Q.I have pain in my pelvic area radiating into both groins and vagina. I had many tests by primary doctor and gynecologist and all of them were normal. What can be done?
A. There are many different structures in the pelvic area and genitalia which can be affected and produce pain. The painful conditions may include inflammation or impingement of a nerve or a muscle, chronic inflammation in the uterus or bladder, endometriosis and others to name a
few. Unfortunately, diagnosing those conditions may be very difficult at times. Pain killers and
pain modulating medications may be helpful. Those patients who do not get significant pain
relief may benefit from the nerve injections in affected areas. There is no general advice for
treatment of pelvic pain and different conditions are treated in different ways.
Q.My 82 year old husband recently developed Parkinson’s disease, which is progressing rapidly with shaking hands, lightheadedness, etc. He is taking medications and has seen several doctors, but none are able to help. Can you suggest any other treatment?
A. Shaking hands, lightheadedness and other symptoms may be a part of many disorders, not only Parkinson’s Disease. Treatment options depend on the patient’s diagnosis. Movement disorders, stroke, seizures, degenerative brain conditions and other neurological problems may present like this as well. There is no universal medication which can be used to treat all of these conditions. Diagnostic tests may be very helpful in making the diagnosis and may include brain imaging (MRI or CAT Scan), recording of the brain electrical activity (EEG - electroencephalography), studying of the brain blood flow (carotid ultrasound and transcranial Doppler), blood work and others. The quality of shaking, coexistence of other symptoms, the order of the symptoms onset, the speed of progression and other pertinent information is as helpful in making the diagnosis as a thorough physical exam or specific tests. This is why it is very important to bring a written history of the disease development and other data to the appointment.
Q.I never get headaches but occasionally have a sharp pain in my head. these last only a fraction of a second and have been in different areas.
Are these typical or when would I know to seek medical treatment?
A. Sharp stabbing pain in the head may be due to different reasons. When no reasons are found during an exhaustive testing it might be an “ice pick” headache, which is very short and can be extremely painful. Trigeminal neuralgia, neuralgia of the scalp nerves are only a few of many other possibilities. Eye redness and tearing during a short headache are part of a distinct, though rear, headache type. There are also secondary headaches due to detectable causes like aneurysm, upper neck arthritis, shingles, pain from the scar or due to jaw joint inflammation and others. Though a short headache can be perceived as a minor problem, it should not be neglected. There is no such a thing as a “typical headache”. Proper investigation will help to establish the diagnosis and treatment if necessary.
Q.“I have suffered through 4 bouts of severe rotational vertigo in the last year. One diagnosis was atypical meniere’s (hearing is not affected and tinnitus is no worse during an attack than during an attack-free period) A second diagnosis was vestibular migraine (or migraine associated vertigo). Are there any diagnostic criteria that would help to determine what the cause of this vertigo is - symptoms that would lead towards a diagnosis of one rather than the other?”
A.Dizziness is a lay term for any sensation of loss of balance or discoordination, while vertigo is a sensation of motion either of yourself or your surroundings like spinning, whirling or rocking and unsteadiness is a sensation of legs being unreliable in keeping the body in an upright position. Vertigo is usually a problem of the inner ear and unsteadiness- of the nerves in the legs. Vertigo symptoms can be caused by multiple conditions. The majority of these conditions are benign though brain tumor, bleeding or stroke can cause those symptoms as well. It may be difficult sometimes to differentiate one cause of the vertigo from another. Thorough history, exam, testing and observations are helpful.
Q.I have a headache in the back of my head. My neurologist said it was a migraine though treatments did not help. What can be done?
A.Though migraine can present with a headache in the back of the head, its location is usually frontal or temporal. Other migraine features include throbbing pain, nausea, increase in pain with bright light, loud sound and movement. A headache in the back of the head may be due to different reasons including a nerve inflammation, impingement of the upper neck nerves due to spine problems, radiating pain from the spine itself, disease of the blood vessels and many others. Many conditions may provoke a trigeminal nerve irritation and cause migraine-like symptoms which are resistant to treatment because it is not just a migraine. Some of the causes are life-threatening and may present with only a mild headache. Thorough evaluation and testing are helpful in establishing diagnosis and appropriate treatment. New medications are now available as well for the migraine treatment.
Q.I have a painful burning sensation on the outer surface of my thigh down to the knee.
A.You may be suffering form a condition known as meralgia paresthetica (thigh pain). It is caused by injury, compression or disease of the lateral cutaneous nerve of the thigh. First described by Bernhardt 130 years ago it is still widely under recognized. Up to 35% of patients with leg pain may suffer from it. It happens in all age groups but is more common in pregnant females, overweight people or diabetics. In all these conditions the nerve is susceptible to pressure from the uterus, weight of the belly or tight clothes like jeans or hard belt. Diagnosis is based on clinical picture, examination, EMG to rule out different other nerve conditions. Similar pain can be caused by pelvic fracture or cancer, diabetes or lower back problem. My personal choice is to perform palpation of the thigh under ultrasound to see the diseased nerve. Anti-inflammatory medications and elimination of pressure on the nerve including weight loss and avoidance of restrictive clothing or heavy belts helps many. If this does not work I perform steroid injection under ultrasound guidance which usually resolves the pain.
