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Novalis TX is a linear accelerator utilizing high dose radiation to treat both intracranial and spine pathology.  Intracranial applications primarily include trigeminal neuralgia, tumors, craniopharyngiomas, hamartomas, epilepsy, and vascular malformations.  Spinal applications primarily include tumors and vascular malformations.

Like other stereotactic radiosurgical systems, Novalis TX offers a noninvasive way to treat pathology with ~1.5mm accuracy in an outpatient setting.  Unlike other systems such as Gamma Knife or Cyberknife, Novalis TX may have certain advantages.  Intracranial lesions can be treated using a stereotactic frame, or as a “frameless” procedure using a sophisticated image guidance system.  Additionally, extracranial applications exist, and the body may be treated circumferentially.  Probably the most unique attribute is the ability to treated lesions with a very conforming homogenous dose and sharp drop-off dose to surrounding tissue.  Numerous collimator options allow the radiation to be delivered in the traditional cylindrical fashion, or as a conformational beam, dynamic conformal arc, or IMRT.  This allows physicians to accurately treat non-spherical lesions with limited exposure outside the target.  Furthermore, the avoidance of purely cylindrical cones limits overlap of isocenters that produce “hot zones”, or non-uniform radiation doses within the target itself.

At the Medical Center of Aurora, we are thankful to have a Novalis TX on campus at the Rocky Mountain Cancer Center.  This technology is just another way our radiation oncologists, physicists, medical oncologists, and surgeons are able to provide the best cancer treatment to our patients.  Both Dr Adam Smith and John Oro are trained and certified in Novalis TX treatment.  Please contact our office today for more information at 303-481-0035.

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Heat Stroke

HEAT STROKE– is generally defined as the inability of the body to cool down after physical activity. Persons most at risk for heat stroke include the very young child, elderly, persons who work outdoors in the heat, and persons who exercise in the heat of the day. Obesity can increase the risk of heat stroke. Persons who take certain medications, such as diuretics, blood pressure pills and diet pills are also at higher risk.        

The symptoms of heat stroke include: chills, weakness, dizziness, extreme muscle fatigue, nausea, shortness of breath, rapid heart rate, confusion and absence of sweating. If you feel these symptoms, stop activity immediately, drink water, rest in a cool place, and seek medical attention immediately if the symptoms persist. If left untreated, heat stroke can lead to damage to the kidneys, and other organs. True heat stroke is a medical emergency and treatment (call 911) should be sought immediately.        

 Take these precautions to help prevent heat stroke:

  • Drink at least 8-12 ounces of water- both before and after exercise. Take a full water bottle with you when you exercise, so it is readily available.
  • Drink electrolyte solution before and after extreme/strenuous exercise
  • Avoid drinking caffeine or alcohol
  • Wear light colored, loose clothing. Wear clothing appropriate to the temperature
  • Wear clothing with SPF >20
  • Stay out of direct sunlight if possible. If you feel yourself becoming too hot, rest in the shade and drink water
  • If possible, exercise early in the morning or late in the evening- avoid the heat of the afternoon.
  • Humidity decreases the ability of the body to cool down- exercise indoors during high humid times.
  • Do not participate in sports or exercise if you have a fever or upper respiratory infection
  • Remove helmet/padding and any excess clothing immediately if symptoms of heat exhaustion are noted
  • NEVER leave a child or pet in a hot car for any length of time– this can be life-threatening

 

 

 

Epilepsy Surgery

The surgical treatment of epilepsy is a valuable option for well-selected patients.  Patients who are not adequately treated with medications, who are proven to have a localized seizure focus, and who can accept the risks and consequences of surgery are candidates for surgery.  The most common location of seizure focus in adults is in the temporal lobe, where surgical removal is associated with a seizure-free rate of ~60-70%.  This patient population with temporal lobe epilepsy (TLE) has the greatest success rate from surgery.  A large study comparing surgery versus treatment with medications for TLE showed that 58% of the surgically treated patients were free of disabling seizures compared to 8% of the patients treated with medications alone.  However, treatment with medications is still first-line and surgery is reserved for intractable cases.  Most patients recover extremely well after surgery, including patients undergoing temporal lobectomy, with little disability attributable to the procedure.

