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  1. 1. 1 THE PHYSICIANS AND STAFF OF NORTHWEST INDIANA NEUROLOGICAL ASSOCIATES WELCOME YOU The information that follows is designed to answer many of the questions patients have. The more you know, the more we can be of service. If there are any questions, however, please ask, since we do want to be of help to you. Dr. Rozenfeld, Dr. Bayer, Dr. DeLeo, Dr.Sun, Dr. Bahreman and Dr. Akan are Neurologists, specialists in diseases of the nervous system and muscles. Neurologists diagnose diseases and offer medical treatment; they are not surgeons. Most patients seeing a Neurologist have been referred by their own physician for evaluation of particular problems. After appropriate tests and the start of treatment, further care may be provided by the Neurologist, or by the patient’s family doctor. In any case, your own physician will continue to care for any other problems you might have. Our doctors are on staff at St. Catherine’s, St. Margaret’s (North & South Campus), and Munster Community Hospital. EMG (Electromyography) tests are performed either in our office or the hospital. EEG (Electroencephalogram), CT Scans, MRI’s and other complicated tests are usually performed in the hospital. (More detailed information about Neurologists and Neurologic tests may be found at the end of this brochure.) Appointments and Office Hours: The office is open Monday through Friday from 8:00 am- 5:00 pm. Patients are seen on an appointment basis only. Our main office phone number is (219) 836-2995 and is answered by staff from 9:00 am until 4:50 pm except for lunch hour, which is generally from noon until 1:00 pm. When we are unavailable to answer the phone, our 24-hr.answering service will always pick up the line and offer to take a message or page a doctor for you if there’s an emergency. We will make every effort to honor your appointment time, and request that you extend the same courtesy to us. On occasion, emergencies can cause delays, and whenever possible you will be informed of scheduling changes or delays. If there is an emergency and your doctor is running late, we will offer to reschedule your appointment at a time that is convenient for you. If you are running late, we will also attempt to fit you in as time allows but might have to reschedule your appointment for another date and/or time. Please remember that your appointment time has been set-aside just for you. If for some reason you cannot keep your appointment, please try to give us 24 hours notice, so that another patient may be seen at an earlier time. As a patient in our office, please remember that more than one physician may be seeing patients in the office at the same time. Therefore, if someone arrives after you but seems to be called in to see the doctor before you, it might be because that person is seeing another physician, or is having a test. If you have waited longer than ½ hr. for your appointment, please be sure to alert the front desk. Also, please make sure to check in at the front desk at each visit. If you don’t check in, we won’t know if you’re here for your appointment. Once you have seen one of our doctors, that particular physician will continue to care for you and will see you for your follow-up visits. The same policy would apply if you happen to be hospitalized. However, the doctors will sometimes alternate weekend, evening, and hospital call schedules. Therefore, if you are in the hospital, or in the emergency room, depending on the call schedule you might see one of our other doctors. Please note that Dr. Pradeep V. Kalokhe shares our weekend call schedule, although he is not an associate in our practice. Also, if you feel that you need to come into the office on an emergency basis, and your particular physician does not have office hours that day, you will probably be able to see one of our other neurologists on that particular day or your neurologist might be able to meet you in the emergency room. Emergency Care: Our 24-hour answering service is available by phoning the office number. Please let the phone ring at least 4 times and the answering service will pick up your call. The doctors will do their best to respond to your problem promptly. In the event of an emergency, or a situation in which you are in doubt, go immediately to the emergency room of the nearest hospital and ask them to contact Dr. Rozenfeld, Dr. Bayer, Dr. De Leo, Dr. Sun, Dr. Bahreman or Dr. Akan. Telephone Calls: All patients are encouraged to call with any non-emergency questions they may have concerning their neurologic problems. These calls should be made during regular office hours. The best time to call is in the mornings between 9:00 and 11:00. Your questions are best answered when your medical records are available to your physician. Since it would be most unfair to you, were the doctor to leave the exam room to answer every telephone call immediately, the office staff has been trained to answer many of your questions. They will also relay your questions to the doctor. On those days when the office is closed, the answering service will forward all messages to the doctor. In either case, your call will be answered at the earliest opportunity. Many telephone calls can be avoided by having a member of the family come in with the patient for their appointments with the Neurologist. Prescriptions and Renewals: Prescriptions and authorizations for renewals are best provided during office hours, when your records are readily available. Prescriptions for certain medications cannot be renewed over the telephone or if you have not seen the doctor for an extended period of time. Medications for pain will not be renewed when the office is closed and your chart is unavailable to the doctor. This policy is in your best interest, and is designed for your protection.
