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Internal Medicine Doctors of
Mill Basin & Bergen Beach, Brooklyn

6301 Mill Lane (Corner of East 63rd) in Mill Basin (11234)

718-942-4600

Dr. Bella Zimilevich

Dr. Bella Zimilevich, MD
Primary Care Doctor

Dr. Bella Zimilevich

Dr. Anatoly Pisman, M.D
Physical Medicine & Rehabilitation

Dr. Bella Zimilevich

Dr. Alexander Shapsis, M.D
Gastroenterologist

Neurological Care

 

Trigeminal Neuralgia (Facial Pain, Tic Douloureux)

Posted by on September 22nd, 2013

Dr. Bella Zimilevich, MD

“Trigeminal neuralgia is an extremely painful condition affecting the nerves of the face. If you have symptoms of trigeminal neuralgia, don’t despair- help is available.”

-Dr. Bella Zimilevich, MD

What is trigeminal neuralgia?

The trigeminal nerve is a nerve in your face that carries nerve sensations from your face to your brain. In trigeminal neuralgia, this nerve malfunctions, so that the mildest forms of stimulation of the nerve (i.e., applying makeup, brushing your teeth) can cause excruciating pain.

Trigeminal neuralgia often starts with short episodes and progresses to longer and more painful episodes. The condition often affects older people, and women are affected more often than men. Although trigeminal neuralgia is extremely painful, treatment is available- you don’t need to be afraid that the pain will haunt you forever.

What are the symptoms of trigeminal neuralgia?

Symptoms of trigeminal neuralgia include:

  •  pain in the area supplied by the trigeminal nerve (teeth, lips, gum, jaw and sometimes the forehead and/or eye)
  • pain triggered by chewing, talking, smiling, shaving, brushing your teeth, applying makeup or touching your face
  • pain on one side of your face
  • pain focused in one particular area or spread out over a wider area
  • pain that begins as occasional mild twinges, progressing to episodes that are more painful and longer lasting
  • episodes of pain lasting days, weeks, months or longer

What causes trigeminal neuralgia?

Trigeminal neuralgia is thought to occur when pressure is placed on the trigeminal nerve by a vein or artery at the base of the brain. This pressure causes the trigeminal nerve to malfunction. Sometimes a lesion such as a tumor applies pressure to the nerve, and sometimes MS, a condition in which the myelin sheath that protects our nerves becomes damaged. Many times a cause for trigeminal neuralgia cannot be found. The condition is more common after age 50, so aging may play a role.

What can I expect when I come to see you?

When you come to see me, I will first ask about your health history, your family’s health history, any medications you are taking and whether you have any allergies.

I will ask you the following:

  • When did your symptoms start?
  • How long do symptoms last? Do they come and go, or is the pain constant?
  • What activities seem to trigger your pain? (i.e., talking, eating, smiling, touching your face)
  • Have you ever had any facial trauma or surgery near the area where you are experiencing pain? (i.e. dental or sinus surgery)
  • What have you tried to ease the pain? Was it effective?
  • Do symptoms affect one or both sides of your face?
  • Are symptoms getting worse over time?
  • How does the pain affect your quality of life?

The answers to these questions will provide me with a lot of needed information so that I can make a proper diagnosis. I will also examine you, including the area where you are experiencing pain. If my examination causes pain, please be sure to tell me. If necessary, I will order an MRI to help me make the diagnosis. We can discuss the need for an MRI if one becomes necessary.

How is trigeminal neuralgia treated?

Medications are used first and are very effective for many people. The two main classes of drugs used are anticonvulsants (used for the nerve pain, not to prevent seizures) and antispasmodic drugs. These medications may have side effects such as drowsiness which will pass with time.

Should medications prove to be ineffective in treating your pain, I can refer you to a neurologist, who may suggest surgery to decompress the nerve, or injections that damage the trigeminal nerve so that it can no longer process pain signals. These procedures are not without risk and should be discussed with your neurologist. If you see a neurologist, I can work with your neurologist to treat you.

If I suspect that something other than trigeminal neuralgia is causing your pain, I may order other tests.

