For expert, comfortable care for all neurologic and sleep disorders come visit Dr. Joel de Ocampo at Arizona Neurology and Sleep Center.
If you're one of the millions of Americans who suffer from some type of neurologic or sleep disorder, your life can be affected in many ways. Everything from poor work and school performance to mood problems, lack of energy and the inability to concentrate. And that's just for starters.
If left untreated, some sleep disorders pose serious threats to your health. They can increase your risk for high blood pressure, heart disease and stroke. And they can damage your immune system, too. These are just some of the many reasons you should let our team of qualified professionals help you put your sleep problem to rest.
When it comes to finding a solution for your sleep disorder, you want credentials you can rely on. Dr. Joel de Ocampo is board-certified by the American Board of Psychiatry and Neurology and the American Academy of Sleep Medicine. He has been in practice since 2001 and he has met and surpassed education, practice, examination and ethical standards of excellence in his field.
With his board certification in neurology and sleep medicine, Dr. de Ocampo is eminently qualified to diagnose and treat residents of Scottsdale, Phoenix, Mesa, and Chandler, Arizona the full range of neurologic and sleep disorders.
Here at the Arizona Neurology and Sleep Center you will be treated with the friendly, personalized care you deserve every step of the way and you'll feel right at home inside a new, state-of-the-art clinic.
We are dedicated, caring, compassionate, and approachable and we will spend as much time as needed to answer your questions and to educate you on what you need to know about your particular needs and how our state-of-the-art care can help you overcome it.
We put great value on personal relationships with our patients. Whether at the reception desk or in the examination room, you'll feel attended to at all times.
Come visit us at www.azns.org
06/08/2006
What do Israeli Prime Minister Ariel Sharon, the late Coretta Scott King, and TV personality Dick Clark have in common? They each suffered a stroke which brought recent international attention to this third leading cause of death in the U.S. and No. 1 cause of adult disability. While the world prays for Prime Minister Sharon’s recovery and mourns the death of Mrs. King, we rejoiced when Dick Clark made his courageous return to ABC-TV’s “New Year’s Rockin’ Eve” and became an inspiration to all stroke survivors.
What is a stroke? “It is a brain attack,” says Dr. Jose “Joel” De Ocampo, a board certified neurologist and stroke specialist who practices at Oaktree Medical Center and is on the medical staff at Palmetto Health Baptist Easley.
“A stroke occurs when a blood clot blocks an artery or a blood vessel breaks and interrupts the blood flow to a part of the brain. When this happens, it results in brain cells dying and brain damage occurring,” says Dr. De Ocampo.
“After brain cells die during a stroke, abilities such as speech, movement and memory that are controlled by that part of the brain are lost. For example, those who suffered a small stroke may be left with a weakness of an arm or leg while those who had larger strokes may be left paralyzed on one side or lose their ability to speak,” he continues.
According to the National Stroke Association (NSA) some people recover completely from strokes, but more than two-thirds of the survivors have some type of disability. Because 80 percent of all strokes are preventable, in 1999 the NSA established stroke prevention guidelines to help people learn how to lower their risk for a first stroke. The NSA recommends that people consult their doctor for advice on how to best use these guidelines.
Know your blood pressure.
“With high blood pressure, or hypertension, as the leading cause of stroke, having good blood pressure control is key to preventing a stroke. You should check it regularly,” says Dr. De Ocampo.
There are many ways to check your blood pressure whether in the doctor's office, at health fairs, at home with an automatic blood pressure machine, or at a local pharmacy or grocery store. “If your higher number (the systolic blood pressure) is consistently above 120 or if your lower number (the diastolic blood pressure) is consistently over 80, talk to your doctor who may recommend changes in your diet, regular exercise, or medicine,” he says.
Find out if you have atrial fibrillation.
“Atrial fibrillation (AF) is an irregular heartbeat that changes how your heart pumps out blood. This change can allow blood to collect in the chambers of your heart and form clots. If one of these blood clots moves into your blood stream, it can cause a stroke. If you feel your heartbeat quivering, see your doctor to confirm or rule out AF with an electrocardiogram, or ECG,” says Dr. De Ocampo.
If you smoke, stop.
