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.
Posted in Podcast and tagged blood, Dr. Kassicieh, healing, ligament, platelet, Platelet Rich Plasma, PRP, regenerative medicine, Sarasota, Sarasota Neurology, Surgery, tendon by Dan Kassicieh, D.O.
In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized Parkinson’s disease expert, provides an overview of the disease and current techniques for managing it.
Parkinson’s disease is the second most common neurodegenerative disease seen in the United States. Only Alzheimer’s disease is more common. They both share the common fact that they are progressive neurological diseases that result in patients losing functional ability. Alzheimer’s disease affects memory, the ability to remember how to do things and general loss of mental function. Alzheimer’s patients are mostly not aware of the fact that they are neurologically deteriorating. They will make excuses for their memory short comings. Like Parkinson’s disease it is important to recognize Alzheimer’s early so that treatment can be started and outcomes will be improved.
Parkinson’s disease is primarily a progressive loss of the ability to move normally. There is a gradual slowing of movements as well as doing routine tasks such as shaving, dressing and getting ready to go out. Walking is affected and patients tend to shuffle with a forward stoop. Although tremor is common in Parkinson’s patients, not all have this. The converse is true: not everyone with tremor has Parkinson’s disease. There are many treatment available for Parkinson patients to improve their quality of life.
Not everything that shakes is Parkinson’s. If you are concerned that you or someone you love may be suffering from this or another movement disorder, 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 movement disorder specialist in your area.
Posted in Parkinson's disease, Podcast and tagged Alzheimer's, Alzheimer's disease, Dr. Kassicieh, memory, movement disorder, neurodegenerative, neurology, Parkinson, Quality of Life, Sarasota, Sarasota Neurology, tremor by Dan Kassicieh, D.O.
Huntington’s disease is a neurodegenerative disease that is a genetic, progressive neurological disorder that slowly takes away a persons ability to walk, talk, and reason. It is characterized by the initial subtle symptoms of change in personality and motor skills ability. As the condition progresses, patients develop involuntary movements known as chorea (hence Huntington’s Chorea.) The word chorea comes from the Greek word choreia, which means “to dance”, which describes the uncoordinated, jerky body movements associated with the condition. Other motor symptoms eventually appear and may include difficulty speaking, walking or writing. It was reported in detail in 1872 by the American physician, George Huntington (1850-1916).
Symptoms of Huntington’s disease usually appear between the ages of 35-44 years old. Affected individuals can show a general lack of coordination and an unsteady gait. Other symptoms include depression, mood swings, forgetfulness, clumsiness, and involuntary twitching. As the disease progresses, concentration and short-term memory decrease and involuntary movements of the head, trunk and limbs increase. Huntington’s dementia eventually occurs. Patients will have memory loss associated with difficulty in abstract thinking, planning and avoiding inappropriate behavior.
In 1993, scientists discovered the gene that causes Huntington’s disease. HD is a genetic mutation stemming from the formation a chain of abnormal DNA sequences. There are four building blocks of DNA. Repeating DNA chains of cytosine-adenine-guanine (CAG) code for the protein glutamine, an amino acid. As a result, these long glutamine chain proteins clump together and are toxic to brain cells (neurons.) The more CAG repeat sequences there are, the more severe the symptoms of HD. Scientists have also discovered the more severely the gene is mutated, the earlier the onset of the disease.
There is no known cure for Huntington’s disease at this time . There are, however, treatments which can be employed to reduce the severity of some symptoms. Tetrabenazine was developed specifically to reduce the severity of chorea in HD. Other drugs that help to reduce chorea include Haldol, Risperdal and other neuroleptic medications. Valium like drugs known as benzodiazepines may also be helpful. Rigidity can be treated with antiparkinsonian drugs, and myoclonic hyperkinesia can be treated with valproic acid. Depression is common in HD and can be managed with medications in the serotonin reuptake inhibitor family, such as Prozac or citolopram.
