September 19, 2019

Headaches and Cutting Edge Therapies | On Call with the Prairie Doc | September 20, 2018


>>THEY CAN INTERFERE WITH
WORK, PLAY AND RELATIONSHIPS. HEADACHES AND CUTTING-EDGE
THERAPIES TO HELP CURE THEM
TONIGHT “ON CALL WITH THE
PRAIRIE DOC.”>>MAJOR FUNDING FOR “ON CALL
WITH THE PRAIRIE DOC” HAS BEEN
PROVIDED BY:>>AVERA IS A PROUD SPONSOR OF
“ON CALL” ON SOUTH DAKOTA
PUBLIC BROADCASTING.>>LARSON MANUFACTURING IS
PROUD TO SUPPORT “ON CALL
TELEVISION” AS IT CONTINUES TO OPEN DOORS FOR IMPORTANT
MEDICAL INFORMATION.>>AND BY THE SOUTH DAKOTA
FOUNDATION FOR MEDICAL CARE, THE MEDICARE QUALITY
IMPROVEMENT ORGANIZATION FOR
SOUTH DAKOTA. AND WITH THE ONGOING SUPPORT OF
THESE INDIVIDUALS AND
INSTITUTIONS… >>GOOD EVENING AND WELCOME TO
“ON CALL WITH THE PRAIRIE DOC.” ALL HEADACHES, LARGE AND SMALL,
IMPACT OUR QUALITY OF LIFE. IF WE’RE LUCKY, A LITTLE
IBUPROFEN OR SOME TYLENOL WILL
BE ALL ONE NEEDS. IF IT REQUIRES SOMETHING MORE
OR IF YOU GET THEM TOO OFTEN, THEN IT IS TIME TO SEEK SPECIAL
CARE. MORE ABOUT THAT TONIGHT.>>>FIRST, LET’S TAKE A LOOK AT
THIS WEEK’S PRAIRIE DOC QUIZ
QUESTION. IT’S A CHALLENGING ONE THIS
TIME. IT IS MULTIPLE CHOICE THIS
WEEK. CHOOSE ONLY ONE. IMAGING, C.T., ON THE HEAD MAY
BE RECOMMENDED IF A HEADACHE IS: A) SUDDEN AND SEVERE. B) FOLLOWS A FALL OF BLOW TO
THE HEAD. C) CAUSES EYE DISCOMFORT. D) A & B. E) A, B, AND C. VIEWERS WHO CALL IN THE CORRECT
ANSWER WILL BE ENTERED INTO A
DRAWING TO WIN A SIGNED COPY OF OUR BOOK, “THE PICTURE
OF HEALTH.” EACH OF MY ESSAYS, ORIGINALLY
WRITTEN FOR THIS SHOW, COMES
WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH
PETERSON. WE WILL ANNOUNCE THE ANSWER AND
THE WINNER AT THE END OF THE
SHOW. REMEMBER, YOU ONLY HAVE 10
MINUTES TO GET YOUR ANSWER IN!>>>WE ANSWER YOUR QUESTIONS
ABOUT HEADACHES AS THEY ARE
CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL. CALL IN QUESTIONS TO
1-888-376-6225 OR SEND US AN EMAIL TO THE ADDRESS ON THE
SCREEN. JOINING US TONIGHT IS DR. CAROL
NELSON OF AVERA MEDICAL GROUP
NEUROLOGY SIOUX FALLS IN SIOUX FALLS, SOUTH
DAKOTA. THANK YOU FOR JOINING
US, CAROL.>>HI. IT’S NICE TO BE HERE.>>IT’S INTERESTING, I THINK I
LEARNED THIS BEFORE, BUT I LEARNED TONIGHT WHEN WE WERE
TALKING TO THE PREPROFESSIONAL KIDS THAT HELP US THAT YOUR DAD
WAS A DOCTOR. TELL ME A LITTLE BIT ABOUT YOUR
DAD.>>SO MY DAD GREW UP IN THE
SMALL TOWN OF VIBORG, HE WAS ACTUALLY BORN IN MY
GRANDPARENTS’ HOUSE.>>HE GREW UP THERE?>>HE GREW
UP THERE, GRADUATED HIGH SCHOOL
THERE. HE WENT TO USD, THAT WAS IN THE
DAYS OF THE SCHOOL OF MEDICINE, YOU COULD ONLY GO FOR
TWO YEARS.>>WHICH WAS MY EXPERIENCE,
TOO, BY THE WAY.>>HE
TRANSFERRED TO?>>HE WENT TO NORTHWEST
UNIVERSITY IN CHICAGO AND
GRADUATED TOP OF HIS CLASS. AND HE FINISHED WITH MEDICAL
SCHOOL, DID A YEAR OF
RESIDENCY, INTERNSHIP TRAINING, AND THEN HE MOVED TO
LAKE ANDY’S FOR, I THINK, FOUR OR FIVE YEARS AND THEN BACK TO
VIBORG. AND THEN SPENT MOST OF HIS
YEARS IN VIBORG. HE ACTUALLY PRACTICED
CONSECUTIVELY IN SOUTH DAKOTA
FOR 51 YEARS.>>AND HE WAS PRACTICING WHEN
HE DIED?>>RIGHT. AND HE PASSED AWAY AT THE AGE
OF 76 AND WAS STILL PRACTICING.>>RIGHT UP TO THAT WEEK.>>
YUP. RIGHT UP TO WALKING IN TO
THE HOSPITAL, RIGHT.>>HE WALKED INTO THE HOSPITAL
WITH A BRAIN –>>WITH A BRAIN
TUMOR.>>WITH A MALIGNANT BRAIN TUMOR. DID THAT HAVE ANYTHING TO DO
WITH YOU CHOOSING TO GO INTO
NEUROLOGY?>>YOU KNOW, MY DAD WAS A HUGE
INFLUENCE ON ME AS FAR AS GOING
INTO MEDICINE. I REMEMBER WANTING TO BE A
DOCTOR SINCE I WAS — SINCE I
CAN REMEMBER, ACTUALLY. BUT I’M SURE I WAS JUST
MIMICKING, YOU KNOW, WHAT MY
DAD DID.>>MOST KIDS DO.>>YEAH. BUT I
WAS ALWAYS THAT KID THAT WAS IN THERE IF THERE WAS BLOOD
OR, YOU KNOW, SOME, YOU KNOW, –>>I WAS THE ONE THAT WAS RIGHT
THERE AND MY SISTER WAS THE ONE
PASSING OUT. SO HE WAS A HUGE INFLUENCE ON
ME DECIDING TO GO INTO MEDICINE.>>SO YOU WERE A VIBORG HIGH
SCHOOL –>>VIBORG VIKING.>>A VIKING, YEAH. PLAYED THE
FLUTE.>>I PLAYED THE FLUTE KIND OF,
NOT VERY WELL. I DID PLAY THE
FLUTE.>>SO, I MEAN, AND THEN YOU
DECIDED — YOU WENT FOUR YEARS OF MEDICAL SCHOOL IN SOUTH
DAKOTA.>>RIGHT. RIGHT. SO, I DON’T KNOW WHAT YEAR IT
CHANGED.>>IT CHANGED IN ’75,
I THINK.>>SO I STARTED IN ’86. SO,
YUP, I WENT FOUR YEARS AT THE UNIVERSITY OF SOUTH DAKOTA
SCHOOL OF MEDICINE AT THAT TIME. I GRADUATED FROM THERE. I DID A YEAR AT SIOUX VALLEY
HOSPITAL, WHICH THE NAME HAS
CHANGED. SO I DID MY INTERNSHIP YEAR
THERE AND THEN I WENT TO VERMONT FOR NEUROLOGY
RESIDENCY. AND THEN BACK HERE, AND HAVE
BEEN BACK HERE SINCE 1995.>>SO THAT WAS THREE YEARS OF
RESIDENCY OR FOUR?>>I DID A YEAR OF INTERNSHIP
AND THEN THREE YEARS OF
RESIDENCY, RIGHT, SO FOUR TOTAL.>>FOUR TOTAL. AND THEN WHEN
YOU — SO, YOU’VE BECOME KIND
OF THE HEADACHE GURU, YOU AND A COUPLE
OTHERS IN SIOUX FALLS NOW. AND THEN SIOUX FALLS NEUROLOGY
HAS BECOME AVERA SIOUX FALLS.
>>RIGHT. WE WERE NEUROLOGY ASSOCIATES
AND WE WERE INDEPENDENT FOR A
LONG TIME. IT GETS A LITTLE BIT HARD TO
STAY INDEPENDENT IN MEDICINE
ANYMORE. AND WE DECIDED TO JOIN AVERA,
WHICH HAS BEEN GREAT FOR US. OUR PRACTICE STAYED, REALLY,
THE SAME. AND WHEN I FIRST CAME
HERE, I WAS THE ONLY FEMALE IN THE
GROUP. AND I HAD SOME INTEREST
IN HEADACHE, BUT I JUST — BECAUSE IT’S SLIGHTLY MORE
COMMON IN FEMALES, I THINK
BECAUSE OF THAT I ENDED UP GETTING MORE PATIENTS THAT WERE
HEADACHE AND MY PRACTICE KIND OF JUST GRADUALLY MORPHED
INTO WHERE I’M ALMOST ALL
HEADACHE NOW.>>YOU’VE DONE A FAIR AMOUNT OF
FURTHER TRAINING IN THAT AREA OR HAVE YOU DONE A LOT OF
RESEARCH AS YOU –>>RIGHT. I’VE DONE RESEARCH. I DIDN’T DO
A FELLOWSHIP IN HEADACHE.>>
RIGHT.>>BACK IN THE TIME WHEN I
FINISHED, IT WASN’T COMMON TO
DO A FELLOWSHIP. BUT I GOT INTO IT AND STARTED
DOING MORE AND MORE AND THEN YOU DO MORE CONTINUING MEDICAL
EDUCATION IN WHAT YOU ENJOY. SO I KIND OF DID MORE
CONTINUING EDUCATION IN THE
HEADACHE REALM. THE MORE YOU DO, THE MORE YOU
READ, THE MORE YOU LIKE IT, THE
MORE YOU DO.>>AND THE BETTER YOU ARE AT
IT.>>YEAH. WELL, IT’S REALLY MY PASSION. I
REALLY ENJOY WHAT I DO AND I REALLY ENJOY THE HEADACHE
ASPECT OF NEUROLOGY.>>AND WE’VE ALREADY GOT
QUESTIONS. AND IT’S SO
IMPORTANT TO HAVE QUESTIONS. BUT I KEEP THINKING ABOUT THE
FACT THAT SOME OF THESE PEOPLE,
NO MATTER WHAT YOU DO, THEY STILL HAVE PAIN. BUT IT CAN BE THE MOST
CHALLENGING, I MEAN, EVEN THE
WORLD OF CHRONIC PAIN, IT ALSO FITS THE HISTORY OF
CHRONIC HEADACHE.>>RIGHT.>>ONCE YOU HAVE IT, SOMETIMES
YOU JUST HAVE TO LIVE WITH IT. HOW MANY PEOPLE WHO COME TO YOU
WITH HEADACHE ACTUALLY GET
SIGNIFICANT RELIEF? WOULD YOU SAY 50%? 75%?>>SIGNIFICANT RELIEF IS
PROBABLY CLOSER TO 80% BECAUSE THERE’S SO MANY MEDICATIONS AND
THINGS THAT WE CAN DO NOW. WE, I THINK, PROBABLY CATCH
PEOPLE EARLIER NOW BEFORE THEY GET INTO THE DEEP HEADACHE
CYCLES BECAUSE WE’VE GOT MORE
OPTIONS. SO I THINK WE HAVE A PRETTY
GOOD SUCCESS RATE. THERE’S ALWAYS GOING TO BE SOME
THAT THOSE HEADACHES JUST DIG IN AND WE DO THE BEST WE
CAN AND MAYBE TRY TO DECREASE THEIR PAIN OR GIVE THEM A FEW
MORE HEADACHE-FREE DAYS. IT IS A CHRONIC DISORDER, SO
IT’S NOT A CURABLE DISEASE.>>NO.>>DISORDER.>>WE HAVE
A QUESTION FROM MILBANK. TWO QUESTIONS FROM A MAN FROM
MILBANK, AND HE SAYS, IN MY
YOUNGER YEARS, I HAD NUMEROUS MIGRAINE
HEADACHES. DO THEY RETURN IN
LATER YEARS? AND THAT WAS HIS FIRST
QUESTION. AND I’LL GO TO THE
SECOND QUESTION IN A MINUTE. HAVE YOU SEEN A TIMELINE, DO
THEY GENERALLY START WHEN
YOU’RE YOUNGER, THEN THEY GO AWAY? WOMEN MOSTLY?>>IT’S MORE COMMON IN WOMEN.
