolgy PRP blog site at PRP Stops Pain.

Much has been said and written about caffeine over the past half century. There have been over 20,000 studies conducted looking at the various effects and benefits of caffeine over this period of time. Numerous studies have demonstrated the tremendous health benefits that can be derived from regular daily consumption of caffeine, most commonly delivered through the consumption of coffee or energy drinks such as Red Bull or similar beverage. All of these have a high caffeine content.  In almost any way that caffeine is consumed, there are certain health benefits that it delivers. Despite all the negative press that has been attributed to caffeine, there has never been a study that has shown that caffeine has long term negative health effects, quite the contrary. The vast majority of studies have shown some beneficial effect in the regular consumption of coffee and caffeine. In that sense, caffeine is truly one of nature’s own wonder drugs.

The use of caffeinated beverages  by humans is documented  since the 15th century. Over the past 100 years there has been an explosive growth in the manner that we get our daily “caffeine fix.” Coffee has been a staple beverage in most countries and cultures of the world. Prepared in various ways, it is all still derived from the humble coffee bean. There are many different types of coffee beans and many more ways to roast and grind the bean. The combination of these factors leads to preparation of coffee and related drinks. Caffeine is also added to various soft drinks and energy drinks, which gives these beverages the ability to make a person feel a “boost” in energy and alertness. In contrast to regular, black coffee – the healthiest of caffeinated beverage genre – many coffee preparations, soft drinks and any energy drink contain high quantities of sugar and/or fat. It is these ingredients that may contribute to the undeserved reputation that coffee or caffeine is not healthy. Of the regular, commercially available coffee, Starbucks has the highest caffeine content coffees.

Caffeine is a complex compound which is used both recreationally and medically. It has the ability to attach itself (the caffeine molecule) to adenosine receptors in the body and brain. Adenosine is the chemical transmitter in the body that helps us to shut down, prior to sleep. It is the body’s own natural braking system that is responsible for us feeling tired, fatigued and go into sleep mode. Caffeine has the quality of being able to “plug into” the adenosine receptors thereby preventing this chemical transmitter from doing its job. This is particularly true in the brain, spinal cord and muscles. Without the “shut down” signal from adenosine, caffeine is able to “rev” up the brain and give the classic caffeine jolt that so many of us are familiar with. Within minutes of being ingested, caffeine speeds to our brain causing a release of another brain transmitter, dopamine. Dopamine is one of our body’s own internal energizers and antidepressants. The release of dopamine in the brain gives us a sense of well being, pleasure, increased awareness and alertness and improved problem solving abilities. Caffeine has the ability to improve brain activity and cognition. Psychological studies done on university students taking a test showed that those students who consumed caffeine prior to the test scored statistically better that their non-caffeinated counterparts. Studies done by the United States military showed that infantrymen or jet pilots scored higher and performed better on training and flight missions when they had consumed caffeine prior to performance testing. With increased alertness and improved problem solving abilities, it is no wonder that those individuals who consumed caffeine did better.

Many other health benefits have been attributed to caffeine and coffee. Some studies have shown that regular daily consumption of coffee may have an effect of protecting one later in life from developing Parkinson’s disease, Alzheimer’s disease, diabetes, high blood pressure and heart disease (coronary artery disease.) Although occasional consumption of caffeine can temporarily raise your blood pressure, a Harvard study showed that the regular consumption of six cups of coffee daily did not increase the chances of developing heart disease. Another study showed that in individuals with regular consumption of coffee actually reduced their chance of dying from a heart attack by 53%. Habitual coffee drinkers bodies become accustomed to the transient elevation of blood pressure, by caffeine, and their blood pressures most commonly normalize. That is true assuming you do not start off with mildly elevated blood pressures. Many foods have high antioxidant levels, but regular, brewed coffee has a very high concentration of antioxidants. It may be this particular component of coffee that provides the health benefits of reduction in risk for stroke, coronary artery disease (heart attack), diabetes, Alzheimer’s and Parkinson’s disease.