Huntington’s Disease profoundly affects not only the patient, but the entire family — physically, emotionally, socially and economically. Since there is no known cure and the prognosis is poor, a plan of action should be developed jointly with a qualified neurologist who specializes in movement disorders so that the patient’s quality of life can be maintained as long as possible. Your neurologist can also help you locate and connect to some of the many support groups, organizations, and resources available to help with both the patient and the family and caregiver(s).
Innovative research is underway and aims to find better treatment options and ultimately hope and a cure for this debilitating condition. If you suspect that you or someone you love may be suffering from Huntington’s Chorea, contact Sarasota Neurology for an appointment.
Posted in Memory Loss / Alzheimer's Disease / Dementia, Movement Disorders and tagged brain, dementia, depression, drug, drugs, gait, memory, movement disorder, Movement Disorders, nerve, neurologist, neurology, Quality of Life, Sarasota, Sarasota Neurology by Dan Kassicieh, D.O.
Patients are being treated currently at Sarasota Neurology with PRP (platelet rich plasma) for a wide variety of joint pain and other pain issues. Among the more common uses for PRP are knee pain, shoulder pain and other painful conditions such as plantar fasciitis, tennis elbow, some types of low back pain. PRP can also be used in patients that have residual joint pain from having had orthopedic arthroscopic knee or shoulder surgery.
PRP works to heal painful joints by using the patients’ own natural biological healing mechanism. The injured or damaged tissue in the joints, ligament and tendons or muscle send out chemical signals that there is injury or incomplete healing. PRP has receptors on the active platelets that seek out these damaged tissues. The PRP graft then biologically and molecularly attach to the damage tissue and trigger the natural healing process of making new collagen. This process takes six weeks to have a full effect although actual healing can continue for up to three months.
PRP may be used in some patients as an alternative to having surgery on their knees, rotator cuffs or in cases of plantar fasciitis (foot pain). Beginning in early 2011, Sarasota Neurology will be offering a new and innovative uses for PRP. This highly effective treatment is ideal for patients who would prefer to avoid the cost, pain and time involved in having surgery for the same problem. Check back with us in February to get more details of this exciting treatment with PRP in Sarasota.
Posted in Back Pain, Pain, Platelet Rich Plasma and tagged collagen, foot pain, healing, joint pain, knee pain, ligament, low back pain, natural, neurology, orthopedic, Pain, plantar fasciitis, platelet, Platelet Rich Plasma, platelets, PRP, PRP in Sarasota, rotator cuff, Sarasota, Sarasota Neurology, Sarasota PRP, shoulder pain, Surgery, tennis elbow by Dan Kassicieh, D.O.
Migraine headaches are a common medical condition in the United States, affecting approximately 12% of the entire population. It is estimated that there are 35-45 million migraine and headaches sufferers in the U.S. An unfortunate fact is that only 50% of all headache and migraine patients are medically treated. Individuals with different types of headaches (or migraines) are either undiagnosed or undertreated. In the 21st century, it is not necessary to suffer needlessly from migraine headache – the number one medical cause of temporary, total disability in the United States.
A new migraine medication has been approved by the FDA for use in treatment of acute migraine attacks. This new medication is called Sumavel DosePro. Sumavel is an injectable form of the well known migraine medication: sumatriptan. Sumatriptan was first released in United States in 1992 as Imitrex injectable and subsequently the tablet form. Imitrex injectable system uses a small needle to administer the medication, sumatriptan. While this was one of the most effective treatments for acute migraine attacks, it did involve a minor needle stick. For patients who did not tolerate the thought of a needle stick, even this excellent therapy was not an option for them. Sumavel overcomes this problem by the use of a unique, needle-free injector system. Sumavel uses pressurized air to administer the medication. This is demonstrated in this video.