BUT IT’S ACTUALLY QUITE COMMON
IN MEN. AND SOME OF THOSE NUMBERS OF
BEING LOW MIGHT BE BECAUSE MEN DON’T COME IN FOR THAT
COMPLAINT AS OFTEN BECAUSE IT’S
SORT OF THOUGHT OF OVER THE YEARS AS A FEMALE DISEASE.
IT IS CLEARLY BOTH GENDERS, BUT
IT IS MORE COMMON IN WOMEN. IT TENDS TO DEVELOP — AND YOU
CAN HAVE THEM AS AN INFANT.>>
YOU CAN HAVE IT WHAT?>>YOU CAN HAVE HEADACHES AS AN
INFANT AND THEY MIGHT VOMIT AND
CRYING. BUT THEY’RE REALLY COMMON TO
DEVELOP IN THE TEENAGE YEARS,
RIGHT AROUND PUBERTY, PARTICULARLY FOR THE FEMALE. BUT YOU CAN SEE THEM AS A NEW
HEADACHE DISORDER UP INTO THE
40s EVEN. IF THEY’RE AFTER AGE 40 WHEN
THEY START, YOU WORRY ABOUT
OTHER THINGS.>>TUMORS.>>TUMOR, ANEURYSMS,
STROKE, MENINGITIS, DIFFERENT
THINGS. I DO HAVE PEOPLE WHERE THEY’LL
HAVE THEM FOR SEVERAL YEARS AND THEY’LL GO AWAY AND WE
DON’T NECESSARILY HAVE A GOOD EXPLANATION FOR WHY THEY GO
AWAY. AND THEN THEY’LL COME
BACK. AND SOMETIMES THAT’S BECAUSE
THEY’VE GOTTEN AN INFECTION OR
THEY’VE GOT SOMETHING ELSE, YOU KNOW, A TUMOR OR SOMETHING
ELSE THAT’S GOING ON. BUT WHEN I’M VISITING WITH A
PATIENT LIKE THAT, I GO BACK TO THEIR HISTORY AND FIND THAT
THEY DID HAVE HEADACHES THAT WERE PROBABLY MIGRAINES, IT’S
MUCH MORE REASSURING WHEN I’M LOOKING AT THEM AGAIN WITH THAT
IF THEY GO AWAY AND COME BACK, I’M PROBABLY GOING TO GET
AN IMAGE, THOUGH, MRI OR C.A.T.
SCAN.>>GENERALLY WHEN YOU GET IT AS
AN OLDER PERSON, IT IS
SOMETHING ELSE.>>ESPECIALLY IF YOU DIDN’T
HAVE THEM WHEN YOU WERE YOUNGER.>>NOW THIS GENTLEMAN ALSO
SAID, I HAVE HEADACHES IN BOTH EYE
SOCKETS AND TEMPLES ON BOTH
SIDES. FEELING OF THE HEAD READY TO
BURST. DOES THAT GIVE YOU ANY CLUE OR
A HINT TOWARD A KIND OF
DIRECTION?>>SO, IT’S HELPFUL. FOR IT TO
BE A MIGRAINE, THEY TEND TO BE
MORE ONE-SIDED, THEY CAN BE ON BOTH SIDES. THEY
TEND TO BE BEHIND THE EYES. THEY TEND TO BE MORE OF A
THROBBING-TYPE PAIN AS OPPOSED
TO A CONSTANT PRESSURE. IS THIS THE SAME PERSON?>>
UM-HUM, I THINK SO.>>YOU WOULD THINK ABOUT,
AGAIN, SOMETHING GOING ON
BEHIND THE EYES LIKE A TUMOR. YOU WOULD ALSO EVEN THINK ABOUT
THE EYES, COULD IT POTENTIALLY
BE GLAUCOMA. COULD IT BE RECURRENCE OF MIGRAINES THAT THEY HAD WHEN
THEY WERE YOUNGER AND THEY’RE
JUST COMING BACK. COULD IT BE INFLAMMATION IN THE
VESSELS. WITH THAT STORY, I
WOULD WANT SOMEBODY TO COME IN AND TAKE A
FULL HISTORY AND EXAMINE THEM
AND SEE WHAT THE SITUATION IS. BUT IT CAN BE LOTS OF THINGS.
>>COULD BE A LOT OF THINGS.>>
UM-HUM.>>I’D LIKE TO KNOW HOW OLD HE
IS OR SHE IS. THIS IS A MAN
FROM MILBANK. SO HE IS. I MEAN, THAT WOULD HELP US.>>
YEAH. DIFFERENTIAL. RIGHT.>>I’M LOVIN’ THESE QUESTIONS.
KEEP ‘EM COMING. THIS IS
WONDERFUL. WE CAN JUST ANSWER QUESTIONS
ALL NIGHT. WHAT KIND OF HOME REMEDIES
COULD YOU SUGGEST FOR
HEADACHES? HOME REMEDIES?>>SO, WHEN I’M FIRST VISITING
WITH SOMEBODY ON THEIR FIRST VISIT, I TRY TO REMEMBER TO
TALK TO THEM ABOUT THINGS THAT THEY CAN DO THAT ARE NOT A
MEDICINE. EAT ON A REGULAR
SCHEDULE. DON’T SKIP BREAKFAST, WHICH IS
COMMON. SLEEP ON A REGULAR
SCHEDULE. YOU WANT TO TRY TO MINIMIZE
STRESS, BUT I THINK WE ALL TRY
TO DO THAT. AND FOODS THAT CAN BE BAD OR
DRINKS WOULD BE ALCOHOL IS
PROBABLY NUMBER ONE. AND FOODS, ANYTHING THAT’S LIKE
A PRESERVED MEAT OR AN AGED MEAT, SO LUNCH MEAT IS
PARTICULARLY BAD UNLESS YOU GET IN THE DELI THAT DOESN’T
HAVE ALL THE PROCESSING WITH IT. SO, — AND REGULAR EXERCISE IS
REALLY IMPORTANT. IF YOU CAN EXERCISE AT LEAST
THREE DAYS A WEEK, AT LEAST 20 MINUTES, IT’S BEEN PROVEN
THAT’S A REALLY GOOD PREVENTIVE
THERAPY FOR HEADACHES.>>HOW OFTEN?>>AT LEAST THREE
DAYS A WEEK, AT LEAST 20
MINUTES, THE MORE, THE BETTER. BUT PEOPLE CAN START THERE.>>
I LIKE THE IDEA OF ONE MILE
EVERY DAY. THAT’S MY PLAN.>>THAT SOUNDS GOOD.>>AND ONE
MILE’S 12 BLOCKS. YOU JUST WALK SIX BLOCKS AWAY
FROM YOUR HOUSE AND SIX BLOCKS
BACK. AND THEN YOU JUST GO HOME.>>
RIGHT. CAN I FINISH ONE OTHER
THING?>>YES, I’M SORRY.>>HOME
REMEDIES, I THINK WHAT THEY
MIGHT BE ASKING IS, THERE’S THINGS THAT YOU CAN USE
LIKE MAGNESIUM, WHICH IS OVER
THE COUNTER.>>YEAH, DOES THAT HELP?>>
THAT CAN HELP. YOU DON’T WANT TO GO TOO HIGH A
DOSE OR THEY’LL GET LOOSE
STOOLS. BUT PEOPLE WITH MIGRAINES ARE
SHOWN TO HAVE A LOWER MAGNESIUM
LEVEL, WE’RE NOT QUITE SURE WHY, BUT REPLACING
WITH MAGNESIUM EVERY DAY OR
EVERY OTHER DAY CAN BE HELPFUL. FEVER-FREE CAN BE HELPFUL. THERE’S FRANKINCENSE AND THAT’S
ACTUALLY ONE THAT’S PROVEN TO
BE HELPFUL. AND YOU CAN GET ALL THOSE
THINGS OVER THE COUNTER.>>FRANKINCENSE. HAS A
RELIGIOUS BENT. I DON’T KNOW
WHY.>>IT SEEMS LIKE IT SHOULD BE
HELPFUL.>>YEAH. I WANT YOU TO RESPOND A LITTLE
BIT MORE TO FOODS BECAUSE I THINK THAT QUESTION ABOUT FOODS
IS SO IMPORTANT. IT SURPRISED ME, I HAD ONE
HEADACHE LECTURER SAY, WELL, ORANGE JUICE IS ONE BAD
CULPRIT, BANANAS IS A CULPRIT,
YOU HADN’T HEARD BANANAS.>>GRAPES, I ACTUALLY READ MORE
THAN 12 GRAPES.>>MORE THAN 12
GRAPES.>>YEAH.>>AND THEN THIS PARTICULAR
PERSON SAID, A LOT OF THE
ALCOHOL BEVERAGES WILL DO IT, BUT VODKA’S THE LEAST.>>THAT’S THE ONLY ONE LISTED
AS A NONTRIGGER, THAT’S THE
ONLY ONE ON THE OKAY LIST.>>SO YOU DON’T MIX IT WITH
ORANGE JUICE.>>RIGHT.>>ARE YOU ALL RIGHT WITH THAT?
