EXPERTISE IN NEUROLOGICAL DISORDERS

KING’S DAUGhtERS MEDICAL CENtER

The human body is a complex system, with specialized structures that work together to allow us to maintain life, think, move and feel. The system that is responsible for transmitting messages from one part of the body to another is called the nervous system.

The nervous system includes the brain, spinal cord, peripheral nerves and related structures. Physicians who specialize in treating diseases and disorders of the nervous system are called neuromedicine

specialists. They include neurologists, neurosurgeons, interventional radiologists, physical medicine/rehabilitation physicians and specially trained

anesthesiologists.

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What is NeuroMedicine?

Neurodiagnostics Lab supervisor Bob Green

Electroencephalography (EEG) – detects electrical activity in the brain. Data are recorded digitally.

Evoked Potentials (EP) – checks the condition of nerve pathways by measuring the electrical signals carried by the nerves in the brain.

Electromyography/nerve conduction study (EMG/NCV) – helps diagnose diseases of the nerves and muscles by recording activity within the muscles.

Electronystagmography (ENG/VNG) – studies the function of the cranial nerves, along with their central connections. Useful in diagnosing vertigo/dizziness.

Quantitative sensory testing (QST) – a painless, noninvasive test to determine the cause and severity of sensory abnormalities.

DiaGNoSiNG NEuroloGiCal DiSorDErS There are a variety of tests to diagnose neurological disorders. King’s Daughters Neurodiagnostics Lab has an experienced, professional staff that performs nearly 6,000 diagnostic tests annually, serving inpatients, outpatients, emergency and surgical patients. Tests include:

Center for Advanced NeuroMedicine

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King’s Daughters Center for Advanced NeuroMedicine brings together physicians and others from across the spectrum to provide the most advanced evidence-based treatment of nervous system disorders.

Our neuromedicine specialists work in collaboration with specialists in many other disciplines, including primary care, emergency medicine, occupational medicine, hospitalists, internal medicine, geriatrics and more.

NEuroloGiSTSNeurologists conduct tests, treat patients medically and are called to consult with other physicians to dertemine the best course of treatment.

A special feature of King’s Daughters Center for Advanced NeuroMedicine is a full-time, dedicated inpatient neurologist.

Neurology

Clockwise from front: Jill Kimm, M.D., inpatient; Douglas Deitch, M.D., outpatient; Kathryn Guggenheim, M.D., outpatient; and Pramit Bhasin, M.D., outpatient

Conditions treated by neurologists include, but are not limited to:

• Alzheimer’s disease and other cognitive impairments (aphasia, dementia, language disturbances)

• Bell’s palsy

• Brain and spinal cord tumors

• Epilepsy and seizure disorders

• Headache disorders

• Injuries to the brain and/or spinal cord

• Multiple sclerosis

• Neuromuscular disorders, such as muscular dystrophy and ALS (Lou Gehrig’s disease)

• Parkinson’s disease and other movement disorders, such as essential tremor, Huntington’s disease, dystonia, balance disorders and multiple system atrophy

• Peripheral nervous disorders

• Sleep disorders

• Stroke

• Trouble speaking, swallowing, breathing or learning

KING’S DAUGhtERS MEDICAL CENtER

Surgical care

MiNiMally

iNVaSiVE aND

CoMPlEx

SurGEriES for

BaCk aND BraiN

The neurosurgical team at King’s Daughters can help patients overcome life-limiting and/or life-threatening conditions using the latest advances in microsurgery, minimally invasive procedures and computer-assisted/image-guided surgery. King’s Daughters Center for Advanced Imaging provides the latest technology in CT, MRI, and PET scanning, allowing our surgeons to take neurosurgery further.

Neurosurgical team members: Kelli Duncan, ORT; Kelly Dalton, RN; Kristi Gresham, ORT; Clark Bernard, M.D., neurosurgeon; Rob Parsley, RN; James Powell, M.D., neurosurgeon; and Bob Hagan, CRNA

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available procedures include:

• Repair of spine fractures, including kyphoplasty

• Disk repair/replacement

• Solutions for spinal stenosis

• Repair of brain aneurysm

• Stereotactic radiosurgery for treatment of brain tumors

• Skull base surgery

• Peripheral nerve biopsies and surgery

• Surgery for stroke, including hemorrhagic and ischemic strokes

• Carotid bypass

• Microvascular decompression surgery

Center for Advanced NeuroMedicine

Transformation: Surgery lets woman smile again

But it hasn’t always been that way. For a dozen years, McDowell, a Catlettsburg resident, suffered from trigeminal neuralgia, a disorder that left her in unbearable pain, afraid to eat, smile, laugh or even brush her teeth.