  2. 2. 2 PLEASE READ THIS IMPORTANT LETTER CONCERNING YOUR INSURANCE COVERAGE AND PAYMENT INFORMATION Dear Patient: We may, from time to time, recommend diagnostic tests or procedures, which are not covered by your insurer, HMO or PPO unless authorized before the test or procedure is performed. It is your responsibility to make sure that the authorization for the test or procedure has been granted. In addition, please be aware that many insurer’s HMO’s or PPO’s will only cover your hospital stay at certain hospitals and prior authorization for hospital admissions is usually required. It is important that you be aware of your insurance company’s policies and knows which hospitals you may use. Although we will work with you in seeking the necessary authorization, we cannot be held responsible for determining that the authorization has been granted. Please understand that we work with over 800 different insurers, which makes it virtually impossible for our office staff to remember the policies for each insurer. Therefore, if your insurer, HMO or PPO has not notified you that it has authorized a specific test, procedure, or hospitalization, you should contact your insurer, before a test or procedure is performed; or before you are admitted to a hospital. We thank you for your understanding and cooperation in this matter. Northwest Indiana Neurological Associates, P.C. INSURANCE AND PAYMENT INFORMATION At the end of your visit, you will receive a statement of charges. Our office policy is that payment is due at the time services are rendered. Other arrangements can be made depending on special circumstances. If you wish, we will accept your Visa or Master Card. Our Physicians and Office Manager invite you to discuss with them any questions you might have regarding our services or fees. We believe that the best medical service is based on a friendly, mutual understanding between the doctor and the patient. Insurance and Insurance Forms: Our insurance coordinator will be happy to help you file your claims for reimbursement under whatever health insurance coverage plans you have. Payment for all services provided by this office is the responsibility of the individual patient unless prior arrangements have been made through a particular insurance carrier or if you are a member of a particular insurance plan with whom we have a contract. Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor, and is not a substitute for payment. Some companies pay fixed allowances for certain procedures, and others pay a percentage of the charge. It is your responsibility to pay the deductible amount, co-insurance, or any other balance not paid for by your insurance company. It is also your responsibility to obtain any required preauthorizations from your Family Doctor or PCP prior to seeing our Doctors. (We realize that this may seem a nuisance for you; it is also time-consuming for your referring doctor and us. None of us appreciate the vast amount of paper work that has been thrust upon us all by the insurance industry.) If we participate in your particular insurance plan, we will automatically bill your insurance for you. Otherwise, our office uses a specially designed super bill. This bill, when completed and signed by the doctor, need only be attached to your regular claim form and sent off to your insurance company. Therefore, our secretaries and the doctors need not complete your insurance form itself. You, however, must fill out your portion of your claim as required by your insurance carrier, so that you are reimbursed as quickly as possible. Please feel free to call the office during regular office hours with any questions you might have concerning your insurance claims or your account. Important Phone Numbers: Emergency: 911 Our Main Office & Answering Service (219) 836-2995 Please visit our web site for information and news about our practice, as well as, links to other neurology information and web sites. 2
  3. 3. 3 INFORMATION ABOUT OUR DOCTORS Dr. David Rozenfeld was born and raised on Chicago’s South Side. He attended college and medical school at the University of Chicago. Dr. Rozenfeld completed his Medical Internship at Michael Reese Hospital and his Neurological Residency at the Albert Einstein College of Medicine in New York City. Dr. Rozenfeld spent a years Fellowship at Einstein College studying Alzheimer’s Disease, cerebral bloodflow, and neuropharmacology and another year of Fellowship at Northwestern University in Chicago studying Electromyography and muscle disease. Dr. Rozenfeld is Board Certified in Neurology (With Added Qualifications in Clinical Neurophysiology). Dr. Rozenfeld is also Board Certified in Sleep Disorders and Neurosonology and lectures on the topics of Sleep Disorders, Headache, Alzheimer’s Disease and M.S. Dr. Rozenfeld has been in practice in Northwest Indiana for the past 25 years and is currently the Director of Neurologic Services at Munster Community