>>YEAH.>>OKAY. AND I THINK THE AGEED MEATS IS
AN ISSUE, YOU KNOW, THE SARDINES AND THE KIPPER SNACKS
AND PEOPLE WHO ARE LISTENING
KNOW WHAT KIPPER SNACKS ARE. OUR PRESTUDENTS DIDN’T.>>ANOTHER THING THAT’S REALLY
BAD IS ARTIFICIAL SWEETNERS, PARTICULARLY ASPARTAME OR
NUTRASWEET. CAFFEINE GETS A LOT OF BUZZ
BEING BAD, AND OVER THE YEARS
KIND OF WATCHING THIS AND TALKING TO MY PATIENTS ABOUT
THIS, I THINK NUTRASWEET IS PROBABLY WORSE THAN CAFFEINE AS
FAR AS A TRIGGER. I REALLY ENCOURAGE MY PATIENTS
TO GO OFF ARTIFICIAL SWEETNERS, BUT PARTICULARLY ASPARTAME.>>
WHAT ABOUT ONES THAT ARE
NATURAL?>>STEVIA IS THE ONE THAT’S
BETTER.>>STEVIA.>>YEAH, I THINK THAT’S THE ONE
WITH THE LITTLE GREEN LEAF ON
IT. I LIKE SUGAR. [ OVERLAPPING
CONVERSATION ] LOTS OF SUGAR.
YEAH.>>SPOONFUL OF SUGAR MAKES THE
MEDICINE GO DOWN.>>EXACTLY.>>ARE THERE ANY NEW THERAPIES
OR MEDICATIONS FOR NEW DAILY
PERSISTENT HEADACHES?>>NEW PERSISTENT DAILY
HEADACHES ARE REALLY THE
BIGGEST CHALLENGE IN MEDICINE. THOSE ARE PARTICULARLY
OLFACTORY.>>EXPLAIN WHAT NEW
PERSISTENT HEADACHES ARE.>>IT’S ACTUALLY EXACTLY WHAT
IT SOUNDS LIKE IT WOULD BE. IT’S SOMEBODY THAT DEVELOPS
HEADACHES, THEY GO FROM NO
HEADACHES, OR RARE MIGRAINES, SOMETIMES, BUT THEY CAN GO FROM
NO HEADACHES TO ALL OF A SUDDEN HAVING HEADACHES EVERY
SINGLE DAY. THEY TEND TO BE
SEVERE. THEY TEND TO BE ALL OVER. THEY
DON’T NECESSARILY HAVE ALL THE
MIGRAINE CHARACTERISTICS LIKE THROBBING,
BUT THEY’RE SEVERE DAILY HEADACHES THAT JUST DO
NOT RESPOND TO THERAPIST. AND REALLY, WHAT WE TRY TO DO
IS TRY THE DIFFERENT PREVENTION
MEDICATIONS BUT YOU WANT TO TRY TO BALANCE, NOT
GIVE THEM SIDE EFFECTS BECAUSE A LOT OF TIMES THE MEDICATIONS
AREN’T REALLY HELPING VERY
MUCH, AND THEN AT SOME POINT IT CAN JUST KIND OF GET BETTER
OR GO AWAY. BUT THOSE ARE HARD. YOU REALLY TRY REALLY HARD TO
TREAT IT AS A MIGRAINE TO SEE IF WE CAN JUST KIND OF STUMBLE
UPON SOMETHING THAT’S GOING TO
HELP THEM.>>RIGHT. PREVENTIVE MEDICINES
INCLUDE THE BETA BLOCKERS,
AMITRIPTYLINE.>>BIG ONES, BETA BLOCKERS.
AMITRIPTYLINE.>>NORTRIPTYLINE.>>TOPAMAX, PROBABLY MOVED
AHEAD OF THOSE AS FAR AS A
PREVENTIVE MEDICATION. THERE’S BOTOX, WHICH HAS BEEN
AROUND — WELL, A LONG TIME, SINCE THE EARLY 1990s FOR
HEADACHE BUT IT WAS APPROVED BY THE FDA FOR HEADACHE IN 2010. SO WE STARTED USING IT A LOT
MORE BECAUSE IT WAS COVERED BY INSURANCE THEN AND WE HAD MORE
AVAILABILITY. BOTOX IS A REALLY GOOD
PREVENTIVE MEDICATION AND
DOESN’T HAVE A LOT FOR SIDE EFFECTS, BUT IT’S 31 INJECTIONS
EACH SERIES, EVERY THREE MONTHS. PEOPLE TOLERATE IT REALLY WELL. MIGRAINE PATIENTS ARE USED TO
HAVING PAIN AND IF THAT’S GOING
TO HELP THEY’RE WILLING TO SIT THERE AND DO THAT.>>TAKE THE SHOT.>>THERE’S A
NEW MEDICATION THAT CAME OUT,
IT’S CALLED AIMOVIG, WHICH IS ONE OF THE MONOCLONAL
ANTIBODY MEDICATIONS THAT JUST
CAME OUT, TOTALLY DIFFERENT MECHANISM
THAN THE WAY THE OTHER
PREVENTIVE MEDICATIONS WORK. AND IT ACTUALLY BLOCKS PAIN.
IT’S A CGRP ANTAGONIST, IT’S A CHEMICAL THAT CAUSES HEADACHE
IN PATIENTS, IF YOU GIVE
SOMEBODY CGRP IN STUDIES, THEY’LL GET A HEADACHE, IF YOU
BLOCK THAT, THE HEADACHE GOES
AWAY. TOTALLY NEW MEDICATION. IT’S
ALSO AN INJECTION.>>REALLY CHEAP, I BET.>>IT’S
AS CHEAP AS BOTOX.>>DOES IT
HAVE SIDE EFFECTS?>>IT’S GOT MINIMAL SIDE
EFFECTS. IT LISTS CONSTIPATION,
LESS THAN 3%, SOME INCREASED TONE IN YOUR
MUSCLES, LESS THAN 1% OF PEOPLE
GET THAT. AND THEN SOME INJECTION SITE
REACTION. IT IS A SUBCUTANEOUS INJECTION
THAT YOU DO YOURSELF ONCE A
MONTH. IT GOES TO YOUR HOME, KEEP IT
IN THE REFRIGERATOR, SO IT’S AN
EASY WAY TO GO. IT IS ABOUT $600 A MONTH. THIS
ONE, WE’RE JUST KIND OF WORKING
OUR WAY WITH THE DRUG COMPANIES NOW BECAUSE IT’S NEW,
THEY’VE GOT A GREAT PROGRAM
WHERE IT’S $5 A MONTH. IF THEIR INSURANCE ISN’T
COVERING IT. AND THEN THERE’S ANOTHER SISTER
TO THAT THAT JUST CAME OUT THIS
WEEK. I DON’T KNOW WHAT THE TRADE
NAME IS FOR THAT ONE.>>SO NEW DAILY PERSISTENT
HEADACHES, SOMETIMES ARE — YOU THINK MAYBE JUST A VIRUS,
AND THEN IT WILL GO AWAY, TOO?
>>YOU KNOW, IT MIGHT BE. IT TENDS TO START WITH SOME
SORT OF VIRAL INFECTION. WE
DON’T REALLY KNOW THE MECHANISM.>>UNKNOWN.>>THAT’S SORT OF
THE THEORY THAT YOU’VE RAMPED
IT UP SOMEHOW WITH A VIRAL INFECTION.
>>OKAY. A WOMAN FROM BRANDON ASKS, I
HAD A PITUITARY GLAND REMOVED
AND IT WAS NONMALIGNANT. ONE PERCENTAGE OF PITUITARY
GLAND TUMORS ARE MALIGNANT?>>THAT’S A NEUROSURGERY
QUESTION.>>YES, THAT IS.>>I DON’T KNOW THAT ANSWER.I
WOULD JUST BE –>>BUT A PERCENTAGE ARE NOT.>>
YEAH.>>I MEAN, A LARGER PERCENTAGE,
IN FACT, THE MAJORITY OF THEM, THEY WATCH
THEM, THEY LEAVE THEM ALONE.