The trigeminal nerve is the largest of the cranial nerves and is responsible for feeling and movement in the face, including the eyes and upper and lower jaw. Trigeminal neuralgia is often caused by an artery or vein pressing on the nerve. This pressure causes the nerve to fire and, as the disorder progresses, branches of the nerve also become affected.

The pain was intense, McDowell said. “It would come on unexpectedly, like a dull knife being pushed from your gum line through to your eye and ear.

“It was so severe, you just wished to die.” As her pain grew, and her body’s tolerance for pain

medication increased, she was in constant misery. In January 2011, McDowell traveled to Cincinnati and underwent a procedure to destroy part of the troublesome nerve. She got relief, but only for a few months. By summer, the pain was back.

McDowell believes the intense pain was responsible for a flare of her multiple sclerosis, which put her in the hospital for four weeks in September. “I was completely helpless. I couldn’t move either leg or one of my arms. I was heavily medicated and could do nothing.”

Fred, her husband of 45 years, was constantly at her side. On Fridays they shared pizza and listened to Boyd County High School football games on the radio. She dreamed of the day she’d be able to see her grandson Jacob play in person.

It was during this time that McDowell saw a newspaper ad announcing a new neurosurgeon at King’s Daughters – Ondrej Choutka, M.D. The ad noted that Dr. Ondrej treated trigeminal neuralgia.

“I’ve always been told in difficult times to seek God and in painful times to trust God,” McDowell said. “I did a lot of seeking and a lot of trusting,” she said, which brought her to Dr. Ondrej.

In late September, McDowell went home. On Oct. 18, Dr. Ondrej performed a microvascular decompression of the trigeminal nerve. The procedure involves drilling a small hole in the skull, exposing the nerve at the base of brainstem and inserting a tiny pad between the compressing blood vessel and the nerve.

After the surgery, McDowell started to feel relief. It took awhile for the pain to go away completely, she said, but every day was better. Today she is pain free.

She is able to smile, laugh, eat, and enjoy life in a way that was not possible before. “There has just been a tremendous transformation,” McDowell said, “my whole family suffered with this. Now, they have the real me back.”

Nancy McDowell’s eyes begin to sparkle and a smile effortlessly spreads across her face.

Neurosurgeon ondrej Choutka, M.D.

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KING’S DAUGhtERS MEDICAL CENtER

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Many patients with neurological disorders can benefit from rehabilitation therapy. King’s Daughters offers both inpatient and outpatient services.

Our inpatient unit is located within King’s Daughters Medical Center and is accredited by the Commission on Accreditation of Rehabilitation Facilities. To achieve CARF accreditation, a facility must provide at least three hours of therapy every day, which may include physical, occupational and speech therapies, depending on the patient’s particular needs.

The goal of inpatient rehab is to make it possible for the patient to return home as quickly and safely as possible. Our inpatient rehab unit serves about 450 patients annually; of these, about half are recovering from a neurological disorder, including strokes and brain/spinal cord injuries.

The road home...Rehabilitation

ouTPaTiENT ThEraPy MakES a DiffErENCE!

We provide physical, occupational and speech therapy, along with hearing services, at our Outpatient Services Center, 480 23rd St., Ashland. A full range of evaluative, preventive, and rehabilitative services are available to adults and children.

• Physical therapists use therapeutic exercise to help patients regain strength and normal function.

• Occupational therapists help patients regain and improve coordination and skill, with the primary goals of basic self-care, return to work and re-integration into the community. Feeding, dressing and personal hygiene are emphasized.

• Speech therapists evaluate and treat communication challenges, language difficulties, swallowing, voice and fluency disorders.

• Audiologists evaluate and treat hearing disorders, including the patient’s ability to process auditory stimuli.

Center for Advanced Neuromedicine

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Center for Advanced NeuroMedicine

King’s Daughters Center for Advanced NeuroMedicine is pleased to offer state-of-the-art treatment for chronic pain, provided under the guidance of a board-certified anesthesiologist credentialed in interventional pain management.