Hospital and St. Catherine’s Hospital. Dr. Rozenfeld specializes in Sleep Medicine, Clinical Neurophsysiology, Headache, Pain Disorders, Alzheimer’s Disease, ADD & ADHD and administers Botox injections for the relief of muscle spasms and Dystonia. Dr. Steven Bayer, a native of Cleveland, Ohio, attended college at the University of Chicago and completed his Osteopathic degree at the Chicago College of Osteopathic Medicine. After his Internal Medicine Residency at the Illinois Masonic Medical Center in Chicago, Dr. Bayer was a Neurology Resident at The University of Cincinnati and Was Chief Resident of Neurology at the Chicago Medical School. Dr. Bayer has been in practice with Dr. Rozenfeld for the past 21years and treats individuals who have a variety of neurologic disorders. He has lectured within the community and for physicians on topics relating to M.S. and Headache. Dr. Andrea De Leo, originally from Harrisburg, Pennsylvania, graduated from Bryn Mawr College. She received her Osteopathic Degree at the Philadelphia College of Osteopathic Medicine and then completed her AMA Internship at Northwestern University/St. Joseph’s Hospital in Chicago and her AOA Internship at Botsford General Hospital in Michigan. After her Neurology Residency at Rush-Presbyterian-St. Lukes Medical Center, Dr. De Leo completed a Movement Disorders Fellowship at the University of Iowa and a Neurophysiology Fellowship at the University of Illinois. Dr. De Leo has been with our practice for 5 years. She received a Masters Degree in Epidemiology from the University of Iowa School of Public Health. Dr. De Leo is Board Certified in Neurology and Sleep Disorders. She has authored a number of manuscripts and abstracts on Parkinson’s Disease and other Movement Disorders and has lectured and done research on Parkinson’s Disease, Tremor, Tourettes, Epilepsy, Botulinum Toxin and Dystonia. In addition to the subspecialty training listed above, Dr. De Leo specializes in “Women’s” Neurologic Issues, Multiple Sclerosis and other Neuroimmunological Disorders. Dr. Ning Sun brings additional specialty training to our Neurology practice. After completing Medical School at The Beijing Medical University, Dr. Sun received a Ph.D. in NeuroAnatomy and NeuroChemistry from the University of Iowa College of Medicine. Dr. Sun completed his Neurology Residency at the Washington University School of Medicine in St. Louis, MO. In addition, Dr. Sun completed an Epilepsy Fellowship at Washington University, as well as a Clinical Neurophysiology Fellowship at the St. Louis University. Dr. Sun has been with our practice for 3 years. He is Board Certified in Neurology and has specialized training in Neurodiagnostic testing. Dr. Sun will be seeing general neurology patients although his primary specialties are Epilepsy, Seizure Disorders and Convulsions. Dr. Amir Bahreman practiced General Medicine in Iran prior to his Medical training in the U.S. Dr. Bahreman completed his Medical Internship at Brookdale University Hospital in N.Y., followed by a Neurology Residency at the Albert Einstein College of Medicine, also in N.Y. He most recently completed a Fellowship in Neuromuscular Disorders and Clinical Neurophysiology at the University of Chicago. In addition to his Clinical Research experience at the Cardiovascular Research Center of Stanford University Medical Center in California, Dr. Bahreman has published a number of journal articles. Dr. Bahreman is Board Certified in Neurology and has been with our practice for one year. He specializes in EMG, Muscle Disorders and Peripheral Neuropathy (e.g. Diabetic Neuropathy). Dr. Bahreman also practices General Neurology and is fluent in English and Farsi. Dr. Andy Akan received his Medical degree from the University of Illinois in Chicago, where he also completed his Neurology Residency and served as Chief Resident. Prior to his decision to specialize in Neurology, Dr. Akan completed a full Internal Medicine Residency at Lutheran General Hospital in Park Ridge, Illinois, where he was the recipient of the “Spirit Award” for excellence in leadership and patient care. Dr. Akan has also worked as Medical House Officer, and has served on the Curriculum Committee at Lutheran General Hospital, Park Ridge, IL. Dr. Andy Akan was born and raised in the Chicagoland area and has served our community as a Volunteer Physician in a number of capacities. In addition to English, the doctor is familiar with the Turkish language. Dr. Akan is experienced in all areas of Neurology and is especially interested in Adolescent and Adult Headache. He is a member in good standing of the American Academy of Neurology and we warmly welcome him to our Neurology Practice. 3