Sumavel comes in a self-contained injector kit. There is no need for alcohol swabs or drawing up sumatriptan into a syringe. With Sumavel a migraine patient, experiencing an acute migraine attack, needs only to snap of the safety cap, flip the small injector lever and press the injector firmly against the skin on the lower, outer abdomen or thigh. Pressurized nitrogen (a neutral gas) causes the sumatriptan change into an aerosol form and this is literally pushed through the skin into the subcutaneous tissue. This delivers a full dose of sumatriptan (6 mg) into the patient. Therapeutic effect and migraine relief can occur in as few as ten minutes. When the injector releases the pressurized air, you will hear and feel a pop noise. There is a slight stinging sensation when the medication is pushed across the skin, but there is no needle involved. The used injector can then be disposed of in any trash receptacle. As there is no needle, special disposal is not necessary. Most insurances cover this new, novel migraine therapy.
Migraine headaches remain a major health problem in the United States. Migraines are a leading cause of missed school and work. For migraine sufferers who have too many headache attacks, this can lead to the risk of losing their job. This is unnecessary as many excellent and effective migraine control therapies are available. If you suffer from migraines, cluster headaches or any type of headache, do yourself a favor – call Sarasota Neurology for an appointment. As a migraine specialist, Dr. Kassicieh can help to improve your quality of life, control your migraines and give you your life back.
Posted in Migraines / Headache and tagged Cluster headaches, Dr. Kassicieh, headache, headaches, Imitrex, migraine, migraine specialist, migraine treatment, Quality of Life, Sarasota, Sarasota Neurology, sumatriptan by Dan Kassicieh, D.O.
Carpal tunnel syndrome is the most common “pinched nerve” condition that neurologists see. It is a form of compression neuropathy The typical patient comes in with complaints of hand or arm pain associated with one or more numb fingers. There is usually sparing of the little finger. This painful numbness will frequently wake affected patients from their sleep. They will complain of a swollen feeling in their hand (or both hands) associated with painful numbness affecting all but the little finger.
Carpal tunnel syndrome is caused by compression of the median nerve (the “carpal tunnel nerve”) as it pass under the carpal tunnel ligament. The carpal tunnel is located at the wrist. There is a small band of tissue across this to hold down the median nerve and vein. When the carpal tunnel becomes too narrowed, the median nerve becomes “pinched” and the vein is compressed. This combination of events results in the hand becoming numb and swollen. Carpal tunnel symptoms frequently occur only at night, during sleep. This is because we all have a tendency to sleep with our wrists slightly flexed. This position further narrows the carpal tunnel, causing symptoms. As the carpal tunnel narrows further, with time, patients will develop daytime hand numbness. Holding a newspaper, magazine or steering wheel can bring on symptoms. In more severe cases hand grip weakness can occur. Patients find that they have difficulty removing jar lids or may drop objects. Carpal tunnel syndrome occurs in both hand about 50% of the time.
CTS is diagnosed, most commonly by a neurologist, on the basis of the patient’s symptoms and detailed neurological exam. Electrical diagnostic testing, nerve conduction studies (NCV), are necessary to confirm carpal tunnel syndrome – particularly if surgery is being considered. Many patients can have carpal tunnel symptoms and have normal NCV studies. These patients are not candidates for surgery. The standard of care medical treatment for CTS is wearing a cock-up wrist brace. These braces prevent wrist flexion, thereby reducing the pressure on the median nerve. Frequently patients can “cure” their CTS with wearing a brace. For more severe symptoms with abnormal NCV studies, surgical decompression may be indicated. This is a procedure done under local anesthesia. A small incision is made at the wrist and the carpal ligament is cut. This relieves the pressure on the median nerve. Success rate for this surgery is approximately 90%.
If you feel that you have carpal tunnel syndrome, you should see a neurologist and have diagnostic studies performed. Most patients will do well with conservative, non-surgical treatment. For more detailed information click here.