Primary generalized (idiopathic) epilepsy is rarely aided by surgery, although vagal nerve stimulation (VNS) is an option.  Generalized epilepsy occurs when multiple different areas of the brain exhibit seizure activity, so no single area can be resected to decrease the seizures.  VNS involves placing an electrode around the vagal nerve, usually on the left side.  The theoretical mechanism of VNS is alteration of diffuse signals throughout the brain to suppress the generalized spread of seizure activity after it starts.

Other surgical treatments are tailor-made for specific problems.  Corpus callosotomy (CC) is used to stop the transmission of seizure activity from one side of the brain to the other.  Patients who suffer seizures that spread from one side to the other may suddenly fall to the ground during their seizure leading to a high risk for injury.  CC prevents this spread of seizure activity.  Hemispherectomy is a term used when the patient’s entire half of the brain is removed, or “disconnected” from the rest, when the entire side is dysfunctional due to widespread seizures.  Both CC and hemispherectomy are rare procedures used for very carefully selected patients.  Multiple subpial transection (MST) is another procedure that is used in carefully selected patients who have seizures that start in important areas of the brain that cannot otherwise be removed without causing extensive neurologic dysfunction.

New epilepsy research focuses on computer devices that are implantable.  These systems, such as Neuropace, use a computer to detect the very first signs of a seizure and then give a localized electric shock (similar to a cardiac defibrillator) to the part of the brain where the seizure is starting.  This then stops the seizure activity before it can spread to other areas of the brain.  Other implantable devices use a similar computer to detect the first signs of a seizure and then release an anti-seizure medication directly into the brain to disrupt the seizure activity.  These devices are still in early trials.

For a patient evaluation or possible surgical treatment of epilepsy, please call The Neurosurgery Center of Colorado at 303-481-0035 to make an appointment with Dr. Adam P. Smith, MD.

HEAT EXHAUSTION- blog

The temperature in Denver broke several records in June this year.  This is a sure sign that summer has arrived. If you are among the millions of persons who spend time outdoors during the summer, you need to be aware of the dangers of excessive heat exposure. Persons who work out in the sun every day (such as roofers, construction workers, road repair and lawn maintenance) are at higher risk for heat related health problems.

Heat Exhaustion is an illness that is directly related to exposure to high temperatures for an extended period of time. Persons at higher risk for heat exhaustion are those who exercise in the sun or during the highest temperatures of the day, and those who work outdoors in the heat daily. The main reason people experience heat exhaustion is due to dehydration (not enough fluid).

The common symptoms of heat exhaustion include muscle cramps, dizziness, headache, light-headedness, nausea, sweating and fast heart beat.

Ways to avoid heat exhaustion include:

  • Drink plenty of water- try to drink at least 8 ounces every 30 minutes
  • Avoid alcohol or caffeinated beverages
  • Wear sunscreen with a minimum SPF 30- reapply frequently
  • Wear a wide brim hat
  • Rest under shade or in a cool place every few hours
  • Wear clothing with SPF rating >20
  • Wear light color, loose fitting clothing
  • Avoid strenuous outdoor activities during the peak heat hours of the day

If you feel you have the symptoms of heat exhaustion, you need to take the following measures immediately

  • Move out of the heat to a cool area- in a shady spot or indoors with a fan or air conditioner
  • Drink plenty of water- do not drink beverages with caffeine or alcohol
  • Remove clothing that is damp
  • Take a cool shower
  • Wrap a cool towel around your neck

If the symptoms do not improve within 30 minutes of taking the above cooling measures, seek medical attention. Heat Exhaustion that is untreated can lead to Heat Stroke— check for future blogs on heat stroke

Gluten is a protein compound that is found in most grains, including wheat, barley, and rye. Some form of gluten is also found in other foods such as white rice, oats and corn. Gluten is the substance that can be mixed with flour that helps give the texture and consistency of breads, crackers and some pasta. There can be small amounts of gluten in many other processed foods such as cereal, sauces, salad dressings, candy, processed meats, and condiments. Beer and many other alcoholic beverages also contain gluten. The best way of knowing if the food you eat contains gluten is to read the label carefully.

