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.

In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh discusses Platelet Rich Plasma  and Regenerative Medicine.

Regenerative medicine is a new, exciting branch of medicine which deals with healing injured or damaged tissue with the body’s own natural healing mechanism. To do this, Platelet Rich Plasma (PRP) is extracted from the patient’s own blood. Using blood from the patient eliminates the risk of transmission of blood born disease, viruses and other infectious agents. PRP is then injected into the area of the body that needs intensive healing and tissue regeneration.

PRP therapy works especially well for injured tendons and ligaments, and is uniquely suited for those difficult knee and shoulder injuries. Even patients who have had knee or shoulder surgery but still have pain can have dramatic benefit and pain relief from PRP therapy.

PRP is revolutionary therapy in that it avoids surgery. It is done as an outpatient procedure, so there is no recovery time or rehabilitation to deal with. If you have joint pain, you may be an excellent candidate for PRP therapy. Call now to schedule an evaluation to see if you would benefit from PRP therapy.

To schedule an appointment, please call (941) 955-5858 or you may request an appointment 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 pain 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 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.

How To Install a RAID Configuration on Windows XP

Here is a step-by-step guide on how to install a RAID configuration on Windows XP. I would encourage anyone contemplating this to read as many tech forums on this subject as is reasonable.

Read Steps 1-6 BEFORE PROCEEDING:

1. Build your computer with all the components installed including the drives for RAID configuration. If you have a card reader, unplug this from the MOBO port for now. Start the computer and make sure that all fans are running and you can boot into BIOS. If you already have a prebuilt computer, do the same. Sorry, you WILL have to reinstall Windows XP. BACK UP YOUR DATA FIRST. ONCE THE OS IS INSTALLED, YOU CANNOT GO BACK AND INSTALL RAID DRIVES. THE RAID INSTALL MUST OCCUR PRIOR TO AND DURING OS INSTALLATION. You will also need a REGULAR (NO USB) FLOPPY DRIVE hooked into your MOBO. If necessary just scavenge one from an older computer and hook it up temporarily. Vista users can use USB. It would be best to flash your BIOS to the most current stable version.

2. Boot into your BIOS. The go to Main – SATA Configuration and change the setting from IDE to RAID. Hit Enter. Go to Boot Sequence and make sure that the CD/DVD drive is the first boot device. Hit Enter then F10 to Save and Exit. Reboot.

3. At the POST, watch for the RAID Screen, it will only be there for 3 seconds. Hit <CTRL – I> to enter the RAID configuration screen. From there select “Create RAID volume”, name it with no spaces. Select RAID type (0, 1, 5 or 10), Select drives to be included (don’t include your main drive (C:) for RAID 5), Select striping rate (64 or 128) Hit Enter. Create RAID volume. ENTER and exit.

4. On another computer, that has a floppy drive. Go to Intel’s website and search for Intel® Matrix Storage Manager. Find the 32-bit Floppy Configuration Utility and create a RAID driver floppy with this utility.

5. On your new computer, insert Windows XP installation disk. Have the RAID floppy disc ready but do not put in drive yet. Reboot your computer and watch for “Press any key to boot from CD…” Hit the space bar or any key. BE READY TO PRESS F6. Watch the bottom of the screen just as the OS disc loads, you will see the message to press F6 to load third party RAID drivers. PRESS F6 NOW. A different screen will come up. Press ‘S”, put floppy in drive and hit Enter. This will load the RAID drivers for the OS installation. Once completed, hit Enter to continue the installation.

6. You will see the screen to install Windows XP on a drive. Select C: drive and follow the prompts. You will need to format your drive for NTFS, do not use QUICK format. This will take 30-60 minutes. Leave the floppy in the drive. Be there just before the system finishes formatting the drive. The system will then load the SETUP files and will reboot. REMOVE THE FLOPPY BEFORE THE REBOOT and hit Enter. Let the system run and on the new screen DO NOT “Press any key to boot from CD” — just let the system run. It will go into the “Installing Windows” screen. Follow the few prompts and let the system complete the installation and reboot. Finish the remaining prompts and you are set.