  4. 4. 4 WHAT IS A NEUROLOGIST ? A neurologist is a physician who has specialized medical training in disorders affecting the nervous system. The nervous system consists of the brain, spinal cord and nerves. Many muscle disorders are also considered within the province of a neurologist. Pain problems, especially headaches, also fall within the neurologist’s field. Illness or injury may affect the nervous system directly, or the nervous system may be involved as the result of disease of other parts of the body. Examples of medical problems, which may lead to neurological complications, include diabetes, hypertension and cancers elsewhere in the body. Some Neurological Disorders are Epilepsy, Neuritis, Brain and Spinal Cord Tumors, Multiple Sclerosis, Parkinson’s Disease and Stroke. Myasthenia Gravis and Muscular Dystrophy are Primary Muscle Diseases included among neurological disorders. At present, neurologists are able to cure some of the diseases of the nervous system and offer symptomatic relief from others. Advances in research continue to provide new treatments, which the neurologist will be able to offer his or her patients in the future. Neurologists see patients with a wide range of problems. These include headaches, dizziness, seizures, blackouts and sleep disorders. Numbness of arms and legs are frequent symptoms of neurological disease. Neck, back and head problems following injuries may also require neurological evaluation. Neurologists may work with psychiatrists, psychologists and others to evaluate mental, emotional or behavioral disturbances. Every neurologist has had training in taking care of children; however, some have had more training in this field, and thus may specialize in neurological disorders of children. A neurologist is often called as a consultant for a patient in the hospital. For example, if a patient becomes confused, has difficulty in thinking or has loss of memory, a neurologist may be called. Symptoms suggesting a stroke, episodes of unconsciousness or a seizure indicate the need for neurological consultation. Indeed, the nervous system is vulnerable to disorders or disease in almost every medical condition. What Is A Consultation? If your family physician is concerned that your symptoms may involve the nervous system, he or she may request a specialized opinion. A neurological consultation consists of a history of your medical background, with special attention to your present problems. The neurological examination will involve test of vision, strength, coordination, reflexes and sensation. This will enable the neurologist to locate where in the nervous system your problem exists. The examination may indicate that tests are required. These tests are necessary to help the neurologist confirm diagnoses, which may lead to specific treatment. This may include referral to a surgeon. The neurologist does not perform surgery, although he or she may continue to follow surgically treated patients and supervise the treatment of the patient’s neurological disorder. The consulting neurologist may temporarily assume management of the patient because of his or her expertise in a particular area. Do I Still Need My Family Physician? Your family physician is in charge of your general health care, and he or she is aware of your total health needs. When the neurological disorder is your major problem, the family physician may temporarily relinquish responsibility and the neurologist becomes your primary physician. A report of your neurological consultation will always be sent to your referring physician. It is possible for you to continue seeing your neurologist strictly for your neurological problems while relying on your family physician for your total medical care. Please remember, that in order to assure the best possible health care for you and your family, you should always inform the doctor if you are seeing one or more doctors, and what medications, if any, you are currently taking. 4
  5. 5. 5 NEUROLOGICAL TESTING Electroencephalogram (EEG): Records the continual brain electrical activity, by means of electrodes applied to the scalp. It is often used to help diagnose structural disease of the brain and episodes described as seizures, fainting, blacking-out or falling out. It is painless and requires little preparation. Evoked Potentials: Records the brain’s electrical response to visual, auditory, and sensory stimuli. They are useful in many diseases of the spinal cord and brain to evaluate and diagnose symptoms of dizziness, numbness and tingling, as well as certain visual disorders. Electromyograms (EMG) and Nerve Conduction Velocity Studies (NCV): Measures and records electrical activity from the muscle and nerves to investigate disorders of these structures. These may be helpful in patients who have symptoms of pain, numbness, tingling or weakness. Because small needles are inserted into the muscle, and often-mild electrical shocks are given to stimulate the nerve, slight discomfort might be experienced. Computerized Tomography (CT) or Computerized Axial Tomography (CAT) Scans: Combines x-rays and computers to construct pictures of the brain and back. These pictures can provide much information