How do you know if you are gluten sensitive? One way of helping to determine if you are sensitive to gluten is to try a strict gluten-free diet for at least 3 months. As more people are becoming aware of gluten sensitivity, there are a wider variety of gluten-free products available. However, read all of the labels carefully, as some products may say “gluten free”, but can still contain a small amount. Be aware that many sauces, canned products and condiments contain small amounts of gluten. One easy way of avoiding gluten completely is to limit any processed food and stick with lean meat, fish, fruits, vegetables, nuts and berries (read more about the Paleo diet). While you avoid gluten, keep a food diary that includes your symptoms (or lack of symptoms). After 3 months, review the diary with your health care provider and discuss if your symptoms have improved.

SYMPTOMS of gluten intolerance include (but are not limited to):

  • Abdominal bloating/cramps/ pain
  • Diarrhea and/or constipation, nausea and vomiting
  • Fatigue
  • Weight  gain
  • Hair loss
  • Skin rash- called Dermatitis Herpetiformis- itching, blisters, redness
  • Depression and mood problems
  • Headaches
  • Joint pain/generalized muscle pain

What foods contain gluten?—most processed foods contain gluten unless stated otherwise on the label

  • Breads/cereals/pasta/tortillas
  • Candy
  • Ice cream
  • White rice
  • Pretzels, chips, pizza
  • many sauces, gravy, soy sauce and salad dressings
  • Beer and several alcoholic beverages
  • Cakes/cookies/pancakes
  • Processed meats (sausage, hot dogs, lunch meat, etc) and some cheese
  • Flavored milks (such as chocolate milk), and some soda such as root beer
  • Some additives in vitamins and supplements

 

The easiest way to avoid gluten is to avoid processed foods and stick to

lean meat, chicken, fish, fruits, vegetables, nuts and berries!

Almost every profession has a language mixed with abbreviations and acronyms that is uniquely theirs. Medicine is filled with confusing terms and abbreviations that are often difficult to interpret. It is important to understand what your provider means when he/she uses terms that you do not understand. Below are some common medical abbreviations and acronyms.

One of the most important things you can do when talking with your provider

is to ask questions when you do not understand!

  • ADA- American Diabetes Association, or can also mean Americans with Disabilities Act
  • AED- Automated External Defibrillator- used by many paramedics and fire departments to start the heart when doing CPR
  • AMA- against medical advice. This typically refers to doing something (like leaving the hospital) against the advice of the provider.
  • BID- two times per day (the provider may write to take Tylenol BID or twice daily)
  • BP= blood pressure
  • CPR- cardio pulmonary resuscitation- chest compressions and passive breathing when a person has a heart attack
  • DO- Doctor of Osteopathic Medicine
  • ED- Emergency Department, or Emergency Room
  • ESI- Epidural Steroid Injection- this is a procedure in which medications such as steroid and a numbing medicine is injected into the back or neck for pain control.
  • ETOH- drinking alcohol- such as beer, whiskey, vodka. It is imperative that your health care provider knows what and how much ETOH you drink
  • FMS- fibromyalgia syndrome
  • GI- gastrointestinal- refers to the stomach/intestine/bowel/gallbladder
  • HR- heart rate or pulse
  • LP- Lumbar Puncture- procedure that involves a needle puncture in the low back to draw spinal fluid
  • MA- Medical Assistant (or Medical Office Assistant)- generally works in the office and helps with vital signs and updating medication lists. An MA cannot give out medical advice unless specifically instructed to do so by a provider.
  • MD- Medical Doctor. This is the degree most physicians will complete.
  • Meds- medications. It is important to carry a current list of all medications you take regularly, including the dose
  • MI- myocardial infarct- or heart attack
  • MVI- multivitamin
  • NPO- nothing by mouth. This is typically recommended by the provider before surgery or procedures.
  • PCA- patient controlled analgesia- this is a machine that is used after many surgeries for control of pain. The patient can push the button on the machine and administer their own dose of pain medications.
  • PCP- primary care provider- this is the provider who manages your general health
  • PO- by mouth. Often written as “take 2 tablets po”.
  • RN- Registered Nurse. This is a health care professional with a college degree and a license to practice nursing.
  • SOB- shortness of breath- used to describe someone who appears to have difficulty breathing.
  • TIA- Transient Ischemic Attack- this is typically a brief episode that can lead to a stroke if untreated.
  • TID- Three times per day- the prescriber may write to take ibuprofen three times per day.
  • UA- urinalysis
  • UTI- urinary tract infection

