Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.
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Epilepsy is a seizure disorder that affects about 1 out of 200 people. It’s the result of abnormal electrical activity in the brain. People with this condition have:
Epilepsy may be inherited or caused by a brain injury. Once seizures are controlled by medications, people with epilepsy can usually do just about everything those without epilepsy can do, including driving a car. Epilepsy is not contagious.
A grand mal seizure is what most people think of when they hear the word "seizure." People with epilepsy often notice a warning sign right before a grand mal seizure. This could be a feeling in the stomach or an involuntary jerking in the hand or foot. Once the seizure begins:
After the attack, the person may appear confused and may fall asleep. Most seizures are over within a minute and cause no permanent harm. However, the shaking can be frightening to those not familiar with seizures.
Absence seizures usually start around grade school age. They commonly cause a brief lapse of consciousness with only slight facial twitching or fluttering of the eyelids. Sometimes the person may seem to be daydreaming. These types of seizures typically come without warning and are not followed by confusion or sleepiness. Most patients will stop having absence seizures once they reach adult age.
Partial seizures are classified as "simple" or "complex" and involve involuntary movements without a complete loss of consciousness.
Simple partial seizures, can involve twitching of the face, hand, or leg on one side of the body. The patient's consciousness and memory are usually unaffected. These are also called focal motor seizures.
Complex partial seizures. The person may:
We’ll ask you about your:
This information will help us rule out other conditions. For example, fainting can cause a loss of consciousness. People usually recover quickly after fainting (often within seconds). Seizures often cause periods of confusion or sleepiness that last 20 minutes or longer.
A single seizure does not mean that you have epilepsy. Epilepsy is defined as a tendency to have recurrent seizures. It’s more common to have one seizure in your life, than it is to have recurrent seizures or epilepsy.
Nonepileptic seizures are not caused by abnormal electrical discharges in the brain. However, they often look like epileptic seizures. Nonepileptic seizures are often called "psychogenic" because they can be caused by stressful psychological experiences. These events can be one way that the body copes with excessive stress.
For some people, these seizures may result from:
We diagnose nonepileptic seizures by observing the seizures and listening to observers descriptions of them.
Often, we need to perform a simultaneous EEG and video monitoring of the seizures to arrive at an accurate diagnosis. If we determine that you do not have epilepsy, we will recommend an evaluation by a psychologist or psychiatrist to help you with any stress or trauma that may be causing your seizures.
We may recommend further tests, including:
Currently, there is no cure for epilepsy. However, in most cases, medications can prevent all, or nearly all, of your seizures.
Finding the right medication and dose can take time because each person reacts differently. We usually treat this condition with a single drug prescribed in increasing doses until the seizures are controlled. The choice of drug depends on the kind of seizures you have.
Sometimes, seizures cannot be controlled with medication and we will consider other forms of treatment.
Medications do not effectively control seizures for all epileptic patients. For some, surgery to remove the part of the brain causing the seizures may be needed. Surgery is most appropriate for people with seizures that originate in one specific area of the brain. Temporal lobe epilepsy is an example.
If you may need surgery, we monitor you in a specialized hospital unit, called an epilepsy monitoring unit. This helps us to observe and better understand your seizures and which part of the brain is affected.
Neurostimulators may be used to control seizures if medications alone are not working. These devices include the vagus nerve stimulator (VNS) and the responsive neurostimulator system (RNS). They send bursts of electrical energy to the brainstem (VNS) or the brain surface (RNS) that result in a reduction in how often seizures occur.
Neurostimulators are often a good option for seizure control when medications are not working and surgery is not a safe alternative.
Tell friends and family about your seizures. Ask them to review the following First Aid advice in case they are with you, or anyone else, during a seizure.
We are required to report lapses of consciousness to the Department of Motor Vehicles in California.
The DMV will:
If seizure medications are changed or stopped, this often requires that you stop driving for a period of time determined by your physician.
In some cases, lack of sleep may trigger seizures. We recommend that everyone, especially epilepsy patients, get 8 hours of sleep a night. If you have epilepsy, it's particularly important to avoid staying up late on a regular basis.
Keep a detailed record of your seizures to help us understand your condition better and make appropriate treatment decisions.
Note any other observations that may be important, such as:
Epilepsy can be a chronic long-term condition. Either I or another neurologist in our department will manage your care. I will work closely with your personal physician, who will continue to oversee your care for nonepilepsy health issues.
If you are having symptoms and you have not yet been diagnosed, your first contact will typically be with your personal physician, who will evaluate your health and symptoms and determine whether specialty care may be needed.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter. If you were first seen in the Emergency Department after a seizure, the Emergency Department physicians may facilitate the process of scheduling an appointment with our department.
During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will also review any lab tests ordered by your personal physician and order any further tests that may be necessary to look for electrolytes or other metabolic abnormalities that could trigger seizures. We may decide that you need an EEG performed in the Neurology department, or I may order a CT scan or an MRI to look for any abnormality in the brain.
I will explain the findings of your exams and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.