Caffeine has a slightly different effect on muscles but can help improve strength when combined with regular exercise. Muscles have adenosine receptors on them. Caffeine can plug into these muscle adenosine receptors. As a result, there is more calcium released when muscles contract. Calcium is the main chemical component involved with muscle contraction. The more calcium released during a muscle contraction, the stronger the muscle contraction. When muscles are repeatedly strengthened with muscle contractions, such as with weight resistant exercise, it is this increase in muscle contraction strength that help build stronger muscles. It is perhaps the effects of the energy drinks, loaded with both sugar and caffeine that provides the increased exercise performance. One study showed that it was actually caffeine tablets, high caffeine content soft drink or energy drinks that provided this benefit as compared to coffee. A cautionary note: if you have known heart disease, check with your cardiologist before consuming caffeine or caffeinated beverages.

Diabetes is a growing epidemic in the United States with over 30% of the population being considered to be obese. Obesity, defined as being over 20% over ideal body weight (BMI over 30), with morbid obesity generally defined as being 100 pounds or more over ideal weight, represents multiple health risks. The concept of metabolic syndrome: central obesity, high blood pressure and diabetes is an ongoing major health concern in the U.S. Drinking regular, black coffee without any sugary additives or even sugar itself can help reduce the risk of developing diabetes. A different Harvard University study showed that drinking 5 cups of regular coffee a day reduced the risk of developing diabetes by 50%. Much of this effect was attributed to the high antioxidant levels contained in regular, brewed coffee. If you must have your coffee sweetened, it may be better to consider a sweetener alternative such as NutraSweet, Splenda or Sweet’N Low over sugar.

In summary, the multiple health benefits of caffeine and regular, black coffee cannot be overstated. Thousands of studies have shown different, multiple health benefits from daily consumption of coffee. With the exception of heart disease, stomach ulcers and uncontrolled high blood pressure, adverse effects of consuming 3-6 cups of coffee have not been shown. The long term benefits of daily coffee consumption are quite clear and the protective effects of this complex drink are tremendous. If you are not a coffee drinker, then the next best thing would be to try caffeine pills. Either way, you have everything to gain for a healthy supplement, in addition to regular exercise and a sensible diet.

The FDA has approved two additional medications specifically for the treatment of fibromyalgia symptoms. The first drug to ever be approved for fibromyalgia treatment was Lyrica. Lyrica was developed as an anti-seizure medication and has FDA approval for this and treatment of painful diabetic neuropathy. Since its initial release, the FDA approved its use for symptomatic treatment of fibromyalgia.

Cymbalta was the second drug to be FDA approved for the treatment of fibromyalgia. This has been a tremendous addition to treatment of this disabling condition. The most recent medication approved for FM treatment is Savella. Prior to the FDA approval of these three medications, there were no proven effective treatments for fibromyalgia. What is fibromyalgia?

Fibromyalgia (FM) is a syndrome of diffuse muscle pains, fatigue, subjective weakness and multiple points of tenderness in spinal muscles (neck pain, back pain) as well as extremities. Other symptoms can be seen with FM. Mental clouding known as fibromyalgia fog is seen in some patients. These patients have a poorly understood clouding of their ability to think clearly. They are able to function but just feel slower in their ability to think and some have memory difficulties as well. It should be made clear that these patients do not have dementia. Fatigue is quite prominent and patients do not seem to be able to be able to get enough rest or restorative sleep. Sleep hygiene is frequently disturbed. Affected individuals have difficulty falling asleep or staying asleep, primarily due to their pain. There is a higher incidence of restless legs syndrome and sleep apnea in FM patients. Other common neurological conditions seen include headache, which is often a mixed headache disorder. Patients complain of a dull low grade daily headache combined with intermittent migraine-type headaches. Due to the chronic refractory nature of their pain and associated symptoms, there is a high incidence of depression in FM patients. It is absolutely necessary to recognize this depression and treat it aggressively to improve the quality of life for FM patients.

The precise cause of FM is not clearly understood. Frequently there is a history of preceding physical trauma. This can be seen after motor vehicle accidents with significant physical trauma or after other physically traumatic events. Some patients may develop FM after particularly severe infections or prolonged acute illnesses. There is a genetic component to FM as it tends to run in families. Put another way, if you have a first degree relative who suffers from FM, you have a higher chance of developing this condition than the general population. There is a clear female predominance of this condition. The exact mechanism of the muscle pain is also not well understood. Extensive study of the muscles has failed to reveal any muscle abnormality. EMG studies in affected patients are normal. More recent theories include the concept of central sensitization. In central sensitization, the FM patient’s brain has a different perception of pain signals. These patients seem to have marked hypersensitivity to lower degrees of pain impulses. These impulses are magnified to a much greater degree in FM patient as compared to the general population.