regarding disease states in the brain and back. A CT Scan is painless. Dye may be injected in a vein. Cerebral Spinal Fluid Analysis (Spinal Tap or Lumbar Puncture): After local anesthesia is administered, a needle is inserted into the lower back and spinal fluid is withdrawn from the spinal canal. This test is often crucial in making a diagnosis of an infectious, bleeding or tumor disorder of the brain or spinal cord. When dye or air is injected through the needle, followed by x-rays of the spinal column, the procedure is then called a Myelogram. A myelogram may be helpful in patients who have neck or back pains or suspected spinal tumors. Arteriograms (Angiograms): This examination requires a needle or catheter to be inserted into a neck or groin artery to inject a dye, which provides x-ray visualization of the neck and brain vessels. Magnetic Resonance Imaging (MRI): Nuclear Magnetic Resonance Imaging is a new technique, which utilizes the computer technology of CT Scanning with magnetic/radio frequency waves rather than radiation, and is therefore free from biological hazard to human beings. MRI scanning has several advantages over CT scanning. MRI scanning can often pick up certain details, which are not clearly visible in a CT Scan. Again, there is no exposure to radiation as in a CT Scan and the procedure is painless. A Polysomnogram (Sleep Study) records and measures various brain and breathing and other body activities, in order to help with the diagnosis and treatment of various sleep disorders. Testing requires an overnight stay in a comfortable hotel-like setting within the hospital (Community Hospital or St.Catherines). OTHER SERVICES PROVIDED IN OUR OFFICE Counseling ,Psychotherapy and Cognitive Behavioral Therapy is often useful for individuals learning to cope with a newly diagnosed medical problem, those who might be experiencing some anxiety or depression related to a medical disorder. Psychotherapy is also helpful for children with hyperactivity who are experiencing behavioral problems and for their parents who may have trouble dealing with their child’s behaviors. Supportive psychotherapy is helpful for individuals with chronic pain conditions, as well as for individuals with chronic or progressive conditions such as Alzheimer’s Disease, Multiple Sclerosis and Parkinson’s Disease; just to name a few. Frequently the spouses or immediate family members need someone to ‘talk to” as well. Relaxation Training and Biofeedback/(EEG) Neurofeedback Training are usually prescribed by your doctor to help with certain medical problems such as Headaches, Seizures, Ulcers, TMJ, various pain conditions and even Anxiety Disorders and Panic Attacks). (See attached page for more specific information.) NeuroCognitive Screening may also be prescribed by your doctor depending on your complaints. Memory, developmental, cognitive and personality tests, (such as the MMPI which is described in more detail on the following page), help us check for memory problems, learning difficulties, subtle brain damage, as well as stress, anxiety and depression which may be contributing to your medical problems. 5
  6. 6. 6 Barbara Rozenfeld, M.A., L.C.S.W. works within our practice. A native of New York City, she received her Masters degree in Clinical Psychology from New York University. She completed her Internship at Mt. Sinai Hospital, Dept. of Psychiatry Day Treatment Center, also in New York City. Ms. Rozenfeld completed her Post-Graduate Certificate Training in Psychotherapy, Psychodrama and Art Therapy at the Institute for Sociotherapy in N.Y. and she received her Biofeedback Training at the Menninger Foundation. She has also completed subsequent Biofeedback and Neuro (EEG) feedback Certification courses. Barbara Rozenfeld has been doing both consulting and private practice work since 1980. She is licensed in the State of Indiana as a Clinical Social Worker and she belongs to the following organizations: The American Mental Health Counselor Association, The American Counseling Association, The American Psychological Association and The Association for Applied Psychophysiology and Biofeedback. Within our practice, Ms. Rozenfeld specializes in the treatment of health-related emotional issues, such as depression, generalized anxiety or “nervousness”, panic disorder and chronic pain. Treatment plans depend on the medical and/or emotional issues of the individual and are always coordinated with your referring physician. Stress management, relaxation techniques, cognitive behavior therapy, psychotherapy and/or biofeedback, along with your physician’s care can help provide symptom relief from a number of problems. BIOFEEDBACK AND RELAXATION TRAINING What is Relaxation Training and how will it help me? Relaxation training procedures can help relieve chronic muscular tension that produces spasms, headaches and other muscle pains. The basis for this procedure is very simple; muscle relaxation and