THEY DON’T REMOVE THEM, RIGHT?>>RIGHT. THAT’S WHERE THE
HORMONES ARE REGULATED. SO IF YOU REMOVE THAT, THEN
YOU’VE GOT TO HAVE HORMONE
REPLACEMENT THERAPY. YEAH, THERE ARE A LOT — A LOT
OF THEM ARE BENIGN. SOME OF THEM ARE JUST EVEN
SOMETHING THAT FORMED WHILE YOUR BRAIN WAS FORMING, CLEFT
CYST AND THEY CAN LOOK AT IT, MICROADENOMA, VERY SMALL, YOU
WORK WITH AN ENDOCRINOLOGIST
AND A NEUROSURGERY. A LOT OF THEM ARE BENIGN. >>CAN SMOKING MARIJUANA HELP
WITH HEADACHES THAT DON’T
RESPOND TO ANYTHING ELSE?>>THAT QUESTION’S A LITTLE
TOUGH FOR ME, JUST BECAUSE IT’S
NOT LEGAL IN SOUTH DAKOTA. SO I HAVEN’T SPENT TIME
RESEARCHING THAT YET. IT IS SOMETHING THAT HELPS A
LOT OF DIFFERENT PAIN
SYNDROMES, THOUGH. SO, I MEAN, UNTIL IT BECOMES
LEGAL IN SOUTH DAKOTA, WE WON’T BE ALLOWED TO
PRESCRIBE THAT YET.>>I WOULD SPECULATE, I’VE
LOOKED AT THE LITERATURE, THERE’S A LOT OF LITERATURE
THAT SHOWS SIGNIFICANT RELIEF OF PAIN FROM MARIJUANA OR
MARIJUANA OILS OR THE CMV —
CMB IN PARTICULAR. CBD ACTUALLY HAS BEEN ABLE TO
HELP PARTICULARLY CHILDREN WITH
SEIZURE DISORDERS. SO, IT’S IMPORTANT, I THINK,
THAT WE WOULD GO FORWARD ON IT. BUT IT’S INTERESTING THAT IT IS
A SCHEDULE I DRUG, WHICH MEANS THAT SOMEBODY CALLED IT A
SCHEDULE I DRUG DURING THE
NIXON ERA, THAT’S AT THE — THAT SET THE SAME LEVEL OF
COCAINE AND HEROIN WHEN WE KNOW
THAT THERE’S PROBABLY, YOU KNOW, IF YOU COMPARE THE
OPIOID DEATHS OF 70,000 IN
2017, GUESS HOW MANY PEOPLE HAVE DIED FROM MARIJUANA. IT’S
VERY LOW.>>YEAH.>>SO I THINK OUR SOCIETY’S
MISSING A BET HERE.>>YEAH, I THINK THERE’S A LOT
OF FORWARD MOVEMENT WE CAN HAVE
IN THAT AREA.>>YEAH.>>AND ANY PAIN
SPECIALIST, AND YOU KNOW, AS A
HEADACHE SPECIALIST, ANYTHING WE HAVE
THAT WE CAN ADD TO OUR TOOLBOX TO HELP THESE PATIENTS, I AM
OPEN TO IT AND I DON’T HAVE ANY
PRECONCEIVED NOTION OF WHAT THE CANNABINOIDS ARE, BUT
IF THEY CAN HELP AND HAVE
MINIMAL SIDE EFFECTS AND LOW RISK, I’M OPEN TO USING THEM.>>MY ONLY THOUGHT IS THAT IF
WE MADE CANNABINOIDS IN A
CONTROLLED WAY, LEGAL, WE COULD BETTER KEEP OUR
YOUTH FROM USING IT BECAUSE
THAT’S — THERE’S THE BIG RUB. WE DON’T
WANT THEM TO BE USING IT.>>
RIGHT.>>IT IS NOT A MIGRAINE, BUT IT
IS CHRONIC AND IT IS CONSTANT. THE HEADACHE LASTS ALL DAY,
EVERY DAY, AND NOTHING SEEMS TO
MAKE THE HEADACHE GO AWAY. FIND OUT HOW ONE PERSON IS
TRYING TO CONTROL CHRONIC DAILY
HEADACHE.>>MY HEADACHES ARE CALLED
CHRONIC DAILY HEADACHES, AND
I’VE HAD THEM FOR 34 YEARS. AND PERHAPS LONGER, I GUESS I
STARTED SEEKING TREATMENT 34
YEARS AGO FOR THESE HEADACHES. AND THEY ARE PRESENT FROM THE
TIME I WAKE UP UNTIL THE TIME I
GO TO BED. MY HEADACHES MANIFEST
THEMSELVES IN MY TEMPLES. SO IT
FEELS LIKE MY HEAD IS IN A VISE. AND, SO, IT’S CONSTANT
PRESSURE. IN THE TEMPLE AREA,
ACTUALLY ALMOST MOVES AROUND A
LITTLE BIT, AND IT RADIATES INTO MY
CHEEK BONES AND SOMETIMES DOWN
INTO MY JAWS. BUT IT’S ALWAYS IN MY TEMPLES, IT’S JUST WHETHER OR NOT IT
RADIATES INTO OTHER PARTS OF MY
FACE. I LOVE HUMOR. BUT THE MORE I LAUGH, ACTUALLY
THE MORE IT EXACERBATES THE
PAIN IN MY TEMPLES. IT’S MISERABLE. YOU LEARN TO
LIVE WITH IT. NOTHING SEEMS TO
HELP. I HAVE KIND OF SAD MOODS MUCH
MORE OFTEN THAN I THINK I WOULD
BE IF I DIDN’T HAVE HEADACHES. I
SOMETIMES FANTASIZE ABOUT NOT
HAVING A HEADACHE AND HOW DELIGHTFUL LIFE WOULD BE AND
HOW FUN LIFE WOULD BE IF I
DIDN’T. AND I WOULD JUST — WHEN MY
DAUGHTER SAYS, OH, CAN WE GO
SHOPPING IN SIOUX FALLS, I’D SAY, HEY, YEAH, YOU KNOW,
LET’S GET IN THE CAR AND GO, RATHER THAN, OH, MAN, MY HEAD
HURTS, BUT I WANT TO DO IT
BECAUSE SHE WANTS TO. SO I WILL. OR IF MY HUSBAND WANTS TO GO
OUT FOR DINNER, I WANT TO SAY,
OH, SURE, THAT WOULD BE GREAT, LET’S, YOU KNOW, RUN DOWN AND
GET SOMETHING TO EAT. BUT I JUST NEVER REALLY WANT TO
BECAUSE I ALWAYS HAVE A
HEADACHE. AND WHAT ABOUT JUST TAKING SOME
IBUPROFEN OR THE OTHER DAY I
MENTIONED THAT I HAD A HEADACHE, AND SOMEONE SAID, OH,
I HAVE SOME EXCEDRINE MIGRAINE
IN MY DESK, WOULD YOU LIKE SOME? AND I SAID, I HAVE
TRIED ALL OF THAT. I’VE TAKEN
THREE AND FOUR IBUPROFEN AT A TIME OR I’VE
TRIED ASPIRIN, I’VE TRIED THIS. IT DOESN’T EVEN TAKE THE EDGE
OFF. IT DOESN’T EVEN BUDGE MY
HEADACHE. I’VE TRIED OVER-THE-COUNTER
MEDICATIONS, I’VE TRIED
PRESCRIPTION MEDICATIONS.
MASSAGE. ACUPUNCTURE, ACUPRESSURE.
RELAXATION TECHNIQUES. NOTHING
SEEMS TO WORK. NOTHING EVEN SEEMS TO TAKE THE
EDGE OFF THE HEADACHES. THEY
ARE ALWAYS PRESENT. THERE WAS ONE THING THAT
HELPED. AND IT WAS A
PRESCRIPTION MEDICATION CALLED
TOPOMAX. AT FIRST I’M THINKING, THIS IS
A MIRACLE DRUG. I COULDN’T
BELIEVE IT. I COULDN’T BELIEVE IT. THEN I
FOUND IT HAD A SIDE EFFECT THAT WAS QUITE NEGATIVE
AND THAT WAS, IT REALLY
IMPACTED MY CONCENTRATION. AND I REALIZED THAT SOME PEOPLE
ACTUALLY CALL IT DOPAMAX BECAUSE IT MAKES YOU
SUCH A DOPE. AND I HONESTLY FELT LIKE I JUST
COULDN’T REMEMBER PRACTICALLY
MY NAME SOMETIMES. RECENTLY INSURANCE COMPANIES
APPROVED BOTOX AS TREATMENT FOR
MIGRAINES AND ALSO IT’S BEEN APPROVED, IN MY CASE, FOR
MY CHRONIC DAILY HEADACHES. AND, SO, I HAD MY FIRST
TREATMENT OF BOTOX IN SEPTEMBER. AND IT DID HELP A CERTAIN
AMOUNT. AND Dr. MILES SAID THAT
IT WASN’T EXPECTED TO MIRACULOUSLY MAKE THEM GO AWAY
OVERNIGHT, BUT OVER THE COURSE OF SEVERAL TREATMENTS, THEY
PROBABLY, IF IT’S GOING TO
WORK, SHOULD CONTINUE TO
IMPROVE. AND THEY DID IMPROVE SOMEWHAT.
AND, SO, I’M EXCITED ABOUT
GETTING FUTURE TREATMENTS OF BOTOX TO SEE IF THAT WILL HELP
BECAUSE THE TOXINS, YOU KNOW, CERTAINLY SHOULD HELP PARALYZE
THE MUSCLES AND SHOULD HELP
THEM RELAX AND MAYBE MY HEADACHES WILL EVENTUALLY GO
AWAY. >>THIS IS YOUR PROGRAM AND
YOUR QUESTIONS ARE KEY TO THE
DIRECTION OF OUR DISCUSSION. CALL IN YOUR QUESTIONS TO
1-888-376-6225 OR SEND US AN
EMAIL TO [email protected] THANK YOU, CAROL, FOR ALL OF
THIS. SO, INTERESTING CASE
PRESENTATION. A PERSON WILLING TO TELL US
ABOUT HER HEADACHES. NOTHING
WORKS PERFECTLY. ONE OF THE THINGS THAT ALWAYS
STRIKES ME IS THAT I LEARN FROM
YOU WAS THE ISSUE OF WITHDRAWALS FROM MEDICINE AS A
HEADACHE CAUSE. TELL US A LITTLE BIT ABOUT THAT
BEFORE WE GO ANY FURTHER.>>SO THEY ORIGINALLY CALLED
WITHDRAWAL HEADACHES LIKE A
CAFFEINE WITHDRAWAL HEADACHE, THEN THEY CHANGED IT TO REBOUND
HEADACHE, WHICH I LIKE THAT
TERM. AND THEN THEY CHANGED THE TERM
TO MEDICATION OVERUSE HEADACHES. AND THEY DID THAT SO THAT THE
PATIENT KNOWS WHAT THEY’RE
DOING. SO, YOU CAN GET REBOUND
HEADACHES OR MEDICATION OVERUSE
HEADACHES IF YOU’RE USING ANY SORT OF PAIN
MEDICATION, WHETHER IT’S
TYLENOL OR MORPHINE OR ANYTHING IN BETWEEN.>>SO
TYLENOL WITHDRAWAL.>>TYLENOL
IS A BIG ONE.>>BIG — TYLENOL EVERY TIME,
THEY’LL END UP WITH REBOUND
PAIN.>>RIGHT. AND SO THEY TEND TO
GET A HEADACHE AS THE LIFE OF
THAT DRUG IS WEARING OFF. SO THE HEADACHE WILL GO AWAY,
THEN IT WILL COME BACK AS THE
MEDICATION IS WEARING OFF, MAKES YOU TAKE MORE MEDICATION.
AND YOU JUST END UP IN THIS
CYCLE DAY AFTER DAY. YOU TEND TO WAKE UP WITH THE
HEADACHE BECAUSE YOU DIDN’T
TAKE THE MEDICATION AT NIGHT.>>THROUGH THE NIGHT.>>RIGHT.