“What more can we say about this except that smoking doubles the risk for stroke. If you stop smoking today, your risk for stroke will immediately decrease,” he says.
If you drink alcohol, do so in moderation.
According to the NSA, studies show that drinking up to two alcoholic drinks per day can reduce your risk for stroke by about half. More alcohol than this each day can increase your risk for stroke by as much as three times and can also lead to liver disease, accidents and more.
“If you drink, we recommend no more than one drink a day for women or two drinks a day for men. And if you don't drink, don't start,” Dr. De Ocampo adds.
Find out if you have high cholesterol.
“Know your cholesterol number. If your total cholesterol level (LDL and HDL) is over 200, talk to your doctor. You may be at increased risk for stroke. By lowering your cholesterol if it’s high, you may reduce your risk for stroke. For some patients, high cholesterol can be controlled with diet and exercise, and for others, it may require medicine,” he says.
If you are diabetic…
The NSA says to follow your doctor’s advice carefully to control your diabetes. Those with diabetes have an increased risk for stroke, but controlling diabetes may lower this risk for stroke.
Exercise.
Include 30 minutes a day most days a week or all for exercise in your daily routine. Choose an exercise or activity that you enjoy, such as walking, biking, swimming, golf, tennis, dance, or aerobics.
Enjoy a lower sodium (salt), lower fat diet.
“By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and lower your risk for stroke,” says Dr. De Ocampo. “Achieve a balanced diet of fruits, vegetables, grains, and a moderate amount of protein. Then add fiber, such as whole-grain bread and cereal products as well as raw, unpeeled fruits and vegetables along with dried beans, to your diet which can reduce cholesterol levels by 6 to 19 percent.”
Circulation problems.
Ask your doctor if you have circulation problems which increase your risk for stroke. Dr. De Ocampo explains, “Fatty deposits can block the arteries which carry blood from your heart to your brain. These deposits can be caused by atherosclerosis – a hardening or buildup of cholesterol plaque and other fatty deposits in the arteries. These arteries, located on each side of your neck, are called carotid and vertebral arteries. If left untreated, this can cause stroke. You can be tested for this problem by your doctor.”
Symptoms.
The NSA urges that if you have any of the following stroke symptoms, seek immediate medical attention:
• Sudden numbness or weakness of face, arm or leg - especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.
“If you have experienced any of these symptoms, you may have had a TIA or mini-stroke. Ask your doctor if you can lower your risk for stroke by taking aspirin, or by other means,” he adds.
If you see someone else having these symptoms, the NSA strongly recommends the following Act F.A.S.T. simple test:
Act F.A.S.T.
FACE - Ask the person to smile. Does one side of the face droop?
ARMS - Ask the person to raise both arms. Does one arm drift downward?
SPEECH - Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?
TIME - If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.
“Remember that time lost is brain lost,” urges Dr. De Ocampo.
This information is provided as an educational service and is not intended to be a substitute for professional medical advice. Contact your primary care physician or other qualified health care provider for specific medical advice, diagnosis and treatment.
When Should People With Dementia Stop Driving?
Neurology Now
May/June 2010
Volume 6(3)
p 11
A new guideline by the American Academy of Neurology (AAN) helps neurologists determine when people with Alzheimer's disease and other dementias should stop driving. (The AAN develops “clinical practice guidelines” to help neurologists make decisions about the prevention, diagnosis, treatment, and prognosis of neurologic disorders. Each guideline makes specific recommendations based upon a rigorous and comprehensive evaluation of all available scientific evidence.) It's an update of the AAN's 2000 guideline, which concluded that “patients with mild dementia categorically should not drive,” says Donald J. Iverson, M.D., lead guideline author and a neurologist with the Humboldt Neurological Medical Group, Inc., in Eureka, CA. “The update softens the message to ‘should strongly consider discontinuing driving,’” Dr. Iverson explains. The guideline is published in the April 20, 2010 issue of Neurology (and a summary of it for patients and caregivers is available at aan.com/guidelines ; search for “driving and dementia”).
Clinical trial evidence illustrates that patients' driving skills deteriorate with increasing dementia severity, according to the guideline. Yet studies also show that as many as 76 percent of dementia patients pass an on-road driving test, making a recommendation that patients with dementia absolutely should not drive under any conditions too restrictive, says Dr. Iverson: “[The guideline authors] wanted to preserve the patient's autonomy to some extent. Giving up driving is associated with depression and increased awareness of mortality. We wanted to limit that as much as possible.”