NOTE: IF YOU GET A BSOD AT ANY TIME DOING THE ABOVE, TAKE OUT THE OS INSTALLATION DISC AND REBOOT INTO BIOS. BE READY TO HIT <CTRL> I AND ENTER RAID CONFIGURATOR. DELETE THE RAID VOLUME YOU HAD CREATED AND THEN EXIT BACK INTO BIOS. GO INTO THE SATA CONFIGURATION AND CHANGE IT FROM “RAID” BACK TO “IDE”, INSERT WINDOWS DISC BACK INTO DRIVE AND HIT F10. REBOOT AND THEN START AT STEP 4.

ONCE THE SYSTEM FORMATS THE C: DRIVE AND INSTALLS THE SETUP FILES AND REBOOTS, BE READY TO ENTER BIOS BEFORE CONTINUING INSTALL. GO INTO SATA CONFIGURATION AND NOW CHANGE SETTING FROM ‘IDE’ TO ‘RAID’, HIT F10 AND LET THE SYSTEM CONTINUE INSTALLING OS.

IF YOU STILL GET A BSOD, SHUT THE SYSTEM DOWN WITH THE POWER SWITCH AND UNPLUG. WALK AWAY FOR 5 MINUTES. NOW GO BACK AND BOOT UP SYSTEM AND GO INTO THE RAID CONFIGURATION (<CTRL – I>). YOU SHOULD SEE THE C: DRIVE LISTED AS A NON-RAID DRIVE AND THE OTHERS DRIVES AS MEMBERS OF THE RAID VOLUME (FOR RAID 5.) GO TO HARDWARE CONFIGURATION. YOU SHOULD SEE ONLY 2 DRIVES (FOR A RAID 5 CONFIG), THE C: DRIVE AND THE RAID VOLUME. IF SO, JUST HIT F10 AND REBOOT. START AT STEP 5.

7. Once the OS loads, reboot into BIOS and go to Hardware Configuration to verify there are only 2 drives: C: and RAID volume. Boot into RAID configuration screen (<CTRL – I>) and make sure that the C: drive is a ‘Non-member Drive’ and the RAID drives are all Members of the RAID volume. Exit and reboot into Windows.

Now here’s the trick that nobody tells you about. If you open “My Computer” you will see only the C: drive. The RAID drive will not show up. That’s because there is ONE MORE STEP…

8. Right click one My Computer. Select ‘Manage” then ‘Disk Management.’ In the right screen, you will see the C: Drive listed as ‘Healthy.” You will also see you optical drive(s). The RAID drive is an unallocated drive without a drive letter.

9. Right click on the Unallocated drive and assign it a drive letter, usually D: but watch your optical drives. If they are D:, first right click on them and change to E: and F: (if you have 2 drives.) The alternative is to list the RAID volume as F:. Then you will need to format the RAID volume. Use the default NTFS format. Click “OK”. The formatting may take over an hour depending on your setup. Once completed you will see the RAID volume with the letter you assigned to it and it will be listed as “Healthy”.

10. Go to “My Computer” and now you will see your RAID drive with the letter you assigned to it.

Congratulations, you have successfully installed a RAID drive. Install MOBO setup drivers and graphic card driver. Run Windows Update and get all critical updates. MAKE A BACKUP IMAGE of the C: drive. Keep this image FOR AS LONG AS YOU HAVE YOUR COMPUTER. If anything gets corrupted, you can go back and reimage the drive, saving you hours of time starting from scratch.