tension cannot both exist at the same time. Therefore, by training a person to relax their muscles, one also trains that person to be calm. Relaxation training also calms an individual mentally, which then allows them to devote their energy to productive pursuits rather than to keep it bound up in tension and anxiety. Relaxation training takes one hour to learn. Daily practice is required thereafter. A cassette player is required. What is Biofeedback and how will it help me? Biofeedback training is widely used as an aid to relaxation and as a method to bring into balance a variety of physiological (bodily) functions. A person learns Biofeedback with computerized equipment which senses biological signals such as electrical activity from muscle fibers or temperature from your fingertip and then displays it in some perceivable form; such as a reading on a meter, a tone of a certain pitch or frequency, or even using a video game. “Biofeedback” represents nothing more than what the name implies; “Feedback” or information about some biological function. Biofeedback is generally used with great benefit in a wide variety of medical conditions, especially headache and other chronic pain conditions. It is also used to teach muscle relaxation and can improve attention and concentration. By observing how one’s efforts at relaxation are affecting a variety of physiological functions, one can discriminate states of tension and relaxation. The individual can then learn to control certain painful conditions and pain response patterns. You will not experience any discomfort whatsoever, with any biofeedback procedure and most people enjoy their biofeedback sessions and find them relaxing and/or entertaining. During a session, tiny sensors will be placed over a specific muscle, or a Velcro band might be placed around your forehead, fingertip or waist, depending on the area we are working with. The sensors transfer the electrical signals from you into the computer, where they are transformed into pictures, sound and/or video games. By learning to relax or tense certain muscle groups, you will actually be controlling the music or videogame. The number of Biofeedback sessions required varies depending on your problem. The average number of sessions required for muscle tension-related issues is 20. Sessions are usually 45 minutes long and it is best to begin with 2 - 3 sessions per week and then taper down. The reasoning for this is very simple; when you are learning anything new, whether it’s riding a bicycle, driving a car or learning a foreign language, you will learn much quicker and make progress sooner if your learning sessions are more frequent. Daily home practice and follow-up is required until your feeling better. What is Neurofeedback or EEG Biofeedback? Neurofeedback or EEG Biofeedback is a specific type of Biofeedback that uses your brain wave signals as the feedback. Tiny sensors are placed on your scalp using a special paste and as with other forms of biofeedback, there is absolutely no discomfort. The electrical impulses from your brainwaves are sent to a computer, where they are transformed into a form of feedback, which you are able to view on a computer monitor. You will have the option of visual and/or audio feedback and can even play video games. Depending on your condition and symptoms, you will work with a special program, which will reward you with the feedback of your choice when your brain waves are achieving the goals, which we set. So if you have trouble paying attention or are having a lot of seizures, we can set the video games or music to play - only when you are creating “good” brainwaves while inhibiting or stopping the “bad” brain waves. Research suggests that EEG or Neurofeedback helps the following conditions: ADD & ADHD, Epilepsy, Anxiety, Depression, Tourettes, Sleep Disorders, Headache, Irritable Bowel Syndrome, Auto-Immune Dysfunction, Raynaud’s Disease, high blood pressure, cardiac arrhythmia’s, Impulse Control Disorders, Substance Abuse, and Chronic Fatigue Syndrome. Many professional athletes also use EEG/Neurofeedback for “fitness” and “peak performance” training. These individuals feel that EEG biofeedback gives them an “edge”, helps put them “in the zone” and helps them achieve a relaxed but highly focused state of concentration. EEG/Neurofeedback works best and quickest when sessions are frequent, especially as you begin. We usually begin with 3-5 sessions per week for the first few weeks and then taper down. Positive results are usually reported by the 20th session for milder conditions, although some individuals feel better after just a few sessions longer. Definite positive results should be noticed by the 40th session at which point the treatment plan will be re-evaluated. 6
  7. 7. 7 For more information on Biofeedback and Neurofeedback, you may visit the following websites: and F:Documents/NWINA Office Manual – Patient Welcome Info (Revised 8/26/05) 7