Treatment of FM can be difficult. Over-the-counter analgesics such as aspirin, ibuprofen, naproxen or Tylenol-like products may provide some temporary relief. Some patients may get benefit from a non-narcotic analgesic tramadol. Narcotics should be avoided due to the risk of abuse and addiction. Currently the state-of-the-art treatment in FM is using one of the three agents: Lyrica, Cymbalta or Savella. Lyrica is an antiseizure drug that also has proven effects in certain painful conditions, including FM. Cymbalta and Savella are both antidepressants that elevate the levels of norepinephrine in the brain. Norepinephrine is a major brain neurotransmitter. Higher levels of this transmitter somehow suppress the pain signals in the brain. These are nonnarcotic, nonaddictive medications. They also have added benefit in that they are antidepressants and can treat the depression that so often accompanies the pain of FM. Certainly some type of regular exercise can benefit patients. Each patient needs to find the particular exercise program that they can do without triggering worsening of their fibro pain. Water based or other nontraumatic exercises are the best in this regard.

Fibromyalgia can also be managed by appropriate, well balanced diet. Eat regularly with adequate daily intake of fruits and vegetables. In some patients, a dietary consultation can be helpful in designing a more appropriate diet. Adequate, restorative sleep is critical in controlling and improving the quality of life in fibro patients. If necessary, a mild sleeping agent can be employed. Despite these measures, FM patients will still have good and bad days. On the bad days, one must recognize this and have a more restful, less stressed day.

The first step in getting better, is to see a physician that specializes in treating fibromyalgia. Adequate laboratory testing should be performed to rule out more serious conditions such as thyroid disease, other muscle diseases, rheumatoid arthritis or other connective tissue disorders.

Vascular disease or “hardening of the arteries”, also known as atherosclerotic disease, is the number one cause of death in the United States. Contributing risk factors include diabetes, high blood pressure and high cholesterol. Diabetes is a major risk factor, equivalent to that of having had a heart attack. There is a direct association with high cholesterol and increased incidence of coronary artery disease. The most significant risk factor for stroke is high blood pressure. Both high blood pressure and high cholesterol are associated with a higher rate of vascular disease, stroke and heart attack.  Recent publications have indicated that coffee and tea may reduce the risk of having a stroke, stroke symptoms or other vascular events such as heart attack. The studies also indicate that individuals who consume coffee have a lower prevalence of diabetes, high blood pressure and heart disease.

As reported in Neurology Reviews, several independent studies have shown that daily consumption of black or green tea reduced the rate of stroke and number of people dying from stroke. These findings were reported at the 2009 International Stroke Conference. A summary of the findings of the numerous studies done show that tea consumption was associated with decreased brain volume injury from stroke with an increase in the number of brain cells that survive in a stroke. Retrospective analysis of the studies published, showed that 195,000 stroke patients were involved and the total number of strokes was 4,300. Dr. Lenore Arab, PhD reported this information and found that the consumption of three cups of tea daily was associated with an average stroke risk reduction of 21%. The exact mechanism of protection by tea in stroke risk reduction has not yet been completely determined. Dr. Arab’s findings were published in Stroke, 2009 February 19.

Coffee consumption has also been reported to reduce the prevalence of stroke. Information regarding coffee consumption and reduced stroke prevalence was also presented at the 2009 International Stroke Conference. This was published in Circulation, a well respected medical journal. It was reported that stroke and other vascular risk factors decreased the amount of daily coffee consumption increased. This finding was consistent even after considering and factoring out other high stroke risk factors such as smoking. Of the 9,384 patients in the study, for whom coffee consumption information was available, it was found that about 3000 had suffered stroke,TIA (transient ischemic attack) or stroke symptoms. The range of coffee consumption ranged from zero to 20 cups daily. Analysis of the data showed that in the individuals studied, those who drank no coffee had the highest prevalence of stroke. Drinking 1-2 cups daily had a stroke prevalence of 5%, 3-5 cups daily 3.5% stroke prevalence and greater than 6 cups daily 2.9% stroke prevalence. Other analysis of the data showed that there was an overall lowered prevalence of high blood pressure, diabetes and coronary artery disease with daily consumption of coffee, particularly in the higher daily coffee consumption group.

