As I write this blog, I am on an Amtrak train on my home to New York.  I have spent the last several days in Washington, D.C. at the American Headache Society Annual meeting.  There are many exciting new developments in our understanding of the biology and genetics of headache and migraine, and some new drugs on their way to market and several that show promise in early clinical trials.  But what fascinated me the most and seemed to be the best news was the apparent slow shift in neurology toward the acceptance of non-pharmacological therapies for the treatment of headaches.  The future looks bright indeed!  Several presentations involved the growing use and acceptance of alternative and non-pharmacological treatments by neurologists who treat headache.  And couple even reported on the use of mobile apps to track headaches and medications and how they impact/improve care. 

This last point is particularly interesting to me as I have been working on a new website and apps that will connect patients with their physicians, and allow patients to use the apps for meditation and other tools, as well as tracking tools that integrate directly with the website. The first of our apps, HealthyUgo's Headache HUG, is now available on the apple i tunes store. For those of you with headaches, we think you will find this app to be a very helpful way to meditate and decrease the frequency and severity of your pain. Finally, I was very pleased and surprised to see all the work and research that has been done regarding the correlation between childhood abuse (of any nature) and chronic pain or headaches as an adult. This is often overlooked by clinicians and even I have struggled with learning how to approach the subject with patients. Incredibly, even the basic biology of how the brain changes as a child due to stress is now better understood and lays the groundwork for adding forms of psychotherapy for some patients with chronic pain and headache. We will be increasing our screening for this at neurOasis and utilizing our on site psychologist much more in the coming months. It's often all about how we behave, and it appears that medicine is starting to get its act together!

Anxiety is a wicked animal.  It can be subtle and insidious.  It can be associated with depression.  It can hit you like a freight train and turn your life upside down.  I know this as a physician and as a patient.  Yes, I do have anxiety - at times quite bad.  I never experienced it or anything in the "psychological spectrum" of illnesses until I was in my early 40's.  Wow.  That first episode was quite the eye opener.  I think God or whoever controls the universe has given me anxiety episodes so that I better understand what my patients go through.  It has worked, believe me.  Stress, of course, is pervasive in our society - and we all go through it, but generally we have developed coping mechanisms as adults and can manage.  I am talking about a very different condition, which for any of you who have had it, knows.  First, anxiety is a MEDICAL condition.  It is orchestrated by our brains, through neurotransmitters and neurons in two major brain networks:  the limbic system and the temporal lobe. 

Here's the thing about anxiety:  it can be easily managed and treated, but only if recognized by both the patient and the physician.  And it must be managed in the context of the patient's life circumstances and any other conditions the patient may have.  This is particularly true for pain or headache.  We know, from a scientific perspective, that the brain in an anxious state will react to pain signals differently than a brain in a calm state.  Read that sentence again and let it sink in.  How incredible!  Our fantastic brains are the control centers of everything in our bodies AND our minds; our consciousness and reality.  So, if an anxious brain that is not working properly can make pain worse, wouldn't the natural answer be to reduce anxiety as a first step in treatment?  The answer, indeed, is yes.  There are many ways this can be done, and one of my favorites is meditation.  I have practiced it for many years now and can tell you that it works very well.  The, key to success is learning how to meditate and being patient as the process slowly works its magic.  Meditation has been in existence probably as long as civilized society, and it can be approached from many different angles.  In coming blogs, I will be talking about the different ways to meditate and how this process might actually be working on our brains to modify neural networks and change the chemical processes that drive the most inner workings of our magical, beautiful brains.

I suspect that often patients forget that physicians go to see their own doctors for various reasons, and often end up waiting one or two hours to see them.  So, when you come to see one of us at neurOasis and we are running behind, believe me when I tell you that it stresses us as much as it does you.  Why does it happen?  Why can't we just organize the schedule to accomodate everyone on a timely basis.

Unfortunately, that is a dream, an unobtainable goal for most physicians.  The harsh reality is that we must pack our schedule tightly and hope the every patient comes on time and no unexpected crises ocurr during the session that will throw our timing off.  Actually, I am always in the office one or two hours before I see patients, so it is clearly not an issue of getting out of bed.  The problem is that medicine practices, as businesses, are forced to see a certain amont of patients in order to receive enough reimbursements to cover our costs such as rent and payroll.  Consequently, it is very easy for the timing of the sessions to get thrown off for a variety of reasons.  Perhaps a patient comes 15 minutes late for an appointment that has only been aloted 15 minutes.  I try my best to squeeze the patient in but sometimes have to turn them away if I am already running behind because they will just compound the situation and it is not fair to patients who came on time. 

I wish fervently that I could decompress my schedule and not have to be in a constant start of 4 shot latte caffeine craziness just to get through the day.  But to do that, I would have to drop most insurances and only take cash or credit card. That gets expensive and I believe in the right of all patients to have access to quality health care. 

For those of you who have had to wait more than an hour to see me, I apologize and thank you for your patience.  I also hope the wait was worth it.  I guess I am blogging about this because I want my patients to see the back side of our organization - we really do try our best to schedule patients so they will have as little wait time as possible. We are always thinking of new ways to do that and promise you that we will continue to evaluate our process and make changes whenever appropriate.