Parkinson’s disease is the second most common neurodegenerative disorder, just behind Alzheimer’s disease. Parkinson’s disease is characterized by specific clinical symptoms including rigidity (stiffness), slowness of movement, unsteadiness (gait imbalance) and tremor. For the accurate diagnosis of Parkinson’s disease to be made, a patient needs to have 3 of the 4 major symptoms of the disorder. Each patient with Parkinson’s disease is different and may have differing degrees of each component of Parkinsonism. Not all patients with Parkinson’s disease have tremor. Some may have more instability of gait, shuffling or slowness of movement. There are several medications available that neurologists can use to treat Parkinson patients to alleviate their Parkinson symptoms and improve their overall quality of life. Unfortunately, there is a down side to this treatment. Patients who have been on Sinemet for a few years tend to develop motor fluctuations. Motor fluctuations include end-of-dose wearing off, where their functional abilities deteriorate before the next dose of medication is due. Other motor fluctuations include freezing and off time.
Parkinson freezing is simply when a patient becomes “stuck” meaning they cannot move. This occurs more frequently when going through doorways, stepping up onto a curb or stair or when getting up to start walking. Freezing can also occur first thing in the morning, just when getting up out of bed. Freezing episodes can last for a second up to a few minutes. It is the goal of every Parkinson’s disease neurologist to minimize a patient’s amount of freezing, through various medications and dosing schedule changes. Off time can occur in two settings: one is predictable, usually at the end of the dosing interval but the other occurs randomly, without warning. These sudden off time events are more problematic as they tend not to respond as well to medication changes. Off time is troublesome for the patient and caregiver. Affected patients become virtually immobile, essentially frozen in place. There are different degrees of off time, but in all cases, the patient’s mobility and ability to function are severely impaired. Off time may last minutes to hours. For those patients with short duration off time, additional medication or shorter dosing intervals usually will help. Off time may also occur first thing in the morning when waking up. Even if Parkinson patients take their medications, it may be an hour or more before they are functioning normally. For patients with prolonged off times, usually greater than 45 minutes, there is treatment.
Apokyn (apomorphine) is a self administered injectable medication that rapidly relieves off time. Its duration of action is generally less than 2 hours. This is an ideal medication for patients with one or multiple daily freezing episodes. For those affected patients, Apokyn can literally give them their lives back, particularly when more waking hours are spent in the “off time” than in “on time.” For a patient or caregiver to administer Apokyn, some training is required. This is covered by the drug manufacturer and by Medicare. Side effects can include a drop in blood pressure, lightheadedness, nausea or vomiting. When initially starting a patient on Apokyn, medication to prevent nausea is given first. After being on the Apokyn for a few weeks, patients frequently can stop the antinausea medication.
If you are a patient or caregiver and feel that Apokyn may be of benefit, contact your neurologist or Parkinson disease specialist for more information. An excellent information package, with DVD, is available at no cost. The first step is to make the call to improve your quality of life.  For more information, visit the website for Dr. Kassicieh at: www.DrKassicieh.com.

Living in Florida is difficult for individual who have migraines and other types of headaches. This is because drops in the barometric pressure can trigger a migraine attack. During the hurricane season in Florida, there are many tropical storms, thundershowers and rarely a hurricane (or hurricanes.) There can just be low pressure weather systems sitting over Florida with no actual “bad” weather. It is not so much the rain that triggers the migraine attack as it is the lower barometric pressure. During the recent string of six different tropical storm and hurricane fronts that lasted six weeks, many patients who normal have perfectly good control of their migraines had their worst attacks ever.

It has been studied extensively as to why changes in barometric pressure, temperature and humidity have such a profound triggering effect on migraine but no definite conclusion has been reached. The effects on the outdoor environment by these weather systems, in Florida, have a profound effect on headache suffers. Not only does the change in weather trigger headache attacks but so does the increase in pollen, mold and fungus spores.