YOU WAKE UP WITH A HEADACHE. IT’S KIND OF A SELF-FULFILLING
THING, YOU KNOW, EXCEDRINE IS A BIG ONE BECAUSE IT’S GOT
CAFFEINE IN IT AND TYLENOL,
ASPIRIN IN IT, TOO, WHICH DOESN’T REBOUND.>>CAFERGOT WAS A BIG DEAL WHEN
I WAS A NEUROLOGY — WHEN I WAS
ON NEUROLOGY AS A RESIDENT, I REMEMBER SEEING A
LADY WHO CAME IN, TAKING JUST
HUGE AMOUNTS OF CAFERGOT AND HE SAID, I GOT TO PUT HER IN
THE HOSPITAL, COVER HER WITH
MORPHINE.>>THAT WAS DANGEROUS, HARD TO
WITHDRAW FROM THAT. THAT WAS A LITTLE BIT BEFORE MY
TIME, THAT WAS USED A LITTLE
BIT RIGHT WHEN I WAS STARTING, THAT WAS THE BIG
REBOUNDER.>>YEAH. SO YOUR TAKE-HOME MESSAGE TO
PEOPLE WHO WANT TO USE
IBUPROFEN OR ALEVE OR TYLENOL.>>IF YOU’RE NEEDING TO TREAT
THREE OR MORE HEADACHES PER WEEK, YOU’RE AT RISK FOR
MEDICATION OVERUSE HEADACHES. AND IF THEY’RE MIGRAINES, YOU
PROBABLY NEED TO BE GETTING ON SOME SORT OF PREVENTIVE
MEDICATION. FOR THE UNDERLYING
MIGRAINE, BECAUSE THE ONLY WAY YOU CAN
GET RID OF THE MEDICATION OVERUSE HEADACHE IS TO COME OFF
THAT BUT YOU PROBABLY NEED SOME HELP AT THAT POINT FROM A
DOCTOR.>>SO, I MEAN, IT’S LIKE TWO
THINGS, WHEN A PERSON CAME IN
WITH HEADACHES, I WOULD SAY, OKAY, NOW I KNOW YOU’RE HAVING
A LOT OF THESE PER MONTH, SO
I’M GOING TO PUT YOU ON SOMETHING THAT KEEPS THEM FROM
COMING BACK.>>RIGHT.>>A PREVENTIVE.>>
RIGHT.>>AND THEN I WILL HAVE
YOU — HERE’S A TOOL TO USE IF IT HITS
YOU SO THAT YOU’VE GOT A RESCUE.>>SYMPTOMATIC MEDICATION,
RIGHT, OR A RESCUE MEDICATION. A LOT OF PATIENTS IF THEY HAVE
THREE OR MORE HEADACHES IN A WEEK, SOMETIMES EVEN TWO OR
MORE, PARTICULARLY IF THEY’RE SEVERE, THEY’LL BE ON A
PREVENTION MEDICATION TO MAKE — THAT THEY TAKE EVERY
DAY TO MAKE THE HEADACHES LESS
FREQUENT, LESS SEVERE AND
SHORTER. THEY’LL HAVE THE SYMPTOMATIC
MEDICATION TO TAKE AT THE TIME THAT CAN CAUSE SOME IMPROVEMENT
IN 20 TO 30 MINUTES.>>SO, A QUICK, PROBABLY YOUR
MOST COMMON PREVENTIVE IS
PROCEED PALMAL?>>I WOULD SAY THE MOST COMMON
PREVENTIVE IS TOTERMATE. I LIKE THE PROPYLAL, TOO, I
THINK NUMBER ONE IS PROBABLY
TORPURIMIDE.>>ONE OF THE BEST GENERICS
THAT’S EASY AND QUICK IS WHAT?>>SO THE BEST RESCUE IS ANY OF
THE TRIPTAN CATEGORY, IT WOULD BE IMITREX OR
SUMATRIPTAN, WHICH IS THE FIRST
ONE. MAXOLT. RELPAX, THERE’S A LOT. THE ONES
THAT END IN TRIPTAN. THOSE ARE VERY EFFECTIVE, THEY
WORK QUICKLY, 20 TO 30 MINUTES. YOU CAN REBOUND ON THEM. BUT
THEY USED TO BE REALLY EXPENSIVE, LIKE $60 A PILL SO
YOU CAN ONLY USUALLY GET
ANYWHERE FROM SIX TO NINE,
USUALLY. SOMETIMES YOU CAN GET 12,
SOMETIMES A LITTLE BIT MORE. BUT — THE RISK OF REBOUND IS
LESS BECAUSE YOU’RE JUST NOT
ALLOWED TO HAVE THAT MANY.>>BUT THE FIRST ONE IS JUST AS
GOOD AS THE OTHERS? I MEAN –>>YOU KNOW, THEY’RE ALL
SLIGHTLY DIFFERENT MOLECULES.
AND, SO, IF ONE DOESN’T WORK, YES, I WILL TRY THREE OF THEM,
PROBABLY, BEFORE I’D GIVE UP ON
THAT CATEGORY.>>OKAY.>>AND THEY’RE USUALLY
PRETTY — RELATIVELY
INEXPENSIVE.>>THEY ARE NOW.>>A DeSMET
MAN ASKS, I BECOME VERY
EMOTIONAL, I TEAR UP SOMETIMES WHEN
SPEAKING. I THINK IT’S A MINOR
CASE OF BULBAR SYNDROME, HE ASKS, CAN
YOU HAVE A MINOR CASE, WHAT’S THE REASON WHY I’M
TEARING UP ALL THE TIME?>>THERE’S A RANGE OF THE
BULBAR SYMPTOMS.>>IS HE
DESCRIBING THE BULBAR SYMPTOMS?>>PROBABLY. IT’S HARD TO KNOW
WITH A BRIEF HISTORY. BUT ANY SORT OF EMOTION CAN
MAKE YOU TEAR UP. AND YOU CAN
GET THAT FROM DIFFERENT THINGS. SOMETIMES IT’S FROM
DEGENERATIVE THINGS, SUCH AS
LIKE A PARKINSONIAN SYNDROME, GET THEM WITH ALZHEIMER’S,
BRAIN TUMORS, PARTICULARLY
FRONTAL BRAIN TUMORS. SO THERE’S DIFFERENT THINGS
THAT CAN BRING THAT ON. SO, ANY SORT OF EMOTION, EVEN
IF IT’S HAPPY, IT CAN MAKE YOU
CRY OR TEAR UP. SO IT CAN BE FRUSTRATING TO THE
PERSON. THAT’S A GOOD REASON TO SEE A
NEUROLOGIST IF YOU’RE HAVING
THAT, JUST TO MAKE SURE IT’S NOT PART
OF SOMETHING ELSE. LIKE I SAID, PARKINSON’S WOULD
PROBABLY BE THE MOST COMMON. THAT’S A GOOD REASON TO GO IN
AND SEE SOMEBODY AND GET
DIAGNOSED.>>AND I HAVE TO TELL YOU, I
MUST HAVE BULBAR SYNDROME,
BECAUSE A GOOD HALLMARK HALL OF FAME COMMERCIAL WILL MAKE ME
KIND OF WEEP WITH A LITTLE BIT
OF JOY, YOU KNOW.>>YUP. THAT IS A NORMAL
EMOTION.>>I THINK IT’S A
NORMAL THING THAT HAPPENS. IF MY WIFE HAD MENOPAUSE, SHE
STOPPED CRYING AT EVERYTHING, I GET MALE MENOPAUSE, I’M
CRYING AT EVERYTHING.>>
SLIGHTLY DIFFERENT THAN BULBAR.>>PROBABLY A LITTLE BIT. OKAY.
A SPEARFISH WOMAN ASKS, DOES EXPOSURE TO ESSENTIAL OILS OR
PERFUMES CAUSE HEADACHES IN
SOME PEOPLE? ARE THERE REGULATIONS AT
HOSPITALS AND HEALTH CARE
FACILITIES THAT PROHIBIT CARETAKERS, NURSES AND DOCTORS
FROM WEARING ORDOROUS OILS OR PERFUMES, SO PATIENTS AND
PEOPLE IN HOSPITALS AREN’T
EXPOSED TO THEM? WHAT’S YOUR TAKE ON THAT?>>
THAT’S A GOOD QUESTION. THERE’S A LOT OF ODORS THAT ARE
TRIGGERS. SO IT’S HARD TO KNOW IF IT
REALLY CAUSES IT OR IF IT’S JUST THAT ONE MORE THING, THAT
TRIGGER THAT TIPS YOU OVER THE
EDGE TO GET A HEADACHE. AND THERE’S A HUGE RANGE OF
DIFFERENT SMELLS THAT CAN DO
THAT. I DON’T HEAR IT PROBABLY QUITE
AS MUCH WITH ESSENTIAL OILS AS
I DO WITH POTPOURRI AND PERFUMES AND SOME HAIRSPRAYS
AND SOME SCENTED LOTION,
CANDLES. AS FAR AS THE REGULATIONS, I
DON’T THINK THERE ARE ANY. I
WORK AT THE HEADACHE CENTER, AND WE HAVE A POLICY THAT
THERE’S NO PERFUME.>>NO
PERFUME.>>RIGHT. AND IF YOU HAVE A SCENTED
LOTION, IT’S GOT TO BE PRETTY
LIGHT. OF COURSE, WE CAN’T CONTROL
WHAT PEOPLE ARE WEARING IN, SO SOMETIMES THE ROOM WILL BE
SCENTED FROM SOMEBODY THAT WAS
JUST THERE. MY PREFERENCE WOULD BE THAT
HOSPITALS AND ANY HEALTH CARE ENVIRONMENT WAS SCENT-FREE
BECAUSE I DEAL WITH THIS ALL
THE TIME.>>RIGHT.>>AND IT CAN BE QUITE
OFFENSIVE TO PEOPLE, BUT IT’S
NOT RIGHT NOW A REGULATION.>>AND, YOU KNOW, I SENSE THAT
ONE OF THE MORE POWERFUL ODORS
THAT YOU SMELL, YOU KNOW, PERFUME ODORS IS MEN’S UNDERARM
DEODORANT.>>YEAH.>>AND, YOU KNOW, I’VE NEVER
WORN DEODORANT BUT SOMEWHERE ALONG THE LINE I WAS REALLY
EXERCISING A LOT, IT WAS THE SUMMER, I THOUGHT, MAYBE I
SHOULD START DOING THAT. I KNOW I OFFENDED ONE OF THE
OTHER DOCTORS IN MY CLINIC ONE
DAY. AND SHE BLAMED THE OTHER GUY.
AND I QUIETLY DIDN’T TELL HER.
I WILL NOT WEAR — I WON’T — I MEAN, YOU KNOW.
