TEXT us 615.550.1800 for an appointment or call 615.550.1800 and leave us a voicemail request. Thank you!



A stroke occurs when the blood supply to a part of the brain is interrupted depriving the tissues of oxygen and food and thereby injuring or permanently damaging these cells.

Strokes are divided into ischemic and hemorrhagic strokes. Ischemic strokes are caused by the blockage of blood vessels supplying the brain. This can be due to fatty deposits known as plaques or it can be caused by blood clots traveling from the heart or other parts of the body to the narrow arteries in the brain.

Hemorrhagic strokes develop when the brain blood vessels burst and are unable to supply the cells with enough nutrients. Common causes of these strokes include high blood pressure and swellings in the blood vessel walls known as aneurysms.

Risk factors:

Common risk factors include diabetes, high cholesterol, high blood pressure, smoking, family history of stroke, clotting disorders, alcohol dependence, elicit drug use


Symptoms of a stroke include numbness or paralysis of one side of the face, one arm or leg. This can result in drooping of one side of the mouth when the person tries to smile and drifting of one arm downwards when they try to raise their hands above their head.

Some patients with strokes also develop slurred speech, become confused and have difficulty understanding the spoken word. Other patients experience trouble walking, dizziness, loss of balance and coordination. A sudden severe headache, which may be accompanied by vomiting and blurred or double vision, is another symptom of stroke.


Diagnostic tests done on patients with a stroke include a computerized tomography scan (CT scan) which utilizes a series of x-rays to create detailed brain images. Magnetic resonance imaging (MRI) scans which use radio waves, can also be done to reveal the areas of the brain that have been damaged by the ischemic or hemorrhagic stroke.

Cerebral angiograms can also be done in patients with strokes. In this medical procedure the doctor inserts a thin tube in the groin and guides it to the arteries which supply the brain. Dye is then injected into this tube to reveal any blockages or leaks when the x-rays are taken.


The treatment of ischemic strokes includes the use of medications like tissue plasminogen activator (TPA) and aspirin to reduce the clots blocking the blood vessels and prevent the formation of new ones. The doctor can also perform angioplasty by guiding a small tube with a balloon from the groin to the blocked artery. They then inflate the balloon to open the blockage.

The treatment of hemorrhagic stroke involves the use of bed rest and supportive measures as the body absorbs the blood. Patients who are taking blood thinners like warfarin are also given medications to counteract their effects. Surgery is done for patients who have bled a lot to remove the blood and relieve pressure on the brain. If aneurysms caused the bleeding, they are also repaired surgically.

After the emergency treatment, patients with both types of strokes are admitted into a rehabilitation program to help them regain the functions they have lost. This program can include physiotherapy and speech therapy.

Patients who develop spasticity of the upper limbs after a stroke are treated with botulinum toxin type A which is commonly known as Botox. This medication which is produced by the bacteria Clostridia botulinum, is injected into the muscles to paralyze them since it blocks the release of the neurotransmitter or signaling chemical known as acetylcholine which causes muscle contractions.

The treatment of strokes regardless of whether they are ischemic or hemorrhagic is important since adequate blood flow to the brain must be restored as quickly as possible to prevent the death of more brain cells.


The latest studies conclude that strokes are rising in younger adults. This is thought to be due to an increase of risk factors like diabetes, obesity, high cholesterol and high blood pressure in persons who are around 40 years.

Support groups for persons with strokes in Tennessee include the Stroke Group whose contact person Shannon Tucker can be reached by phone at 615 769 7867. This group meets on the first Monday of the month at 2.00 pm at the Skyline Medical Center Auditorium B. Their address is 3441 Dickerson Pike, Nashville, TN 37207. http://www.strokeassociation.org/STROKEORG/strokegroup/public/supportGroupDetail.jsp?groupId=2229

The National Stroke Foundation also offers a toll free help line 1 800 STROKES (1 800 787 6537) and valuable resources at its website http://www.stroke.org.



Essential tremor

Essential tremor


Benign essential tremor is a disorder of the nervous system that causes rhythmic shaking. Though it can affect any part of the body from the head to the legs, it most often affects the arms and hands. When it affects the head it results in the person making yes-yes or no-no movements. This uncontrollable shaking of benign essential tremor increases when the person moves or tries to do simple tasks like writing. Other factors that worsen this tremor include emotional stress, anger, hunger, fatigue, caffeine and temperature extremes.


Approximately 50 percent of the cases of benign essential tremor arise as a result of genetic mutations or changes in the genes. The cause of the other cases is not known.


A diagnosis of benign essential tremor is made after the doctor listens to the symptoms and examines the patient. Though there are no diagnostic tests to make the diagnosis, the doctor can order blood tests and CT scans to rule out other conditions.


The treatment of benign essential tremor includes the use of medications that relieve tremors like the beta blockers propranolol (Inderal), atenolol (Tenormin) and metoprolol (Lopressor). Side effects of these medications include tiredness, lightheadedness and heart problems.

Medications used to control seizures are prescribed for patients who do not respond to beta blockers. Examples of such medications include primidone (Mysoline), gabapentin (Neurontin) and topiramate (Topamax). Side effects of these drugs include nausea and drowsiness.