Q.My son who is 21, has had several bouts of vomitting for the last 6 years. No doctor seems to be able to give a diagnosis. Isn’t it possible that he could develop cancer in the esophogus from the stomach acid repeatedly going up his throat? He has not been diagnosed with GERD. Could this be neurologically related?
A.There are multiple neurological causes of nausea and vomiting. Abdominal Migraine presents with nausea, vomiting, inconsistent abdominal pain and some symptoms of migraine, though not necessarily with the headache itself. This is a clinical diagnosis since there are no tests for the migraine. Children younger then ten-years-old are affected the most, though abdominal migraine is seen in adults as well. Another possibility is an inner ear disorder when vomiting may start suddenly with a vertigo of different degree. An increase in the intracerebral pressure and seizures may also present with sudden vomiting even without other symptoms. There are other neurological conditions which may be associated with vomiting. In any case the diagnosis is not straight-forward and will require thorough exam and possibly additional testing.
Q.I have constant pain if you turn your right hand around and look at the thumb, it is right above where the bottom of the thumb meets the wrist. It has become progressively more chronic especially when I am attempting to open a jar and do yard work. At night my thumb and middle finger seem to go numb. My family practitioner stated it was a neuropathy. Is there a treatment and or surgery like carpal tunnel to alleviate this problem?
A.The condition you have described may be due to different causes including a nerve impingement, a joint or tendon inflammation and others. There are different tests to diagnose the cause of pain. For example, in our office I perform ultrasound imaging of the soft tissues to find the pain source. Treatment may require taking pills, injection of an anti-inflammatory medication or even surgery and should be tailored to the problem. In my experience, the majority of patients with similar complaints were able to improve with treatment within days or weeks.
Q.My mother is a fit 79 and for the last few months has experienced a certain amount of numbness and a loss of use in her right leg and foot. She has had an MRI scan which didn’t show anything - could this be Motor Neurone Disease?
A.The term “Motor Neuron Disease” means exactly what it states - a problem with strength and movements because these are functions of muscles and nerves connected to them - all together they comprise a “Motor System”. Numbness is a function of the Sensory System and not the Motor System, so the problem in the letter is likely something different. The fact that the author has “numbness and a loss of use in her right leg and foot” rather testifies for the problems with the nerves (motor and sensory) coming to the right leg. An MRI scan may be non-diagnostic in many conditions and neurological evaluation and additional tests are necessary to make the diagnosis and provide treatment.
Dr. Kaplan's Role in Wellness
Dr. Kaplan has been a founder and Medical Director of “Neurological and Stroke Care, PLLC”, a private practice in Schenectady since 2002. Having practiced medicine for more than 25 years he specializes in the diagnosis and treatment of patients with neurological diseases and chronic pain. He considers himself a good student first of all:
“Medicine literally explodes with new knowledge and it’s impossible to be a good physician without relentless learning.”
He started practicing medicine in Samara, Russia at the age of 23 as a general surgeon already having had several scientific publications and patents. After Dr. Kaplan and his family had moved to the United States he completed four years of Neurology Residency at Albany Medical Center. His training was finessed by two years in the Columbia University Stroke Fellowship program working as an attending physician at Columbia-Presbyterian Hospital in New York, learning from internationally renowned stroke experts, treating stroke patients, utilizing cutting edge scientific methods, participating in stroke research, presenting at international conferences, and also working on two Masters degrees – one in Epidemiology and Clinical Research and another in Health Care Management and Policy.
He returned to Schenectady to open his private practice.
“I did not want to be influenced by business goals of big medical centers offering employment. I value interactions with my patients above anything else and am able now to give them as much time and attention as necessary.”
Patients appreciate Dr. Kaplan for his dedication to see patients on a short notice if necessary and because of his depth of knowledge and experience.
Dr. Kaplan is the only physician in the Capital Region with Board Certifications in four fields of medicine. Board Certification is the highest mark of integrity of physician’s knowledge and skills and is awarded after a thorough peer review and examination. He is a Diplomate of American Board of Psychiatry and Neurology. His second Board Certification is in Vascular Neurology – he is one of two Board Certified physicians and the only with fellowship training in this field in the Capital Region. Dr. Kaplan is also the only neurologist in the Capital Region certified in the methods of ultrasound brain vessels testing . Such high level of expertise attracted to him patients from as far as Buffalo. Headaches is the third area of expertise and he is the only physician in the Capital Region with Board Certification in Headache Medicine. He is well known for never giving up on his headache patients. Not only migraine patients themselves but also their families chose Dr. Kaplan to manage this difficult condition. Management of neck pain in headache patients has evolved over the years into a comprehensive diagnostic and treatment program covering a variety of pain conditions. He received his fourth medical Board Certificate from the American Board of Interventional Pain Physicians.
Dr. Kaplan became a Fellow of Interventional Pain Practice after successful completion of a unique and prestigious hands-on exam in Interventional Pain Management. Dr. Kaplan personally participates in devising the treatment plan for every patient in his practice with the help of Nurse Practitioner Steve LaPlante. In spite of having a busy professional life Dr. Kaplan is also a Founder and President of the Connecting Link, Inc., a cultural non-profit organization in the Capital Region. His wife, Dr. Irina Kaplan, is practicing Family Medicine in the same practice.
This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