LET YOURSELF SWEAT AND NOT
COVER IT.>>THERE’S A LOT OF SCENTS THAT
ARE BAD. AND, YOU KNOW, I THINK
MODERATION IS KIND OF ONE OF
THOSE KEY THINGS IN THAT SITUATION, TOO. SOME PEOPLE
DON’T PUT ON JUST A LITTLE
PERFUME.>>NO, THEY DON’T.>>IT’S
QUITE OVERBEARING.>>YOU CAN TELL THEY’RE COMING
DOWN THE STREET FROM A HALF A
MILE AWAY. A WOMAN FROM PARKER ASKS, I
HAVE INSTANT HEADACHES THAT COME ON REALLY STRONG AND
INTENSE, BUT DO END AND GO AWAY. DO YOU KNOW THE CAUSE OF THESE?>>SO THERE ARE CERTAIN
HEADACHES THAT CAN COME ON
REALLY SUDDENLY. YOU WORRY ABOUT THE THUNDER
CLAP HEADACHE. NOT WHICH IS MORE OF A CONCERN
BECAUSE YOU DON’T KNOW AT FIRST, IS IT A BLEED IN THE
BRAIN.>>YES.>>FROM AN ANEURYSM OR
SOMETHING. SO WITH YOUR FIRST
ONE, FOR SURE OF THOSE, YOU DEFINITELY SHOULD GO IN AND
GET EVALUATED. BUT THERE’S DIFFERENT TYPES OF
HEADACHES THAT CAN COME ON
REALLY SUDDENLY, LIKE CLUSTER-TYPE HEADACHES COME ON
SUDDENLY, THEY PEAK QUICKLY.>>
YES.>>THEY’RE ONE-SIDED, THEY TEND
TO GET A WATERY EYE, RUNNY NOSE
ON THAT SIDE, THEY’RE VERY SEVERE, THEY LAST
ABOUT 15 MINUTES TYPICALLY. IF YOU EVER WATCH A PATIENT IN
A CLUSTER, IT’S VERY ANXIETY PROVOKING FOR THE PATIENT BUT
ALSO FOR SOMEBODY WATCHING IT. IT’S AN INCREDIBLE AMOUNT OF
PAIN. THERE’S SOME OTHER
HEADACHES THAT COME ON SUDDENLY, LIKE
EXERCISE-INDUCED HEADACHES. SO — AND YOU CAN GET THOSE
WITH ANY SORT OF SUDDEN RELEASE. SO YOU COULD GET THAT WITH A
SNEEZE OR A COUGH OR A SUDDEN
LAUGH. YOU CAN GET THAT WITH SEXUAL
ACTIVITY. YOU CAN GET IT BY
BENDING OVER TO PUT YOUR SHOE ON. OR PICK
SOMETHING UP. ANYTHING THAT COMES ON — YOU
KNOW, SUDDENLY LIKE THAT. AND THOSE HEADACHES SHOULD
ALWAYS BE EVALUATED. BUT THEY CAN ALSO, IF IT’S NOT
SOMETHING EMERGENT THAT
REQUIRES THE EMERGENCY ROOM VISIT AND YOU’VE HAD THEM
BEFORE, THERE’S MEDICATIONS
THAT WORK FOR THAT. AGAIN, A REASON TO GO IN. >>IT WAS INTERESTING, YOU WERE
TELLING US A CASE AS WE WERE
PRESENTING TO OUR PREPROFESSIONAL GROUP EARLIER
ABOUT A PERSON WHO HAD A
PERFORATED CSF PLATE, CSF, THE FLUID AROUND THE BRAIN AND
THE SPINAL CORD WAS LEAKING OUT. AND HE WOULD GET A WORSE
HEADACHE WHEN HE WOULD BEND
OVER.>>RIGHT.>>THERE’S A LOT OF
THINGS THAT YOU NEED TO MAKE
SURE — BECAUSE THAT COULD BE FIXED AND
IT’S A RISK OF INFECTION.>>
RIGHT.>>SO GO IN AND BE SEEN IF
YOU’RE HAVING SOMETHING NEW.>>
RIGHT.>>AND I’M SAYING THAT TO MEN
AND WOMEN, BUT THE ONES WHO REALLY NEED TO HEAR IT ARE THE
MEN. BECAUSE THEY DON’T COME
IN.>>YEAH.>>DO YOU THINK THAT THAT’S A
REAL DEAL?>>YOU KNOW, I THINK THEY’RE
MAYBE A LITTLE LESS LIKELY TO
COME IN. I THINK — SEEMS LIKE OVER ALL
MY YEARS OF PRACTICE, WHICH IS 23 YEARS HERE NOW, BUT I THINK
THE MEN OVER THIS PERIOD OF TIME ARE MORE LIKELY TO COME
IN. I THINK HEADACHES, SPECIFICALLY, IS THOUGHT AS A
WOMAN’S DISEASE BUT I THINK THAT HAS CHANGED SOMEWHAT OVER
TIME. AND, SO, BOTH GENDERS CAN
HAVE IT. THE ONLY WAY IT CAN BE TREATED
IS IF YOU COME IN. MIGRAINE IS ONE OF THE MOST
UNDERDIAGNOSED DISORDERS
BECAUSE PEOPLE DON’T GO IN.>>YEAH. AND I DON’T KNOW, I
HAVE A CASE, MY OWN PERSONAL
CASE, HAVING FLOWN TO A MEDICAL
MEETING WITH MY FAMILY. WE WENT TO BOSTON FOR THIS BIG
DEAL. AND I GET DOWN FROM THE
DEAL, AND I THINK I HAD A LOW-GRADE
SINUS THING, AND I WOULD HAVE
PREVENTED IT, PERHAPS, HAD I SPRAYED MY
NOSTRILS WITH AFRIN OR
SOMETHING BEFORE THE FLIGHT BUT I ENDED UP WITH THE MOST
MISERABLE, TERRIBLE, FOCAL, ONE-SIDED EYE PAIN THAT
WOULDN’T LET GO. AND IT LASTED
20 MINUTES.>>I’VE HAD THAT ACTUALLY
HAPPEN ON A FLIGHT, TOO, EVEN THOUGH THEY’RE PRESSURIZED,
THERE IS THAT PRESSURE CHANGE, YOUR BRAIN, PARTICULARLY THE
TRIGEMINAL NERVE IS REALLY
SENSITIVE TO PRESSURE CHANGE.>>RIGHT. SO WHAT DO YOU DO FOR
PEOPLE WHO HAVE — I MEAN, THAT
WAS PROBABLY A SINUS HEADACHE,
RIGHT?>>IT COULD HAVE BEEN
SINUS, BUT IT COULD HAVE BEEN JUST
FROM THE PRESSURE CHANGE, NOT
JUST FROM THE SINUS. I MEAN, JUST FROM — YOU KNOW
HOW YOU HAVE TO POP YOUR EARS? YOU’VE GOT TO TRY TO POP YOUR
EARS, YOU KNOW, CHEW GUM, DRINK
SOME WATER, OR SOMETHING. THOSE HURT.>>BEFORE I GO ON FLIGHTS, I
BUY AFRIN MAYBE ONCE A YEAR BECAUSE I DON’T USE IT ANY
OTHER TIME BUT BEFORE I GO ON A
FLIGHT I SPRAY IT DOWN. I HATE AFRIN AS A PRIMARY CARE
PROVIDER. I TOLD PEOPLE TO AVOID THEM
BECAUSE IT CAUSES A LOT OF
PROBLEMS. WHAT ABOUT CHRONIC SINUS
HEADACHE PAIN? WE’VE GOT A
QUESTION ABOUT THAT HERE.>>THE INTERESTING THING WITH
CHRONIC, WITH SINUS PAIN, I ALWAYS BACK UP AND SEE WHAT
PEOPLE MEAN BY THAT. USUALLY PEOPLE MEAN IT’S RIGHT
HERE AND THEY’LL CALL IT SINUS.>>AND THEY WANT ANTIBIOTICS.
>>IT CERTAINLY COULD BE SINUS. BUT A LOT OF PEOPLE THAT HAVE
MIGRAINES, THEY’RE DIAGNOSED
WITH SINUS. A LOT OF TIMES SELF-DIAGNOSED.
>>YES.>>I THINK I’VE EVEN READ LIKE
80% OF THE DIAGNOSIS OF SINUS, AGAIN, SELF-DIAGNOSIS ALL THE
WAY THROUGH, IS — IT’S
MIGRAINE. THE REASON IS BECAUSE MIGRAINE
IS IN THAT SAME LOCATION. AND IT’S WORSE WITH WEATHER
CHANGE. YOU KNOW? SO PEOPLE
THINK MAYBE IT’S SINUSES. AND INTERESTINGLY, THE
TRIGEMINAL NERVE, WHICH IS
RESPONSIBLE FOR HEADACHE PAIN, THERE’S A BRANCH THAT GOES TO
YOUR NOSE. AND, SO, YOU CAN
HAVE AS PART OF YOUR HEADACHE SYNDROME HAVE
NASAL STUFFINESS AND CLEAR NASAL DRAINAGE SO THEN YOU
THINK, OH, IT’S SINUSES BECAUSE
MY NOSE IS RUNNING, THEN YOU TAKE SUDAFED OR
WHATEVER, YOU CAN ACTUALLY
REBOUND FROM THAT. SO, IF IT’S A REALLY BAD
THROBBING HEADACHE, AND YOU
DON’T HAVE COLORED NASAL DRAINAGE, YOU HAVE TO BE
THINKING MIGRAINE.>>YOU KNOW, WHEN YOU HAVE
MUCOUS, I MEAN, PUS DRAINING, FEVER, TEETH AND ONE-SIDED
PAIN, OKAY, MAYBE YOU HAVE —
THEY’VE FIGURED IT OUT, ONE OUT OF SIX WOULD BENEFIT
FROM AN ANTIBIOTIC IN THAT
SCENARIO.>>YEAH. AND WE DON’T WANT TO
USE OVERUSE ANTIBIOTICS.>>WE WANT TO AVOID THEM. WE’VE
GOT BUNCHES OF QUESTIONS. THANK
YOU. I HAVE A HARD TIME FALLING AND
STAYING ASLEEP AT NIGHT. IS THIS A NEUROLOGIC ISSUE, IF
SO, WHAT CAN I DO TO FIX IT?>>THE TROUBLE FALLING ASLEEP,
PROBABLY A BETTER QUESTION FOR
YOU. IT CAN BE PART OF A NEUROLOGIC
ISSUE, MORE LIKELY IT’S SOMETHING ELSE AND THEN IT KIND
OF EXACERBATES ANY NEUROLOGIC
ISSUE. WE HAVE SOMEBODY IN OUR GROUP
WHO SPECIALIZES IN SLEEP. SO, PULMONOLOGY ALSO
SPECIALIZES IN SLEEP. THERE’S A BROAD RANGE OF THINGS
THAT CAN CAUSE SLEEP DISORDERS. PSYCHIATRISTS AND PSYCHOLOGISTS
SEE A LOT OF SLEEP. THAT’S A
BIG QUESTION.>>THAT’S A TOUGH ONE.>>YEAH.
>>I WOULD TRY TO AVOID AMBIEN. AND BENZODIAZEPINES, BECAUSE
THERE’S SO MUCH REBOUND. CAN’T
SLEEP. IT’S THE SAME STORY AS THE
HEADACHE. YOU CAN’T GET OFF OF
THEM.>>RIGHT.>>YOU HAVE TO GO HIGHER DOSES,
HIGHER DOSES, YOU BECOME
DEPENDENT ON THEM. I THINK THE BIGGEST THINGS, IN
THE SSRIs, ANTIDEPRESSANT
BECAUSE THEY HAVE THE SIDE EFFECT AND COMMONLY THERE’S AN
UNDERLYING EMOTIONAL, SOMETHING THAT’S GETTING AT
THEM.>>RIGHT.>>AND THE
SSRIs HELP IN THAT REGARD.>>UM-HUM.>>HOW HELPFUL IS
THE AIMOVIG?>>THAT’S THE INJECTION THAT I
WAS TALKING ABOUT.>>WE TALKED
ABOUT IT.>>AND THE STUDIES SHOW THAT IT
DECREASES HEADACHES FREQUENCY BY ABOUT 50%, WHICH
IS FABULOUS IF YOU’RE A CHRONIC
DAILY HEADACHE PATIENT WHICH MEANS YOU HAVE AT LEAST
15 HEADACHE DAYS PER MONTH. SO, AMIVIG IS AN INTERESTING
ONE. IT’S A PREVENTIVE. IT’S ACTUALLY INDICATED FOR THE
CHRONIC DAILY HEADACHE BUT ALSO
EPISODIC HEADACHE. I THINK IT’S GOING TO BE TOUGH
TO GET THAT ONE TO BE COVERED
BY INSURANCE COMPANIES. THERE WERE STUDIES ON IT. IT’S
A GOOD DRUG FOR THAT AS WELL.>>600 PER MONTH.>>PER MONTH.