Our goal is to help chronic pain patients live as full a life as possible while managing symptoms and discomfort. Treatment plans often include physical therapy, nerve blocks/injections, and psychological counseling to reduce stress and anxiety and help the patient cope with pain effectively.

Our program is nationally accredited by the American Academy of Pain Management. This accreditation recognizes pain programs that meet and exceed published quality standards for clinical and administrative operation. These standards, developed by leaders in the field of pain management, require a meaningful commitment to high levels of quality, concern for the patient as an individual who suffers from pain, and the use of outcome measurements to continuously improve quality of care.

Our Spine and Pain Center is an outpatient clinic that offers individualized treatment plans, assists injured employees in returning to work sooner, and helps chronic pain patients live more productive lives.

The multidisciplinary program includes experts in anesthesiology, physiatry, neurology, neurosurgery, psychology, physical therapy, social work and nursing.

The Fifth Vital Sign: Pain

Types of pain that may be treated at the Center for Advanced NeuroMedicine include:

• Acute back or neck injury

• Spinal degeneration

• Cancer pain

• Sciatica

Second opinion consultations also are available.

Anesthesiologist leon Briggs, M.D.

• Nerve injury, carpal tunnel syndrome, repetitive stress injury

• Reflex sympathetic dystrophy (RSD)

• Pain of undetermined origin

KING’S DAUGhtERS MEDICAL CENtER

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TyPES of STrokE A stroke occurs when blood flow to the brain is disrupted. There are two main types: ischemic and hemorrhagic.

An ischemic stroke occurs when a clot blocks blood flow. The clot may occur in the carotid arteries that lead to the brain, or in one of the arteries within the brain itself. Nearly 90 percent of all strokes are ischemic strokes. A transient ischemic attack, or TIA, is a temporary disruption in blood flow. A TIA is an advance warning of a full-blown stroke and should never be ignored.

A hemorrhagic stroke occurs when a blood vessel in the brain ruptures.

During a stroke, time is of the essence. The most effective treatments need to be given quickly, usually within the first three hours of symptom onset. Because the time to act is so limited, it is absolutely critical that people experiencing signs or symptoms of a stroke get to the hospital immediately.

To recognize a stroke, remember

F.A.S.T.Face Does one side of the face droop?

Arms Is one arm weak or numb?

Speech Is speech slurred? Is vision impaired?

Time Stroke is a medical emergency. Call 9-1-1 and get to the hospital IMMEDIATELY.

An ischemic stroke patient loses 1.9 million neurons every minute until treatment begins. That’s the equivalent of your brain aging 3.6 years an hour, every hour, until treatment begins.

Lost brain cells don’t regenerate. That’s why we say “Time Lost is Brain Lost” and emphasize the importance of rapid identification and quick treatment for patients with stroke.

Our NeuroMedicine Team provides education throughout the region – to clinicians, churches, businesses, social organizations, schools – to help people understand the urgency of stroke treatment.

Within King’s Daughters, every one of our team members must complete education on stroke signs and symptoms and know what to do when someone exhibits them. It’s our commitment to provide world-class care, not just in the hospital, but also in every community in which we live, work or play.

Stroke is an eMeRgeNcy!

Center for Advanced NeuroMedicine

King’s Daughters has earned The Joint Commission’s Gold Seal as an advanced primary stroke center. This certification recognizes facilities that follow national standards and guidelines that significantly improve outcomes for stroke patients.

We also have earned the American Heart Association/American Stroke Association’s Get With the Guidelines – Stroke Gold Plus award. This award recognizes King’s Daughters commitment and success in implementing and maintaining adherence to high standards of stroke care.

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The most important factor in successful treatment of stroke is rapid intervention … and the people who have the most control over this are the patient and family. Stroke symptoms must never be ignored. Even a TIA must be reported and treated promptly.

Clot-busting medications Clot-busting medications, such as tPA, are only effective if they are administered within three hours of the time symptoms began. While administering clot-dissolving agents is complex, they can significantly reduce the effects of stroke and reduce permanent disability. Unfortunately, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment.

