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Melanie Cole (Host): Each year more than six million Americans are diagnosed with a neurological disorder. In fact, more than 144 million Americans are or will experience a neurological disorder at some point, and this number is expected to rise as our population ages. At Our Lady of Lourdes Medical Center and Lourdes Medical Center of Burlington County, neurologists are available to diagnose and treat a wide variety of neurologic conditions. Here to help us with some red flags that it might be time to see a neurologist is Dr. Sean Hubbard. He’s a neurologist and a neurohospitalist at Our Lady of Lourdes Medical Center. Welcome to the show, Dr. Hubbard. So what type of conditions do neurologists typically treat?

Dr. Sean Hubbard, DO (Guest): Neurologists treat conditions that have a lot to do with – tends to be things that we take for granted like just walking and being able to see straight, talking, enjoying a pain-free existence, and even sleeping all the way through the night. So, we tend to see people when they have problems in one of these areas.

Melanie: What diseases do you typically see? Are we talking about movement disorders or Parkinson’s, and MS? What do you see?

Dr. Hubbard: Well, personally, I'm a neurohospitalist. So, I tend to see people that have abrupt changes in their usual function and so these tend to be diagnoses like stroke. This is the number one cause of disability, particularly in adults. I see people with seizures. Most of the times, we enjoy a nice, alert wakefulness, but if a person suddenly passes out, then it means they could be having a seizure. So, I see people that have seizures. I see people that have abrupt falls and even changes in mental function. So, a person may be suddenly forgetful, suddenly have difficulty talking or sudden difficulty walking. Tends to be stroke, seizure, just passing out due to a fainting episode, like due to a cardiac problem, and then because we see people of more advanced age, we tend to see problems that are degenerative as well. Problems with memory and movement disorders like Parkinson’s and Alzheimer’s disease.

Melanie: So, then let’s start with something that many people experience: headaches. At some point usually due to tension or perhaps a mild illness like a cold, many people get headaches and when is a headache something that you say, okay, this is enough, now. I need to go see somebody about this?

Dr. Hubbard: So, you're right, Melanie. You mentioned that headaches are a common phenomenon, but I would say that people should seek attention when there is a change in the headache pattern. So, all of a sudden, now, whereas we used to get headaches maybe let’s say, once a month or only when we’re tired or only if we’re hungry, but now we’re getting headaches that are lasting for longer periods. They don’t respond to the same medications that they used to, and they're interrupting our lifestyle in a way that they hadn’t before, and so we usually classify these as headaches of a first type. So, headaches of a f first type – they’ve changed our lifestyle; they don’t respond to medications that they used; they last longer. Another category of headache that we should seek evaluation for is headaches that are associated with other neurological problems. Let’s say you get a headache and visual loss or headache and you can’t talk. You get headache, and you get weak on one side or some other neurological dysfunction, and then, finally, another headache that we should seek attention for is when you have the worst headache that you’ve ever had. So, you may be used to having headaches if you don’t get your coffee in the morning, but now these headaches are really crazy in terms of being the worst. So, we categorize these as the first of a type, the worst of a type and cursed. Cursed meaning it’s associated with other neurological symptoms.

Melanie: Which could possibly be stroke? Yes?

Dr. Hubbard: That’s right. That’s right. So, we always are concerned of stroke when a person suddenly has new problems: the worst headache of their life. We’re generally concerned of not only stroke but a certain type of stroke whereas arteries break and lose their integrity, and it generally means that there may be a bleed.

Melanie: So, when you mention things like vision problems or difficulty thinking, all of a sudden you can't really come up with the words, or you can't remember something, what might that signal and when does something like that because we all have our what we used to call “senior moments”, right, where you forget something, but when is that kind of thing something that you say, well, this could be really something I need to have checked out?

Dr. Hubbard: Well, you're right. As we get older and get beyond the age of, let’s say, 19, then things are just not the same. Even our 13 year old can generally help us find the car at the mall when it’s time to go back home in ways that we’re just not able either because we’re distracted or whatever. There’s more things going on, but part of that is normal. Our memory does change as we get older, but when we start losing our ability to function in a normal work environment and normal socially, then it suggests that we should get evaluated. So, if a person is, let’s say, they have a certain function at work – they’re an accountant – or if they’re used to performing certain tasks quite easily and then it becomes a lot harder, and it becomes more difficult to learn some new tasks. Then, that is beyond normal, and so we should seek help for those. That suggests that there may be a new degenerative condition going on.

Melanie: What about balance issues or problems with movement because again, sometimes, people lose their balance or they notice their hand shakes a little bit, especially with our older population that can happen for no reason at all or just on a regular basis. When do those problems, you know, worry us enough that we would come to see you thinking maybe that it’s God forbid, Parkinson’s or something else?

Dr. Hubbard: That’s right. So, when we start having tremors and movements that are not normal for us, then we should even go ahead and get evaluated by a neurologist at that time. Certainly when a person has a tremor and movement problem that’s associated with moving slower than we usually do and having difficulty getting initiated when walking or getting up off of a couch or out of the car, and if we have a tendency to fall, then these are cardinal features. Any neurologist hears this across the country and thinks that, oh, uh oh, you know, this sounds like it could be Parkinson’s disease, and so it’s a combination of tremor and a slowness of movement and rigidity of muscle movement, and then like a postural instability. These are all very cardinal features of Parkinson’s disease, but we don’t have to wait until we get all of these features. It’s best to get evaluated sooner rather than later and get some treatment.