If you don’t understand what your provider is saying—ASK!

Dr Harvey Cushing is considered one of the father’s of Neurosurgery in the United States.  Dr Cushing was born in Ohio in 1869. He graduated from Yale University with a degree in Medicine in 1895. He completed his training at Johns Hopkins Medical Center and studied Neurosurgery in Liverpool, England. He then returned to the United States to practice Neurosurgery at Johns Hopkins.

One of the innovations that Dr Cushing was responsible for was the use of a mercury tube that attached to a cuff used to measure blood pressure from the patient’s arm. This was quite a revolution at the time, as no one had previously measured systolic blood pressure in this manner.

Dr Cushing was a prolific writer and authored several manuscripts on the brain and central nervous system. He also studied pressure in the brain and blood pressure during surgery. One of the most important contributions from Dr Cushing was the study of the pituitary gland, and his findings that were published in 1932.

Dr Cushing was a pioneer in the surgical treatment of brain tumors, and developed several instruments that are still used in Neurosurgery today. He helped to develop the use of electorcautery instrument, and was one of the first to use x-ray in the diagnosis of brain tumors. He developed many of the surgical techniques that are still in practice today.

The United States Postal Service created a postage stamp in 1988 honor of Dr Cushing- the stamp cost was 45 cents.

Gluten is a protein compound that is found in most grains, including wheat, barley, and rye. Some form of gluten is also found in other foods such as white rice, oats and corn. Gluten is the substance that can be mixed with flour that helps give the texture and consistency of breads, crackers and some pasta. There can be small amounts of gluten in many other processed foods such as cereal, sauces, salad dressings, candy, processed meats, and condiments. Beer and many other alcoholic beverages also contain gluten. The best way of knowing if the food you eat contains gluten is to read the label carefully.

How do you know if you are gluten sensitive? One way of helping to determine if you are sensitive to gluten is to try a strict gluten-free diet for at least 3 months. As more people are becoming aware of gluten sensitivity, there are a wider variety of gluten-free products available. However, read all of the labels carefully, as some products may say “gluten free”, but can still contain a small amount. Be aware that many sauces, canned products and condiments contain small amounts of gluten. One easy way of avoiding gluten completely is to limit any processed food and stick with lean meat, fish, fruits, vegetables, nuts and berries (read more about the Paleo diet). While you avoid gluten, keep a food diary that includes your symptoms (or lack of symptoms). After 3 months, review the diary with your health care provider and discuss if your symptoms have improved.

