Healing Services

• Diseases we treat
  Neurology
  Pain Management Disorders

• Pathways in Recovery of Function
• Management of Chronic Pain

NEUROLOGY

• Parkinson's Disease
• Multiple Sclerosis
• Neuropathy
• Herniated discs
• Radiculopathy
• Migraines, cluster headaches, temporal arteritis
• Carpal tunnel syndrome
• Sleep disorders, obstructive sleep apnea, excessive daytime sleepiness, narcolepsy
• Seizures, epilepsy, complex epilepsy
• ADD, ADHD, failure to thrive, childhood developmental syndromes
• Hereditary neuropathy
• Brain tumor
• Aneurysms
• AVM
• Agenesis of the copus callosum
• Cysts and Arnold Chiarii Malformations

PAIN MANAGEMENT DISORDERS

• Fibromyalgia
• Chronic pain disorders
• RSD Reflex sympathetic dystrophy, chronic regional pain syndrome, phantom limb pain
• Neck and low back spasms
• Painful diabetic and alcoholic neuropathy
• Cancer pain
• Non-surgical back pain, post laminectomy pain, post laminectomy fusion pain, Arachnoiditis
• Pelvic floor syndrome's
• Carpal tunnel syndrome
• Ulnar entrapment neuropathy
• Brachial Plexopathy

PATHWAYS IN RECOVERY OF FUNCTION

Our Management Tree:

1. Initial encounter: This includes history, family history, previous medical experience with other physicians and specialists, hospital stay, x-ray, MRI and CT reviews, taking a genetic history and occupational history with exposure to toxic chemicals, smoking history, drugs and alcohol, toxic chemicals, work and repetitive stress injury and previous surgery as well as diet.

2. Physician Encounter: Specific questions, directed questions about symptoms, specific issues, drug and prescription history and previous attempts at management and failure.

3. Physical examination: The general exam including vital signs, cardiac, chest, mental status, neurological, psychiatric, psychological and neuromuscular exam.

4. Review of x-rays and films: CTs, x-rays, MRIs, blood work, genetic testing and electrodiagnostic studies.

5. Making the presumptive clinical diagnosis: This is a clinical impression based on the above data with a differential diagnosis presented to our patient’s.

6. Further studies requested: These are oft usually to confirm the clinical impression not to go on a fishing expedition looking for diseases. Any studies done are only there to confirm or disprove our clinical impression and will alter the management of the problem. This includes EMGs, EEGs, MRIs, blood work, spinal fluid analysis and other specialty consultations, nerve and muscle and skin biopsy.

7. Treatment strategies: Outlined and presented to the patient.

8. Initial treatment plan to include therapy, whether physical, occupational, myofascial or alternative care, medication, injections, counseling, diet, psychological issues, other specialty consultations and surgical options.

9. The review of the response to initial therapy following a week or two of the initial treatment plan. Modification of the plan based on initial response and further studies if no response to initial plan.

10. Main treatment strategies implementation.

MANAGEMENT OF CHRONIC PAIN THE DECISION TREE

1. Intake evaluation including history, examination of patient, review of prior intervention, surgery and medicines review.

2. Diagnostic studies if needed including EMGs, EEGs, x-rays, MRIs, CTs, spinal fluid analysis, blood and urine analysis and biopsies.

3. Initial treatment plan.
   1. Therapy: Myofascial release, massage, modalities, casting, splinting and TENS unit.
   2. Counseling: Psychological, diet, spiritual, recovery groups, smoking and alcohol cessation plans.
   3. Medication: Issues regarding narcotics and the management of narcotics, non- narcotic approaches.
   4. Injections: Trigger points, nerve blocks, Botox, steroids, epidurals, sympathetic blocks, stellate ganglion blocks, sacral nerve blocks, peripheral nerve blocks, joint injections.
   5. Surgical options and referrals if all the above have failed.

4. Review of treatment plan and implantation.

5. Review and modification of treatment bi-weekly.