>>YEAH. CUTTING-EDGE THERAPIST
FOR TINNITUS?>>OH, I DON’T KNOW THAT.
THAT’S A EAR, NOSE AND THROAT
QUESTION.>>NO CUTTING-EDGE THERAPIES
THAT I KNOW. IT’S ONE OF THOSE — I HAVE A
TON OF IT WITH CHEMOTHERAPY. I THINK THERE’S A LOT OF NEURO
— JUST KIND OF A PERIPHERAL NEUROPATHY THAT’S IN
THAT PARTICULAR NERVE. WE JUST
HAVE TO LIVE WITH IT.>>UNFORTUNATELY.>>
UNFORTUNATELY.>>YEAH.>>MAN FROM TEA ASKS, CAN YOU
EXPLAIN TRIGEMINAL NEURALGIA AND TREATMENT OPTIONS FOR THIS?>>SO TRIGEMINAL NEURALGIA, IT
INVOLVES THE SAME NERVE. THE TRIGEMINAL NERVE IS WHAT
PROVIDES SENSATION TO YOUR FACE. AND THERE’S THREE BRANCHES SO,
THE TOP, MIDDLE AND BOTTOM
BRANCH. SO THE TOP BRANCH IS THE ONE
THAT’S RESPONSIBLE FOR
MIGRAINES. BUT YOU CAN ALSO GET TRIGEMINAL
NEURALGIA IN THAT AREA. AND TRIGEMINAL NEURALGIA IS A
SLIGHTLY DIFFERENT SENSATION OF PAIN, IT’S MORE IN YOUR FACE
AS OPPOSED TO YOUR HEAD AND
IT’S A SHARP, SHOOTING, SEARING, VERY BAD PAIN AND IT
TENDS TO BE TRIGGERED BY WASHING YOUR FACE OR TOUCHING
YOUR FACE, BRUSHING YOUR TEETH,
EATING, SOMETIMES DRINKING SOMETHING
HOT OR COLD, WIND CAN DO IT. AND THAT NERVE IS JUST
IRRITATED. AND IT CAN BE BY
DIFFERENT THINGS. SO, THE THERAPIES ARE TO QUIET
THAT NERVE DOWN. GABAPENTIN CAN
HELP. STEROIDS QUIET IT DOWN. >>THE ANTISEIZURE DRUGS, THE
STEROIDS.>>YEAH.>>BUT YOU DON’T WANT TO START
NARCOTICS, YOU DON’T WANT TO
START VALIUM.>>IT’S A RECURRING PAIN THAT
CAN COME BACK AND BACK AND BACK. SO, ANY CHRONIC PAIN SYNDROME,
YOU’RE BEST TO AVOID THOSE. AND USE SOMETHING THAT GETS
MORE TO THE ROOT OF THE PROBLEM. YOU’RE TRYING TO QUIET THAT
NERVE DOWN WITH THE MEDICATIONS THAT HAPPEN TO BE
IN THE ANTISEIZURE CATEGORY.>>WE HAVE A QUESTION FROM
SOMEONE — SOMEONE FROM WEBSTER
WHO’S ASKING ABOUT BACK PAIN, FOUR OR FIVE
OPERATIONS, SCREWS INTO THE
LUMBAR AREA, CAN’T EXERCISE, I’VE BEEN IN SO MUCH PAIN I’VE
LOST TRAIN OF THOUGHT. IT SOUNDS LIKE A SEVERE CHRONIC
PAIN SYNDROME. WHAT DO YOU SUGGEST FOR PEOPLE
WHO JUST SUFFER FROM THIS KIND
OF CHRONIC SURGERY, CHRONIC PAIN, ON AND ON AND ON?>>THERE’S ACTUALLY SPINE
CENTERS AT BOTH OF THE
HOSPITALS BECAUSE OF THIS, LIKE, YOU KNOW, SOMETIMES WE
HAVE FAILED BACK, YOU KNOW,
THEY’VE DONE EVERYTHING, THEY’VE DONE THE SURGERIES AND
FROM THE NEUROLOGY SIDE, WHAT WE DO FOR THAT IS TRY TO SEE IF
THERE’S A PINCHED NERVE. IT SOUNDS LIKE WE’RE KIND OF
PAST THAT POINT THERE.>>YES.>>WE DO THE EMG STUDIES,
NEUROCONDUCTION STUDY, SEE IF WE CAN FIND A PINCHED NERVE
THAT POTENTIALLY NEEDS A
EPIDURAL BLOCK OR MAYBE GO BACK TO SURGERY. A LOT OF THE
PATIENTS WILL END UP WITH
PHYSICAL MEDICINE AND REHAB, BECAUSE IT’S AN ONGOING
REHAB TYPE OF SITUATION SO THEY KIND OF TAKE OVER AFTER
WE’VE CHECKED TO SEE IF THERE’S
ANY PINCHED NERVE.>>THAT’S A TERRIBLE DILEMMA.
>>VERY.>>CHRONIC PAIN. I THINK THE MOST IMPORTANT
THING IS TO TRY TO WEAN OFF OF
MEDICINES AND GET INTO EXERCISE AND IT’S SORT OF LIKE
THE PEOPLE WHO HAVE CHRONIC
PAIN, WHAT IS IT WHEN YOU SQUEEZE EVERY MUSCLE AND
EVERYTHING –>>FIBROMYALGIA.>>NOTHING
WORKS. PUT THEM ON AN SSRI,
AMITRIPTYLINE, GET THEM EXERCISING, TRY TO GET
BACK TO LIFE.>>LIKE THIS PARTICULAR ONE
HERE MIGHT BE IN THAT TOUGH
SITUATION WHERE KIND OF UNABLE TO EXERCISE, YOU KNOW, TO GET
INTO THAT CYCLE. AND I SEE THAT
A LOT IN PATIENTS.>>YEAH, CAN’T EXERCISE.>>SO
I TELL THEM TO DO THAT, I MEAN, IT’S DIFFICULT TO BE
ABLE TO PICK IT UP AND DO IT
BECAUSE IT HURTS MORE. YOU KNOW, AGAIN, THE SPINE
CENTERS AT BOTH PLACES HAVE
PHYSICAL THERAPISTS AND EVERYBODY KIND OF IN LINE TO
TAKE OVER AND HELP THAT.>>I JUST HOPE PEOPLE CAN STAY
PHYSICALLY MOBILE SO THEY NEVER GET INTO THIS
KIND OF SITUATION. HERE IS A STORY ABOUT A
55-YEAR-OLD SEVERE HEADACHE, WEATHER CHANGES TRIGGERS HER OR
HIS PAIN. AND THROBBING AT THE ROOF OF
THE MOUTH WITH THE WORST
HEADACHES. COULD IT BE A STROKE?>>
STROKES DON’T USUALLY HURT. SO
IT’S PROBABLY NOT A STROKE. STROKES ARE MORE NUMBNESS OR
WEAKNESS ON ONE SIDE OF THE BODY OR THE OTHER, TROUBLE
SPEAKING, TROUBLE SWALLOWING,
MAYBE.>>RIGHT.>>BUT NOT SO MUCH PAIN. UNLESS
THEY DISSECTED A ARTERY. SO PAIN IS NOT WHAT COMES TO
MIND FIRST WHEN I’M THINKING OF
STROKE. THAT PAIN, AT THE ROOF OF THE
MOUTH, THAT’S STILL IN THAT
TRIGEMINAL DISTRIBUTION, IT COULD BE A TRIGEMINAL
NEURALGIA, IT COULD BE MIGRAINE. BOTH OF THOSE CAN WORSEN WITH
WEATHER CHANGE.>>YEAH.>>SO MY PATIENTS FOREVER HAVE
TOLD ME THAT WHENEVER A FRONT
IS COMING THROUGH, HIGH PRESSURE OR LOW PRESSURE,
THEY CAN TELL. AND THEN IT WAS
STUDIED, LIKE, IN THE LATE 1990s, AND I WOULD
TELL MY PATIENTS THAT, THEY’RE,
LIKE, OKAY, WHATEVER, WE ALREADY KNEW THAT. IT’S HAVE
A STRONG TRIGGER, YUP.>>SO WE’VE GOT SHORT AMOUNT OF
TIME, A LOT OF QUESTIONS. LET’S
BE FAST. PERSON SLEEPS ON MERE BACK,
GETS BLINDING HEADACHES, LAYING
ON MY RIGHT SIDE, PUTS PRESSURE ON MY HEAD, IT GOES
AWAY EVENTUALLY. WOULD THERE BE
ANY IDEAS?>>THAT ONE I WOULD DEFINITELY
WANT TO SEE BECAUSE THAT’S A COMPLICATED ONE BECAUSE MOST
HEADACHES AREN’T GOING TO BE POSITIONAL BUT YOU WOULD WORRY
LIKE A SPINAL FLUID LEAK OR
SOMETHING, YOU KNOW, SOMETHING AT THE
NECK, PINCHED NERVE OR
SOMETHING.>>ACUPUNCTURE –>>REALLY HELPFUL. I MYSELF
DON’T DO ACUPUNCTURE BUT I SEND PATIENTS FOR
ACUPUNCTURE AND IT’S QUITE
HELPFUL FOR HEADACHES.>>AND DO YOU HAVE ANY CONCEPT
OF WHY IT WORKS?>>I DON’T
KNOW EXACTLY, NOPE. I KNOW THERE’S A LOT OF SCIENCE
BEHIND IT. I DON’T KNOW THE
SCIENCE. BUT I KNOW IT’S TRULY STUDIED,
MEDICALLY STUDIED AND IT’S A
MEDICALLY PROVEN THERAPY.>>FROM, LIKE, POINSETT,
SOMEONE HAS MIGRAINES FOR 50 YEARS AND 15 PER MONTH AND
SHE’S TRIED EVERYTHING. LAST TWO YEARS I’VE TRIED
MASSAGE, EVERYTHING. ALLERGY
SHOTS HAVE HELPED SOME. SUMATRIPTAN HELPS. I CAN ONLY
TAKE SO MUCH SIDE EFFECTS.