SYMPTOMS of gluten intolerance include (but are not limited to):

  • Abdominal bloating/cramps/ pain
  • Diarrhea and/or constipation, nausea and vomiting
  • Fatigue
  • Weight  gain
  • Hair loss
  • Skin rash- called Dermatitis Herpetiformis- itching, blisters, redness
  • Depression and mood problems
  • Headaches
  • Joint pain/generalized muscle pain

 

What foods contain gluten?—most processed foods contain gluten unless stated otherwise on the label

  • Breads/cereals/pasta/tortillas
  • Candy
  • Ice cream
  • White rice
  • Pretzels, chips, pizza
  • many sauces, gravy, soy sauce and salad dressings
  • Beer and several alcoholic beverages
  • Cakes/cookies/pancakes
  • Processed meats (sausage, hot dogs, lunch meat, etc) and some cheese
  • Flavored milks (such as chocolate milk), and some soda such as root beer
  • Some additives in vitamins and supplements

The easiest way to avoid gluten is to avoid processed foods and stick to
lean meat, chicken, fish, fruits, vegetables, nuts and berries!

Cervicogenic headache is a common type of head pain that occurs in approximately 2.5% of the U.S. population. Occipital (back of the head) headaches generally occur from problems in the neck, especially the upper part of the neck. The pain originates in the neck, but it can radiate up to the head and cause head pain- called cervicogenic headache.

The headache usually radiates from the neck to the occipital area (back of the head), to the temples, or around the eyes. It can be on one side of the head (unilateral) or both sides (bilateral). The pain is often described as dull, aching, and is aggravated with head/neck movement . Poor posture, looking up, or looking down for long periods of time can trigger or worsen the head pain. Some people who have desk jobs or look up or down for long periods of time can have cervicogenic headache. Generalized muscle tension can also result in headaches that radiate from the neck up to the head.

The pain of cervicogenic headache can be due to problems in the neck, such as cervical discs disease, facet joint degeneration (arthritis), ligaments that become less stretchy, or from muscular spasm. The pain can come from any area of the neck, but commonly originates from the upper ( C2-3, C3-4) joints or discs.  Pain can also occur from unstable areas in the upper two joints (atlanto-occipital and atlanto-axial joints), and is called “atlanto-axial instability”.

Common causes of Cervicogenic headache can include:

Degenerative changes: or age-related changes in the cervical discs or joints

Kyhposis -reversal of cervical curvature

Whiplash injury

Nerve compression– typically from a herniated cervical disc that puts pressure on a neck nerve

If you think you have cervicogenic headache or other neck problems, the providers at the Neurosurgery Center of Colorado may be able to help. Call today for an appointment for evaluation.

Concussion

CONCUSSION– is a very common injury related to contact sports. Most athletes who participate in contact sports (such as football, soccer, rugby, etc) run the risk of concussion. A Concussion is a mild form of head injury that occurs from the brain being rapidly shifted back and forth within the skull. A concussion can range in severity from very mild to severe (with loss of consciousness). Symptoms of concussion can include dizziness, poor coordination, speech changes, memory and concentration difficulty, vision changes, nausea, confusion, and drowsiness. Anyone who sustains a head injury with loss of consciousness should be evaluated by a medical professional immediately after the event. In most cases, a CT scan or MRI will be done to rule out a blood clot. In some cases, the symptoms of concussion may take several days to appear. The effects of concussion (post-concussion syndrome) can last many months, and include memory problems, chronic headache, irritability, mood swings, dizziness, and lack of energy.              

  Take these precautions to help avoid concussion:

  • Always wear appropriate head protection when playing football or contact sports
  • Make sure the helmet fits well- get a new helmet if the old one is too small or too big
  • Always wear a helmet when riding a bicycle or motorcycle, horseback riding, skating or skiing
  • Always wear a batters helmet when playing baseball or softball
  • Wear appropriate mouth/jaw/ear protection when wrestling or boxing
  • Always wear your seat belt in the car and secure young children appropriately
  • Avoid hitting the ball with your head while playing soccer

If you or someone you know is hit in the head and loses consciousness (passes out)- call 911 for emergency help immediately.