Melanie: So, before we talk about a few of the treatments that you have in your toolbox, sleep problems are so common. I mean, especially today with all of the electronics and people up late at night and even with our teens, I mean it, really sleep disorders are becoming all too common. When is a sleep disorder, and it’s certainly for women, you know, going through menopause and this sort of thing; these are common-place, but when are sleep disorders something that you say, you know what, this is definitely not normal?

Dr. Hubbard: Well, you know, whenever we have difficulty performing our daytime activities because we’re not getting restorative rest at night then it’s a good time to get evaluated. Just a couple days ago had a gentleman that came to the hospital reporting of pins and needles feelings in his legs and cramping, both sides in his feet and as well as his calves, and it had been going on for months and months. It seemed to get worse, and he even said that he was doing well during the daytime, but whenever in the evenings when he retired and when he got into bed, that’s when it started really acting up, and he’d have to go and get up and get in the shower for 20 minutes and then finally, he might be able to go to sleep. We ultimately diagnosed him with Restless Leg Syndrome, and this was after an MRI. The brain had been done and imaging of the spine, but the association with a nighttime disturbance, not being able to sleep, and then leaving him during the daytime just really feeling tired and completely fatigued and falling asleep in his meals. He was really just miserable and then unhappy, naturally because we need sleep. Physiologically, it’s a need. So, anytime we’re not able to function during the day, and it’s affecting our ability to think straight and behave the way we’re happy emotionally and even physically, then we should definitely seek help.

Melanie: So, what types of diagnostic tools do you use as a neurologist and a neurohospitalist and then what types of treatments are available? I mean I know we’re not going to talk about every single one, but what do you typically use as a neurological workup to kind of find out what some of these things like numbness or tingling or difficulty thinking or any of these things we’ve discussed, what do you typically use as a way to diagnose or see what the problem is?

Dr. Hubbard: So, usually, what we do, if I could back up just a second, is when we listen to a certain problem, we’re listening for a pattern of neurological condition that may be happening. So, if a person reports that, oh, I'm having problems talking and getting my words out and understanding what people say; then, we’re more likely to look at the brain, and we’re more likely to look at the left side of the brain because that’s where language comes from, and so we would typically do a CAT scan of the brain and then follow that with an MRI because it’s a more sophisticated study. The CAT scan will help us to make sure that there’s not bleeding and artery breakage in the brain and then the MRI will help us to make sure that there's not artery blockage and stroke in the brain, but if a person says, well, oh, you know, I'm having weakness, and it started in all of my limbs or both sides involved, then we’re more likely to focus on the spine and then we’re more likely to go with an X-ray of the spine and then an MRI of the spine. If we are not able to detect problems through imaging and for certain problems, we might even have to look at nerve function and ask a person to undergo an EMG and nerve conduction study and so this focuses on smaller nerves that go into the arms and legs as opposed to the brain itself. So, that’s called an EMG, a nerve conduction study. Some of these tests are performed in the hospital for the more acute and emergent problems that require hospitalization, and then once we know there’s not a severe, disabling problem that requires immediate attention, then the EMG and nerve conduction study can be performed in the outpatient setting. Now, we also look at brain vessel imaging, and so for that, we might ask a person to undergo an MRI of the arteries, a so called MRA, and we also do some studies by ultrasound. Now, we all have carotid arteries, one on either side of our neck, and so we can check their function by doing ultrasound and making sure that the blood flow is optimal, and then lastly, I might just recommend that we do a study called an EEG when we’re concerned about people passing out and potentially having seizures. An EEG is performed by actually placing electrodes on the scalp and evaluating the frequency and normalcy, or even abnormalcy, of electrical function coming from the cortex of the brain. If there's one area where there’s irritation, then that gives us a clue that a person may be having seizures from that area. So, that’s an electroencephalogram, an EEG.

Melanie: So, then, wrap it up for us, Dr. Hubbard, with your very best advice about all of these things that we’ve been discussing and the red flags and signs that it is time to see a neurologist, what you really want people to know and why they should come to Lourdes for their care.

Dr. Hubbard: You know, I like to see people at their best personally, and most people like being at their best, and so I would get a firm understanding as to what is my best function, and let’s see what we can do to keep my best function and maintain that, and whenever we start seeing a lapse in our best functional state – our best ability to speak clearly and speak fluently with full sentences and understand what's being said, our best function in terms of being able to see, look in the rearview mirror and walk nice and fluidly down the street, get up off the couch— when these things start to change, then it’s a good idea to get in to see a neurologist. Even with pain freedom, it’s not normal to have headaches really, and headaches and pain in general let us know when there's a problem going on, and so this lets us know that, hey, you know, I should in to get evaluated. Some of the neurological conditions are common and so many times what we do is associate common problems and then we sort of accept them as normal and then they get worse. So, I suggest, look at what baseline is and look at what we see as our optimal function and then when we start slipping from there, let’s get in and get evaluated by a neurologist.

Melanie: Thank you so much for being with us today. This is Lourdes Health Talk, and for more information, please visit lourdesnet.org. That's lourdesnet.org. This is Melanie Cole. Thanks so much for listening.