BOTOX MAKES ME NERVOUS. I DO SEE A NEUROLOGIST. WHAT
SHOULD I DO?>>SO, IN THIS SITUATION, I
WOULD HAVE TWO THINGS TO SAY. ONE IS THAT NEW CATEGORY OF
MEDICATION JUST CAME OUT. AND THAT’S A TOTALLY DIFFERENT
MECHANISM. VERY FEW SIDE
EFFECTS. THE SECOND THING, WHEN PEOPLE
TELL ME THAT BOTOX MAKES THEM NERVOUS, I TALK TO THEM ABOUT
THE DRUG. IT IS BOTOX, IT’S A
TOXIN. BUT IT’S VERY SAFE. I’VE DONE IT SINCE — ON MY
PATIENTS SINCE 1998. AND I DO, LIKE, TODAY I THINK I
DID EIGHT PATIENTS. I DO IT A
LOT. I’VE SEEN VERY –>>IT WORKS.>>VERY FEW SIDE EFFECTS AND
I’VE SEEN VERY GOOD EFFICACY.
>>VERY GOOD.>>>AND NOW, FOR THE WINNER OF
TONIGHT’S PRAIRIE DOC QUIZ
QUESTION. IT’S MULTIPLE CHOICE, CHOOSE
ONLY ONE. IMAGING, C.T., ON THE HEAD MAY
BE RECOMMENDED IF A HEADACHE IS: A) SUDDEN AND SEVERE. B) FOLLOWS A FALL OF BLOW TO
THE HEAD. C) CAUSES EYE DISCOMFORT. D) A & B. E) A, B, AND C. AND THE ANSWER IS D, WHICH IS A
AND B. IT WASN’T THE EYE. IN OTHER
WORDS, WHICH ONE DIDN’T WORK? AND THE ANSWER IS THE EYE WAS
NOT RIGHT. THE OTHER TWO WAS IMPORTANT
BECAUSE THESE CAN BE BLEEDING. IT WAS CAROL HAAS WHO ANSWERED
THE QUESTION CORRECTLY. THANK YOU, CAROL, FOR
PARTICIPATING AND A BOOK WILL
BE IN THE MAIL TO YOU SOON. WE’LL BE RIGHT BACK AFTER THIS.>>HAVE YOU HEARD? THE PRAIRIE
DOC HAS A RADIO SHOW. LISTEN TO YOUR LOCAL SOUTH
DAKOTA RADIO STATION FOR “A
PRAIRIE DOC CONVERSATION.” THIS PROGRAM FEATURES
PHYSICIANS AND OTHER HEALTH
PROFESSIONALS DISCUSSING VARIOUS MEDICAL TOPICS
IMPORTANT TO YOU AND YOUR
FAMILY. ASK YOUR LOCAL RADIO STATION IF
THEY BROADCAST “PRAIRIE DOC
CONVERSATIONS.”>>THANK YOU FOR LISTENING.
UNTIL NEXT TIME, STAY HEALTHY
OUT THERE, PEOPLE.>>THE WORD “CHRONIC” MEANS
LONG-TERM AND UNRELENTING, NOT SOMETHING THAT GOES AWAY
QUICKLY. ADD TO THIS THE
DESCRIPTOR “PAIN,” AND YOU HAVE CHRONIC
PAIN, WHICH HAPPENS TO TOO MANY PEOPLE IN TOO MANY GUISES.
THERE ARE MANY EXAMPLES. CHRONIC HEADACHES, CHRONIC LOW
BACK PAIN, THE POST-HERPETIC
PAIN FOLLOWING SHINGLES, THE NEUROPATHIC FOOT PAIN OF
DIABETES AND THE BODYWIDE
MUSCLE PAIN OF FIBROMYALGIA, TO NAME A FEW. THE BAD NEWS IS
THAT ONCE A PERSON HAS ONE OF
THESE CHRONIC PAIN SYNDROMES, IT IS
VERY DIFFICULT TO BE RID OF IT,
LIKE AN UNWANTED GUEST WHO NEVER WANTS TO LEAVE. SURGERY
OR MEDICINES, ESPECIALLY
OPIOIDS, TOO OFTEN ARE OF NO HELP AND
SOMETIMES MAKE THINGS WORSE.
EVEN INJECTIONS OF STEROIDS, WHICH ARE INVASIVE, EXPENSIVE
AND OFTEN OVERUSED, ARE USELESS
FOR CHRONIC PAIN. IN THE END, TOO MANY PEOPLE
STILL SUFFER, THE PAIN TAKES CONTROL AND THE PERSON SHUTS
DOWN COMPLETELY, BECOMES INACTIVE, WHICH ONLY TURNS
ATTENTION TOWARD THE PAIN. MOST HELPFUL IS TO UNDERSTAND
THAT IMMOBILITY WORSENS THE
SITUATION. IF A JOINT OR MUSCLE IS NOT
USED REGULARLY, IT BARKS AND BITES WHEN CALLED UPON TO BE
MOVED, WHICH IN TURN RESULTS IN LESS MOVEMENT, MORE PAIN AND
EVEN LESS MOVEMENT. THIS
CASCADE, IF UNSTOPPED, CAN RESULT IN SEVERE DISABILITY
AND MORE TIME TO DWELL ON THE PAIN, OFTEN A
SENSE OF HOPELESSNESS, THE ADDICTION POTENTIAL OF PAIN
MEDS. THIS BECOMES A VICIOUS CYCLE
AND IS EXACTLY THE REASON THEY
SAY, “USE IT, OR LOSE IT!” PARADOXICALLY, VERY OFTEN THE
MOST EFFECTIVE WAY TO BRING
PEOPLE OUT OF SPIRALING, PROGRESSIVE, AND CHRONIC PAIN
IS TO GET THEM MOVING. AGAIN, THE BEST ANSWER FOR
CHRONIC PAIN IS USUALLY NOT
SURGERY OR MORE PAIN MEDICINES. OF COURSE, EACH CASE IS
DIFFERENT, AND SOMETIMES A
TRAPPED NERVE NEEDS RELEASE OR SEVERE INFLAMMATION NEEDS TO BE
RESTED. HOWEVER, OFTEN CAREFULLY MOVING
THROUGH STIFFNESS AND
DISCOMFORT GIVES THE MOST LONG-TERM RELIEF. AS THEY SAY,
“YOU SOMETIMES HAVE TO PAIN TO
GAIN.” ONE PATIENT TOLD ME, “MY BEST
HELP WAS TO ACCEPT THE FACT THAT I HAD TO LIVE WITH SOME
PAIN, GET ON WITH LIFE AND
BEGIN EXERCISING. THE ANTIDEPRESSANTS DIDN’T
HURT, EITHER.” STUDIES SHOW THAT RETURN TO
FUNCTION, ALTHOUGH NOT EASY, IS
THE KEY TO REHABILITATION. CHRONIC PAIN DOESN’T HAVE TO
MEAN PROGRESSIVE IMMOBILITY,
DISABILITY AND HOPELESSNESS. WE SHOULD REMEMBER TO ACCEPT
THE PAIN WHEN WE HAVE TO, AND, WHEN ADVISED BY THE DOCTOR, TO
MOVE THOSE MUSCLES. USE IT OR
LOSE IT. >>>A BIG THANK YOU TO OUR
GUEST, CAROL NELSON, FOR VOLUNTEERING TO COME TO OUR
STUDIO IN YEAGER HALL ON THE CAMPUS OF SOUTH DAKOTA STATE
UNIVERSITY. HER EXPERIENCE WAS KEY TO THE
SUCCESS OF TONIGHT’S PROGRAM. REMEMBER, WE ARE GETTING INTO
THE ANNUAL FLU SEASON. IT REALLY ISN’T TOO EARLY TO
GET YOUR FLU SHOT. TONIGHT’S SHOW WILL CONTINUE ON
“PRAIRIE DOC” FACEBOOK PAGE. WE HAVE ANSWERS YET TO COME.
THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT “ON CALL
WITH THE PRAIRIE DOC,” UNTIL NEXT TIME, STAY HEALTHY
OUT THERE, PEOPLE.>>IT DOESN’T END THE PAIN, IT
JUST MOVES IT TO SOMEONE ELSE. SUICIDE, A BAD CHOICE – NEXT
TIME – “ON CALL WITH THE
PRAIRIE DOC.” >>USEFUL SCIENTIFIC-BASED
MEDICAL INFORMATION DELIVERED
IN A RESPECTFUL AND COMPASSIONATE MANNER. THIS IS
WHAT WE GET FROM THE PRAIRIE
DOCS. I AM PROUD TO SERVE ON THE
BOARD OF THE HEALING WORDS
FOUNDATION. OUR NONPROFIT ORGANIZATION
WORKS BEHIND THE SCENES BUILDING FINANCIAL SUPPORT TO
CONTINUE AND EXPAND PRAIRIE DOC
PROGRAMS. WE THANK THE MANY HEALTH
PROVIDERS WHO VOLUNTEER THEIR TIME TO ANSWER OUR HEALTH
QUESTIONS, SIGNIFICANT FUNDING IS REQUIRED TO PRODUCE AND
DISTRIBUTE VIDEO, RADIO, AND
PRINT THROUGHOUT THE REGION. YOUR DONATIONS WILL HELP THE
FOUNDATION CONTINUE TO OFFER
FREE AND EASY ACCESS TO THE ENTIRE LIBRARY OF PRAIRIE DOC
HEALTH EDUCATION PROGRAMS. I GREW UP WITH RICK HOLM ON THE
PRAIRIES IN DeSMET. ON BEHALF OF THE HEALING WORDS
FOUNDATION –>>ON BEHALF OF A
LIFELONG FRIEND.>>– WE INVITE YOU TO JOIN OUR
MISSION. GO TO PRAIRIEDOC.ORG AND CLICK
THE DONATE BUTTON TODAY. BOTH:
THANK YOU. >>MAJOR FUNDING FOR “ON CALL
WITH THE PRAIRIE DOC” HAS BEEN
PROVIDED BY:>>AVERA IS A PROUD SPONSOR OF
“ON CALL” ON SOUTH DAKOTA
PUBLIC BROADCASTING.>>LARSON MANUFACTURING IS
PROUD TO SUPPORT “ON CALL
TELEVISION” AS IT CONTINUES TO OPEN DOORS
FOR IMPORTANT MEDICAL
INFORMATION.>>AND BY THE SOUTH DAKOTA
FOUNDATION FOR MEDICAL CARE, THE MEDICARE QUALITY
IMPROVEMENT ORGANIZATION FOR
SOUTH DAKOTA.>>AND WITH THE ONGOING SUPPORT
OF THESE INDIVIDUALS AND
INSTITUTIONS…

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