Guideline authors reviewed 422 out of 6,000 studies published between 1970 and 2006. Among their recommendations, the authors recommend physicians use the five-point Clinical Dementia Rating (CDR) scale to identify those dementia patients who are at an increased risk for unsafe driving. The CDR scale—which detects cognitive and functional impairments—is based on a physician's examination of the patient as well as information from caregivers.
Indeed, caregiver concerns about the driving ability of a person with dementia are a useful part of the evaluation process, the guideline authors note. For example, they found that a caregiver's rating of the patient's driving as “marginal” or “unsafe” is probably useful, whereas a patient's self-rating of “safe” is not.
What behaviors may indicate an increased risk for unsafe driving? Guideline authors identified these, among others: a decrease in the number of miles driven; the avoidance of driving in certain situations, such as at night or in the rain; a recent history of collisions or moving violations; and aggressive or impulsive personality traits.
Dr. Iverson compares stopping driving to “the same end-of-life issue as financial conservatorship, transition to assisted living, or advanced health directives.” The decision to stop driving, he says, should be made after the clinician, patient, and caregivers or family discuss it openly. In addition, state laws may be considered, because some states require doctors to report any medical conditions that may impact driving ability.
The guideline also suggests follow-up evaluations every six months may be useful to determine whether driving risk has increased.
Kierstin Wesolowski
Warning Signs of Unsafe Driving
These behaviors are signs that a person with dementia may be an unsafe driver:
▸ Decrease in number of miles driven
▸ Avoidance of driving in certain situations, such as at night or in the rain
▸ Recent history of collisions or moving violations
▸ Aggressive or impulsive personality traits
Doctors, patients use smartphones, but can't make mobile connection
A study cites a lack of payment from insurers to physicians for electronic monitoring and an unwillingness among patients to pay for that service.
By PAMELA LEWIS DOLAN, amednews staff. Posted Oct. 4, 2010.
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Joel De Ocampo, MD, a neurologist and sleep specialist from Scottsdale, Ariz., is disappointed that he can't read his patients' headache journals on his smartphone. His patients have expressed similar regrets.
And yet, Dr. De Ocampo's patients are still writing their journals on paper, and he is still reading them in that format.
The mobile disconnect between Dr. De Ocampo and his patients -- and other physicians and their patients -- is happening for two major reasons, according to a study released by the PwC (formerly known as PricewaterhouseCoopers) Health Research Institute.
One is a lack of connectivity between mobile phones and practice and hospital systems. The other is money.
PwC says the inability of many practice and hospitals electronic medical records systems to integrate data from smartphones isn't stopping doctors from using them, but it is limiting their use.
Two-thirds of doctors using smartphones can't connect them to a practice or hospital EMR.
Meanwhile, money is an issue, according to PwC, because of a lack of payment from insurers to doctors for electronic monitoring of patients, and an unwillingness among many patients to pay for that service themselves. "Unfortunately, the payment wires are crossed," PwC said.
The survey, which included about 2,000 patients and 1,000 physicians, didn't determine an overall smartphone ownership rate for both parties. But it painted a picture of doctors and patients who each were enthusiastic mobile users -- just not with each other.
About two-thirds of doctors using their smartphones in the course of a practice day said they could not connect the devices to a practice or hospital electronic medical records system. The report notes that such a barrier is keeping physicians from using their smartphones as much as they would like, particularly in tasks such as patient monitoring.
Dr. De Ocampo said he is frustrated that his device won't connect to his EMR. "I just want to have the ability to tweak the EMR system to work in a way I am comfortable with," he said.
Cliff Bleustein, MD, a director at PwC on the advisory team overseeing the research institute's survey, said it will take a joint effort "not only from hospital environments but from information technology vendors as well as telecommunications companies."
The report noted that most medical practice EMRs aren't able to integrate with their doctors' smartphones. Hospital EMR systems, even if they could be integrated with doctors' smartphones, are struggling to have enough bandwidth to process the information they have.
Medicaid patients are the most active text messagers of any class of insured or uninsured.