Tranquilizers are also used to treat patients whose tremors are worsened by tension or anxiety. Examples of such medications include alprazolam (Xanax) and clonazepam (Klonopin). Side effects of these medications include fatigue and sedation.

Botulinum toxin type A which is commonly known as Botox, may be used to treat patients with certain head tremors. This medication which is produced by the bacteria Clostridia botulinum, is injected into the muscles to paralyze them since it blocks the release of the neurotransmitter or signaling chemical known as acetylcholine which causes muscle contractions. Repeat injections are required since the effects usually last for a just a few months.

Deep brain stimulation (DBS) is a surgical procedure that is used to treat persons with severe benign essential tremor that does not respond to medication. In this operation the surgeon places electrodes in the part of the brain known as the thalamus. These are then connected to a battery operated pulse generator known as a neurostimulator that is implanted in the chest. This neurostimulator sends electrical impulses to the areas in the brain that control movement and stops the tremors.

Thalamotomy is another surgical operation that is used to treat this condition. In this procedure the thalamus is destroyed on one side of the brain to reduce the tremor.

The Gamma Knife is another treatment option for these patients since it delivers radiation to the affected part of the brain.

It is important to treat benign essential tremor since it progressively worsens over time and can spread from one arm to affect the other one as well as the legs. This condition can also become increasingly severe and reduce the patient’s quality of life by making it difficult for them to work or to perform day to day activities like drinking from a cup without spilling the contents, shaving and putting on makeup.


The latest developments in the benign essential tremor field involve its treatment with focused ultrasound by The Swedish Neuroscience Institute. This painless procedure bombards the diseased parts of the brain with high intensity ultrasound from multiple angles.


Supportive treatment for benign essential tremor pain includes physical therapy in which a structured exercise program is designed by a physical therapist to strengthen the muscles and improve coordination.

Occupational therapists can also help patients adapt to living with the condition. They may recommend adaptive devices like wrist weights, wide-grip pens and heavier crockery.

  IMG 6675 from KCA on Vimeo.

Neck Pain

Neck Pain


Neck pain can be caused by muscles which have been strained by poor posture or by overuse. Nerve compression by slipped discs or bone spurs (overgrowths) can also be the genesis of a pain in the neck. Osteoarthritis and neck trauma from sporting injuries as well as whiplash from motor vehicle accidents can also cause neck pain. Fibromyalgia, polymyalgia rheumatica, meningitis and cancer are other conditions which can also cause neck pain.


Symptoms of neck pain include a dull ache in the neck which can be worsened by turning the head. Other symptoms that may be associated with it include weakness of the arms and hands as well as numbness, tingling sensations and pains that shoot down the arm.


Diagnostic test for neck pain include x-rays of the cervical (neck) spine since these can show fractures, tumors, bone spurs, narrowing of the spaces between the spinal bones and other features of osteoarthritis. Magnetic resonance imaging (MRI) is also done to reveal the presence of herniated disks.
Electrodiagnostic studies that can be done on patients with neck pain include electromyography which evaluates whether the nerves that control the muscles are working normally. Nerve conduction studies are also used to help make the correct diagnosis.


Medications used to treat neck pain include non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil) and naproxen (Aleve) since they reduce the pain and inflammation. Narcotics like codeine are prescribed for those with more severe pain. Heat and/or ice packs are also used to relieve the pain. These are usually applied for 20 minute durations several times during the day.
Muscle relaxants like zanaflex are given for those with spasms. Anti-inflammatory medications such as meloxicam are often used as well.
Trigger point injections are also used to treat neck pain. In this procedure the doctor injects a mixture of corticosteroids and local anesthetics into trigger points within the muscle. These are areas which irritate nerves because the muscle is in spasm. This procedure which is done in the doctor’s office, relieves the pain by making the trigger point inactive.
Surgery is usually reserved for those patients in whom compressed nerves cause severe pain, numbness or muscle weakness. In these operations the surgeons remove the disks or bone spurs that are pressing on the nerve.
Supportive treatment for neck pain includes physical therapy in which a structured exercise program is designed by a physical therapist to stretch and strengthen the muscles. Traction may be used to stretch the neck and keep it immobilized in order to relieve pain caused by nerve root irritation.
The treatment of neck pain is important since if not treated it can persist and cause chronic pain and a loss in economic productivity. A study even showed that around 50 percent of patients continue to have pain and disability five years after the diagnosis was made. Another study showed that patients with neck pain also tend to get trunk muscle dysfunction which can eventually lead to low back pain.


The latest research on neck pain which was published in The Spine Journal reveals that an observational registry can inform patients and their doctors about the prognosis of their chronic neck pain.


Support groups for patients with chronic pain include a Pain Management Group hosted by Bob Coates who can be reached by phone at 615 567 5786. This group meets at Clinical and Family Therapy Associates, 1205 Columbia Avenue, Franklin, Tennessee 37064.
The American Chronic Pain Association whose website is http://theacpa.org/ also offers valuable resources.