Merci retrieval Restoring blood flow to the brain is the primary goal in treatment of an ischemic stroke. The Merci Retrieval System available at King’s Daughters gives physicians an additional tool. The Merci system is a minimally invasive, catheter-based system designed to retrieve and

remove blood clots.

iNNoVaTioNS iN STrokE CarE

The Merci Retrieval System

Interventional radiologists Pho Nguyen, M.D., and

Paul Wesley lewis, M.D.

KING’S DAUGhtERS MEDICAL CENtER

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Advanced NeuroMedicine Physicians

King’s Daughters offers specialized nursing units and specially trained nurses dedicated to caring for neuromedicine patients. This specialization results in improved patient outcomes, fewer complications, and quicker return to independence.

Our NeuroScience Care Unit specializes in caring for patients who:

• are recovering from stroke

• have undergone neurosurgical procedures

• have neurological disorders such as seizures, vertigo, epilepsy or Parkinson’s disease

• patients who have been stepped down from critical care

Following a neurological event, patients may benefit from intensive rehabilitation. King’s Daughters CARF-accredited inpatient rehabilitation provides a comprehensive range of services to help patients regain functionality and return to the most independent life possible. Services include:

• Physical, occupational and speech therapies

• Audiology

• Nursing care

• Social workers and counselors to help patients and families cope with life changes

In the Hospital – Physicians and Nursing

Dr. Bhasin

Dr. Guggenheim

Dr. Bernard

Dr. Kimm

Dr. Akers

Dr. Hussain Dr. Lewis

Dr. Briggs

Center for Advanced NeuroMedicine

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NEUROLOGIStSKing’s Daughters Medical Specialties - NeurologyPramit Bhasin, M.D. Douglas Deitch, M.D. kathryn Guggenheim, M.D. Jill kimm, M.D. (inpatient only)Medical Plaza A | 617 23rd St.Suite 5 | Ashland, KY 41101(606) 326-0300

Wilma Castro, M.D. Medical Plaza A | 617 23rd St. | Suite 12Ashland, KY 41101 | (606) 326-1557

henry Goodman, M.D.2301 Lexington Ave. | Suite 300Ashland, KY 41101 | (606) 329-2823

NEUROSURGEONSKing’s Daughters Medical Specialties - Neurosurgical Specialists Clark Bernard, M.D.ondrej Choutka, M.D. Medical Plaza B | 613 23rd St. | Suite G20Ashland, KY 41101 | (606) 329-1770

Tri-State Christian Neurosurgical AssociatesJames S. Powell, M.D.Medical Plaza A | 617 23rd St. | Suite 15Ashland, KY 41101 | (606) 324-7737

PhySICAL MEDICINE & REhAbKing’s Daughters Medical Specialties - Physical/Rehabilitation MedicineScott akers, M.D. 5425 North Mayo Trail | Suite 202Pikeville, KY 41501 | (606) 432-2269Also practicing in Paintsville, Ky.

Diana hussain, M.D. 336 29th St. | Suite 301 Ashland, KY 41101 | (606) 329-2155Also practicing in Grayson, Ky.

King’s Daughters Spine & Pain CenterMedical Plaza A | 617 23rd St. | Suite 8AAshland, KY 41101 | (606) 408-PAIN (7246)Dhruv Pandya, M.D.ushma Patel, M.D.

RADIOLOGy - INtERvENtIONALTri-State Vascular SpecialistsPaul Wesley lewis, M.D.Pho Nguyen, M.D.617 23rd St. | Suite 140 Ashland, KY 41101 | (606) 326-1675

INtERvENtIONAL PAIN MANAGEMENtKing’s Daughters Spine and Pain Centerleon Briggs, M.D.Medical Plaza A | 617 23rd St. | Suite 8A Ashland, KY 41101 | (606) 408-7246

Dr. Castro Dr. Deitch Dr. GoodmanDr. Choutka

Dr. PowellDr. PatelDr. PandyaDr. Nguyen

kdmc.com/neuromedicine

The Center for Advanced NeuroMedicine 617 23rd Street | Medical Plaza A | Suite 8AAshland, KY 41101 | (606) 408-PAIN

To request an appointment with The Center for Advanced NeuroMedicine at King’s Daughters Medical Center, please call 1-888-377-KDMC (5362) or call (606) 408-PAIN.

Visit us online at kdmc.com/neuromedicine