Posted in Nerve Diseases, Nerve Pain, Neuropathy and tagged braces, Carpal Tunnel, Carpal Tunnel Syndrome, compression neuropathy, hand, hands, nerve, neurologist, neurology, Neuropathy, numb, Pain, pinched nerve, Sarasota, Sarasota Neurology, sleep, Surgery by Dan Kassicieh, D.O.
How many times have you had an appointment in your doctor’s office, gotten there on time and then had to wait 30 minutes, an hour or even more? We all have. It is one of the frustrating aspects of visiting your doctor’s office. Dr. Kassicieh, at Sarasota Neurology, understands that. He respects patients’ time and makes every effort to see patients at their scheduled appointment time. Dr. Kassicieh does not want his patients waiting for more than a few minutes after they check in, to be seen. He values their time as much as they do and understands his patients have other commitments and time constraints.
Dr. Kassicieh and his staff strive to make sure that his patients are seen in time, tests scheduled and they can leave within a reasonable amount of time. The availability of his website, www.DrKassicieh.com, patients can read about Dr. Kassicieh’s background and learn about the neurological problems he treats. These include neurological problems such as migraine headaches, neck and back pain, Parkinson’s disease, Botox medical therapy and many others. New patients have the availability to download all the required forms, allowing them the freedom to complete these accurately in the comfort of their own home. This saves a tremendous time for the patient in filling out paperwork in the office.
Once the patient comes into Sarasota Neurology, they are pleasantly greeted by our front office manager. Insurance is verified and the patient is brought back for their appointment in a very short time. With the state of the art electronic medical record keeping, Dr. Kassicieh is able to provide better, more efficient care to his patients. Consultations, lab and x-ray as well as other tests and referrals are generated electronically. Once your visit is completed, the completed office visit is immediately faxed to your primary care physician and any consulting physicians you request. Your prescriptions are already printed and waiting for you at check out.
In summary, we here at Sarasota Neurology strive to make the patient comfortable and have a pleasurable experience. You are provided with timely, state-of-the-art medical and neurological care – based on evidence based medicine. We look forward to seeing our patients and treat them with the respect they deserve. Thank you for visiting our blog site and would invite you to visit Dr. Kassicieh’s website for more information.
Posted in Welcome and tagged Back Pain, Botox, Dr. Kassicieh, headaches, migraine, Pain, Parkinon's disease, Sarasota, Sarasota Neurology, website by Dan Kassicieh, D.O.
Shingles is a condition characterized by a painful, blistering skin rash. This rash can affect any part of the body. The medical name for shingles is Herpes Zoster. It is the caused by the same virus that causes chicken pox. People who have had chicken pox are potentially at risk for developing shingles later in their life. Patients who have never had chicken pox can get this from individuals who have an active attack of shingles, as the rash is contagious. Shingles can appear anywhere on the body but tend to follow the distribution of the nerves, as this is where the virus lives. Although severe in any part of the body, facial involvement around the eye presents an even greater problem. If shingles involves the upper face, the eye can be affected, potentially leading to eye complications including infection and corneal ulceration. The treatment of an acute attack of shingles involves giving a patient one of the specific antiviral agents such as Zovirax (acyclovir), Famvir (famcilovir) or Valtrex (valacyclovir) along with Prednisone to shorten the duration of the attack and to lessen potential for development of postherpetic neuralgia. Postherpetic neuralgia develops in about 20% of patients who have had shingles. Shingles is much more common in individuals over the age of 50. Approximately 1 million people in the United States get shingles every year.
The FDA has recently approved a shingles vaccine, Zostavax, to aid in the prevention of this condition. This is an injectable medication that requires only one treatment. The Center for Disease Control has recommended that all eligible patients over the age of 60 be immunized. The requirements for receiving the vaccine are as follows: you are in good health and must not have any condition that would lower your immune system function. Conditions that lower your immune system include diabetes, cancer, chemotherapy or steroid therapy, active tuberculosis, excessive alcohol consumption or acute illnesses such as pneumonia. The best available treatment to prevent shingles is this vaccine.