Reimbursement becomes a stumbling block because in most cases, physicians are not paid for communicating electronically with patients, whether through a mobile device or some other form. The report quoted some insurers who said they still are waiting for proof that mobile health monitoring saves money before they start reimbursing for it. Meanwhile, 40% of doctors said 11% to 30% of their office visits could be eliminated with mobile monitoring of patients. PwC said this could affect the severity of any future physician shortages. Left unanswered in the report was how physicians would make up revenue lost from fewer office visits.
Only about half of patients surveyed said they would pay for some sort of mobile health technology or device, according to PwC. Of those who would pay, most would prefer to spend less than $10 a month for the service, and less than $75 for any device. Patients also said they would like those costs to be picked up by a third party.
One observer quoted in the report, Mike Weckesser, director of emerging business-health solutions at Best Buy, said consumers' expectations that insurers would pay for mobile health monitoring was "slanting the data" on their supposed willingness to cover the cost.
Based on the amount consumers are willing to pay for some of these services, the potential market for remote/mobile monitoring devices is estimated to be between $7.7 billion and $43 billion annually, according to PwC research.
Which patients use mobile
The report noted that mobile devices might have physicians finding themselves connected to patients with whom they previously had relatively little interaction.
For example, while most surveys show women to be the health decision-makers in most households, the PwC study showed that men were more likely to express an interest in connecting with a doctor through a mobile device. Those who are individually insured and patients who had delayed visits were more likely to be willing to pay for smartphone contact.
Medicaid patients were found to be the most active text-message senders of any class of insured or uninsured, with 79% of Medicaid recipients with phones considered active texters.
The report was less positive about contact with chronic patients, saying those in good health, rather than bad, were likely to participate in and pay for mobile health monitoring.
Despite the barriers, some physicians are forging ahead. Claudio Palma, MD, a San Francisco-based anesthesiologist and pain management specialist, said he implemented mobile technology into his practice to make his life easier. Dr. Palma mostly uses resource applications, such as drug references. He said it's convenient to have that resource with him wherever he goes.
"I'm a pretty busy guy. I'm running around, I have a couple of practices, I see tons of patients, and this really allows me to deal with all the information that's coming from all different sources."
Daniel Slaughter, MD, an otolaryngologist and facial plastic surgeon from Austin, Texas, said he foresees app development becoming customized so that apps can be designed with each specific practice and physician in mind. His practice is working on one that will allow him to access his EMR in a read-only mode from his iPhone. He is able to open attachments from his EMR sent to him by his nurse.
The momentum for mobile technology in health care mostly has been pushed by technology and telecommunication companies, the study points out. But it found that doctors and hospitals could create their own revenue streams by developing mobile products for their patients. According to the survey, consumers said hospitals are the preferred place to purchase mobile health products, and physicians are overwhelmingly the most trusted source of health information.
The print version of this content appeared in the Oct. 11 issue of American Medical News.
ADDITIONAL INFORMATION:
| Physicians interested in monitoring | |
|---|---|
| Weight | 65% |
| Blood sugar | 61% |
| Vital signs | 57% |
| Exercise/physical activity | 54% |
| Calories/fat intake | 36% |
| Pain level | 36% |
| Sleep patterns | 35% |
| Cardiac rhythm | 28% |
| Bladder control | 17% |
| Acid reflux/indigestion | 16% |
| Digestive health | 13% |
| Percentage who would pay for task | |
|---|---|
| Patient monitors fitness/well-being | 20% |
| Doctor monitors condition remotely | 18% |
| Patient monitors previous condition | 11% |
| Patient not willing to pay anything | 51% |
| Mobile users who text | |
|---|---|
| Medicaid | 79% |
| Tricare | 74% |
| Employer-sponsored | 68% |
| Individual policy | 65% |
| No insurance | 63% |
| Veterans' health | 45% |
| Medicare | 43% |
Copyright 2010 American Medical Association. All rights reserved.
Source: "Healthcare Unwired: New business models delivering care anywhere," PwC Health Research Institute, September
Source: "Healthcare Unwired: New business models delivering care anywhere," PwC Health Research Institute, September
Source: "Healthcare Unwired: New business models delivering care anywhere," PwC Health Research Institute, September