In conclusion, it is clear from the available data published in several medical journals, such as Stroke and Circulation, that there is a significant reduction in rate and prevalence of TIA, stroke and stroke symptoms with daily consumption of tea and/or coffee. Higher coffee consumption appears to be associated with a greater reduction in stroke prevalence. This in combination with a healthy diet, exercise of any kind and optimized medical therapy will provide individuals with the greatest protection against having a stroke and stroke prevention.

There are many studies that have shown excellent health benefits from taking omega 3 type fish oil. Omega 3 oils are found in fish oils, flax seed and several vegetable oils including canola, soybean and olive oils. There are different components to these oils that provide health benefits. The DHA and EPA oils in fish oil have been linked to reducing hardening of the arteries and lowering triglycerides. They also have the benefit of lowering blood pressure and heart rate to a mild degree. This all results in an overall reduction in risk for coronary artery disease, heart attack, sudden death, irregular heart beat and stroke. Fish oil can also have a blood thinning effect to reduce abnormal blood clotting, similar to that of aspirin. This latter effect is a two edge sword because too much fish oil can increase the risk for serious bleeding. Generally three grams (3000 mg) daily or less is considered safe. Daily intake of Omega 3 should come from dietary sources with no more than 2000 mg (2 grams) coming from supplements.

Omega-3 is derived from high fat containing fish such as albacore tuna, salmon, flounder, pompano, anchovies, sardines and mackerel. Fish in the equatorial regions around South America have a higher content of Omega 3 than do those caught in the more northern areas around Scandinavia and Iceland. Interestingly flax seed, flax oil and kiwi fruit contain higher amounts of Omega 3 oils than do that of fish. Flax seed can be added to cereal, baked goods or eaten alone. Fish oil capsules are available in 1000 mg and 1200 mg sizes. It is important to not confuse Omega-3 oils with Omega-6 oils. Omega-6 oils do not confer the health benefits that Omega-3 fish oils do. Omega-6 is found in high concentrations in various types of vegetable oils derived from the following: corn, safflower, sesame, soybean, sunflower and walnuts. It is important to reduce the consumption of Omega-6 oils as they compete with Omega-3 oils, thereby decreasing the benefit from Omega-3 fish oils. Eating fish twice a week is the standard recommendation, in addition to taking any supplements.

There have been many studies showing the beneficial effects of Omega-3 oils. The main benefit comes from reduction of hardening of the arteries (atherosclerosis), reduced coronary artery disease, decreased risk of heart attack and potentially fatal heart beat rhythms. Omega-3 oils have also been shown in some studies to have a brain cell protective effect in such conditions as Alzheimer’s and Parkinson’s disease. Fish oils can improve memory to a degree. Several studies have shown that 2000-3000 mg of Omega-3 oil intake daily, has a potent antiinflammatory action as that of high dose ibuprofen. Patients with arthritis or rheumatoid arthritis may benefit from Omega-3, without the risks associated with taking
antiinflammatory drugs for extended periods (such as bleeding stomach ulcers, kidney and liver damage.) It should be noted that the fish oil capsules have a more robust effect for reducing inflammation than that of flax seed oils.

Omega-3 oils can reduce total triglyceride levels and increase “good” cholesterol (HDL) levels. These oils also have an overall beneficial effect on the blood vessels, both in increasing blood flow and improving the health and stability of the vessel walls themselves. This effect is in part responsible for the risk reduction in having a stroke or heart attack as well as patients with problematic varicose veins and leg pains due to peripheral vascular disease. A word of caution: in patients with congestive heart failure, consultation with your cardiologist is first advised. As fish oil has a blood thinning effect, you should check with your doctor if you are taking prescription blood thinners. Additional benefits from Omega-3 fish oils have been shown in improving retinal (visual) function and possibly slowing down macular degeneration. Studies in psychiatric conditions have demonstrated Omega-3 beneficial effects in reducing depression, lessening memory loss and improving memory function.