Postherpetic neuralgia (PHN) is an extremely painful condition that follows after having an attack of shingles. Although the rash and blisters clear, affected patients are left with a searing, burning painful sensation on the skin, in the area of the rash. This is a form of peripheral neuropathy. Their skin can be so sensitive that even clothing or bed sheets brushing up against the skin can trigger severe pain. Unfortunately, narcotic pain killers do not help in reducing this pain. Alternate treatment with nonnarcotic medications is necessary. Commonly used medications for treatment of PHN include the anticonvulsants such as Tegretol, Lyrica, Neurontin, Trileptal and Topamax. Other agents that are helpful are the tricyclic compounds such as amitriptyline, imipramine and nortryptiline. A novel approach to treatment involves using Lidoderm patches. These are lidocaine embedded patches that control the pain without having to take an oral medication. These can be used in combination with oral medications to better control the pain of PHN. Most patients will have clearing of their PHN within 1-6 months. Rarely it can persist for a longer period of time. For patients who have received the shingles vaccine, who subsequently develop shingles, the incidence of developing PHN is significantly reduced and the severity of the symptoms are generally less. Please contact Sarasota Neurology for more information.
Posted in Nerve Diseases, Nerve Pain, Neuropathy and tagged acyclovir, amitriptyline, Center for Disease Control, famciclovir, Famvir, FDA approval, herpes zoster, immune system, Lidoderm, Lyrica, neuralgia, Neurontin, Neuropathy, Peripheral Neuropathy, PHN, Postherpetic Neuralgia, Postherpetic Neuropathy, Prednisone, Sarasota, shingles, Shingles vaccine, Tegretol, Topamax, Trileptal, valacyclovir, Valtrex, Zostavax, Zovirax by Dan Kassicieh, D.O.
Kevin Pho, M.D. is a general medical physician who writes an interesting blog. His blog contains a wide variety of information on various medical topics and news interest stories. I put his blog site link on Sarasota Neurology because I feel that it adds a different twist, covering many subjects and topics that I could never hope to keep up with. Dr. Pho is obviously quite committed to maintaining his blog site, trying to post several times a day. Hope that you enjoy Kevin M.D. blog. For more information on neurology and what a neurologist does, please visit www.DrKassicieh.com.
Posted in General Medicine and tagged neurologist, Sarasota by Dan Kassicieh, D.O.
Welcome to Sarasota Neurology’s new web blog site. This site is dedicated to helping patient’s get up-to-date information on different neurological conditions. I am a board certified neurologist, practicing in Sarasota Florida. I specialize in treating migraine and other head, neck and face pain disorders as well as most movement disorders. These include Parkinson’s disease, dystonia, tremor, blepharospasm, hemifacial spasm, limb dystonia and spasticity and restless legs syndrome. As part of the Florida Headache & Movement Disorder Center, we also treat patients with various disorders of sleep such as narcolepsy, cataplexy, nocturnal leg cramps and other conditions that cause patients to move or twitch while they are sleeping. Of course, other important neurological problems will be discussed. I will post the latest reliable information for you to review. You will notice that almost all of the conditions discussed involve seeing a neurologist. If you are in the Sarasota treatment area, we would be happy to schedule you for a consultation. Occasionally, I may put other items of interest on this site. Suggestions are always welcome but I would ask that you fax them to my office in Sarasota. Please visit my main website at: DrKassicieh.com
Welcome to Sarasota Neurology blog site.
Posted in Welcome and tagged blepharospasm, dystonia, face pain, headache, hemifacial spasm, leg cramps, limb dystonia, migraine, movement disorder, Movement Disorders, neurologist, Parkinson, Parkinson's disease, Restless Legs Syndrome, Sarasota, spasticity by Dan Kassicieh, D.O.