Patients will often claim that they have “sinus headaches.” True sinus headaches belong in the same category as chances of winning the lottery: 1 in 14 million. Why? Because true sinus headaches are rare. What patients are actually feeling is a milder form of their migraine headache, triggered by weather, pollen and molds. Migraine headache symptoms include: nasal congestion, sinus pressure, sensitivity to light and nasal drainage. While these are sinus symptoms, they are part of the migraine syndrome, which is a collection of symptoms associated with migraine. Patients frequently will take sinus medications that will help or stop their headache. This, unfortunately, reinforces the mistaken belief that they are suffering from “sinus headaches.” The fact is, is that sinus medications have a similar effect in relieving headaches as do those of the more specific migraine drugs.

In conclusion, more Florida patients suffer from more headache and migraine attacks during hurricane season (June 1 – November 30) than at other times of the year. About fifty percent of migraine suffers find that changes in weather will trigger their headaches. The best thing to do, if you suffer from migraines or recurrent headaches, is to seek out a neurologist headache specialist and get started on preventative headache treatment as well as migraine treatment specific medication to stop an attack. If you do suffer from allergies, there are many medications to help control this as well.

Occipital neuralgia is a commonly missed headache diagnosis. The symptoms for headaches can be quite different. Occipital neuralgia can mimic migraine headaches but do not respond to standard migraine medications. Occipital neuralgia rarely occurs as a headache syndrome by itself. The majority of patients with occipital neuralgia have one or more other types of headache including: migraines, tension headache, rebound headache and cluster headaches. Occipital neuralgia is frequently misdiagnosed as migraine or cluster headaches. Patients with prominent face pain as part of their occipital neuralgia may be incorrectly diagnosed with tic delaroux (trigeminal neuralgia.)

Occipital neuralgia is caused by an irritation of the occipital nerve as is comes through the muscles in the back of the neck. The occipital nerve is formed from branches of the second and third cervical nerve roots. This nerve passes posteriorly up the back of the head, piercing through the muscles of the upper neck. The occipital nerve then curves over the back of the head to the frontal area, stopping at approximately the hair line. This nerve provides pain and sensory information over the back 2/3 of the head. When the nerve becomes irritated from various causes such as strained or tense neck muscles, whiplash injury, neck arthritis or even just sleeping wrong – getting a kink in your neck.

The headache symptoms of occipital neuralgia include upper neck pain, pain at the base of the skull, which may be on one or both sides, and pain traveling up the back up the head as far forward as the forehead. Some patients experience pain behind the eyes or even facial pain. The pain is commonly made worse by laying on your back. The back of the head or scalp can be sore to touch. The head pain can be anywhere from a nagging aching pain to an excruciating migraine headache type of pain, which can be debilitating. The latter type of occipital neuralgia pain is frequently missed and instead treated as a migraine. Most migraine therapies do not work to relieve occipital neuralgia.

Diagnosis of occipital neuralgia is made by careful neurological examination of the patient. Most individuals have normal exams except for exquisite tenderness at the base of the skull, in the area of the occipital nerve. If pressing on this area reproduces the occipital head pain, the diagnosis is made. Treatments can include the use of anti-inflammatory agents such as aspirin, Tylenol, naproxen (Aleve) or ibuprofen (Advil, Motrin.) Ice to the back of the neck and head can provide temporary relief. One of the most effective therapies, which can be curative for occipital neuralgia, is an occipital nerve block. This is a very safe procedure and consists of injecting a mixture of a local anesthetic with a long acting cortisone. This injection is put in the neck muscles just below the skull base, in the area where the occipital nerve pierces through the muscled. The needle is directed away from the spinal cord and is outside the skull so there is no chance of injury to the spinal cord or brain. The anesthetic works immediately and may cause some temporary scalp numbness. The cortisone is long acting – slow release so that it may take a week to be fully effective. Success rates of up to 80% have been reported. In patients with additional types of headaches, it is not uncommon to add an antidepressant to prevent migraines and other similar headaches. The antidepressants are the mainstay therapy in headache treatment and prevention and have nothing to do with their use for treatment of depression. If you think you have occipital neuralgia or have persistent headaches, particularly ones that are always on one side, you should seek out care from a neurologist who is also a headache specialist.