Stroke occurs when a blood vessel in the brain becomes blocked or ruptures. The most common form of stroke is due to blockage of a blood vessel. Blood vessel blockage is caused by a condition known as
atherosclerosis, commonly known as “hardening of the arteries.” This is the most common type of stroke. Stroke is one of the three major leading causes of death in the United States. The other two are heart attack and cancer. Stroke is the leading cause of disability in the U.S. It is for this reason that it is much wiser to focus on stroke prevention in the first place rather than trying to limit the damage with stroke treatment after event has occurred. High blood pressure (hypertension) is the single biggest, treatable risk factor for stroke. In the 1970s, there was a push by the medical community to aggressively treat high blood pressure to lower the risk of stroke, premature heart disease and kidney failure. One cannot feel that their blood pressure is elevated but the damage to major body organs (heart, brain, kidneys) continues on. It is only when these organs start to fail or a stoke occurs, will it become apparent that a given individual may have hypertension. On occasion, patients with untreated hypertension may have headaches. Fortunately checking one’s own blood pressure is easy. This can be done at your doctor’s office, pharmacies or the local fire department. If you have high blood pressure with the top number greater than 150 or the lower number greater than 85, you need to see a physician for treatment. Fortunately there are many different types of medication to treat high blood pressure. Many patients can be successfully treated with a single drug, for mild hypertension. Individuals with moderate to more severe hypertension, multiple drug therapy may be necessary. With the aggressive push to treat high blood pressure, the rate of stroke in the United States has dropped dramatically over the past two decades. There is a class of blood pressure medication, the ACE inhibitors, that have been shown in well designed clinical studies to significantly reduce the risk of stroke independent of their ability to lower blood pressure. Current evidence based medicine strongly suggests that addition of an ACE inhibitor should be done in patients with high blood pressure, even if their blood pressure is adequately controlled on other agents. Ideal blood pressure range should be with the upper number (systolic) being less than 130 and the lower number (diastolic) less than 80.

It has been well known for several decades that aspirin thins out the blood. Cardiologists have used aspirin extensively for 30 years to lower the risk of having a heart attack. Aspirin slows down the formation of clots by blocking the clumping of platelets to form blood clots. In 1994 a hallmark study, the Antiplatelet Trialists’ Collaboration, was published demonstrating the clear benefit of aspirin in the prevention of stroke and transient ischemic attacks (TIA, “mini strokes”.) In 1998, the FDA approved labeling of aspirin for the prevention of TIA and stroke. Dosage recommendations in the range of 81-325 mg daily should be used. Unfortunately aspirin does not entirely prevent stroke or TIA from occurring. Other blood thinning agents can be used in patients who fail aspirin therapy. The other two agents are Plavix and Aggrenox. Either agent can be used in patients who have had a TIA or stroke while taking aspirin. In patients who have no history of heart disease, Aggrenox is the preferred agent. Plavix is preferred in those patients who have known coronary artery disease.

Lastly, high cholesterol has been implicated in the development of accelerated atherosclerosis. There have been studies that have shown some correlation of high cholesterol with the increased risk of having a stroke. Multiple, double-blind, placebo controlled studies have shown that the use of cholesterol lowering statin drugs for cholesterol reduction results in an average of a 27% overall secondary risk decrease in stroke. Studies are ongoing to show if statins may help in primary prevention of stroke and TIA. At this time, it is prudent to be on a statin drug, for cholesterol reduction. The currently available statins include: Lipitor, Zocor, Pravachol, Crestor or Mevacor if you have a cholesterol over 200. The marked benefit of this class of drugs on the reduction of stroke and cardiac events (35%) is dramatic and strongly supports more aggressive treatment for high cholesterol (hyperlipidemia.) The objective is to have a total cholesterol less than 180, good cholesterol (HDL) of greater than 50 and bad cholesterol (LDL) less than 100. A recent study published in the journal Stroke reported that discontinuing statin therapy in the year after a stroke is associated with a significant increase in the risk for death, even in the absence of heart disease.

Medications are not the only treatment for stroke prevention. Smoking is associated with a 2-3 times greater risk of stroke and bleeding in the brain. Smoking also contributes to the accelerated development of heart disease, emphysema and peripheral artery disease. Chantix is a new medication that received FDA approval to help stop smoking. Exercise is important in maintaining overall body conditioning and weight control. This in turn leads to an overall lowering of blood pressure and cholesterol. In summary, stroke prevention is much easier and cost effective than fixing the problem after someone has a stroke. This approach to stroke reduces mortality and disability for the entire United States population. The cost saving are in the hundreds of billions of dollars over stroke treatment. If you feel that you are at risk for stroke, contact a neurologist for evaluation and treatment.