If you suffer from facial pain, make an appointment to come in to the clinic to see me. I can help you get to the root of the problem and treat your pain. Don’t delay- make an appointment today.

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How I Can Help Treat Shingles (Herpes Zoster)

Posted by on September 3rd, 2013

Dr. Bella Zimilevich, MD

“Shingles is an extremely painful condition that can result in a chronic pain syndrome called postherpetic neuralgia. If you think you may have shingles it is important to seek help. Antiviral medication given in the first few days can reduce the risk of neuralgia. Don’t wait if you have symptoms of shingles- make an appointment right away and come in to see me”.

-Dr. Zimilevich, MD

 What is shingles?

Shingles is a reactivation of the same virus that causes chickenpox (varicella zoster virus). Once you have had chickenpox, the virus goes dormant, hiding in the nerve tissue surrounding your brain and spinal cord. Many years later, the virus can reactivate, causing the condition known as shingles. Although shingles is more common after age 60, people of any age can get shingles if they have had chickenpox. The condition is very common, affecting almost 1/3 of the population at some point in their lives. You should know that although shingles is caused by a type of herpes virus, it is not the same herpes virus that causes genital herpes, the sexually transmitted infection.

What are the symptoms of shingles?

Pain is often the first symptom of shingles and may occur before the rash makes its appearance. The pain is often described as burning in nature. Skin in the affected area may be hypersensitive, so that even clothing rubbing against the area will be painful. The pain may precede the rash by several days to a week.

When the rash appears, it will look like tiny blisters on top of a reddened base. New blisters may continue to form for up to 5 days. The rash follows a dermatome (the path of an individual nerve as it comes out of the spinal cord), creating a band-like pattern. The rash usually occurs on only one side of the spinal cord. Rarely, more than one nerve will be affected, but usually a single nerve is affected.

The blisters eventually rupture and they will ooze and crust before they heal, much like chickenpox. The condition may last 3 to 4 weeks from the beginning symptoms until resolution of the rash.

Is shingles contagious?

Yes, but not in the way you might think! People who have shingles can pass the virus on to individuals who have never had chickenpox, or who have never been vaccinated for chickenpox, and these unlucky people will get chickenpox, not shingles. They may develop shingles at a later time, but they won’t get shingles from contact with someone who has it.

Can shingles cause complications?

Yes. Although most people with shingles recover completely, complications sometimes occur. Shingles may affect the eye when nerves of the face are involved. This can be very serious and may lead to vision loss. Hearing can also be affected, as can the facial nerves, leading to facial paralysis on the affected side.

The most dreaded (and most common) complication of shingles is postherpetic neuralgia, in which the pain of shingles lingers long after the rash has subsided. The pain can be severe and debilitating. This is why it is important to seek help immediately if you suspect you may have shingles, as treatment with antiviral medications in the first 72 hours of symptoms may reduce the risk of this devastating complication.

Is there a vaccine for shingles?

 Yes. There is a vaccine for adults over the age of 50 who have had chickenpox. The vaccine has been found to reduce the occurrence of shingles and significantly reduces symptoms, including the incidence of postherpetic neuralgia. If you get the vaccine and still develop shingles, you will likely have a much less severe case.

What can I expect when I come in to see you?

If you come in to see me with symptoms of shingles, I will first need to know a little about your past medical history. I will also want to know what medications you are taking and if you have any allergies to medications. I will want to know if you have any medical conditions that affect your immune system (and thus your ability to fight off infection).

I will ask you when your symptoms started. If you have pain, where is the pain located and when did it start? Does the pain come and go? What is the character of the pain? Is it sharp, stabbing, dull, aching or something else? Is there anything that makes the pain better or worse?

If you have a rash, I will need to examine your rash. I will look for the tell-tale blisters along a nerve distribution, which is characteristic of shingles.

Usually your symptoms, along with the characteristic appearance of your rash, is enough to make the diagnosis. If I believe that you have shingles and it has been less than 72 hours since your symptoms started, I will prescribe an antiviral medication. The medication will lessen the severity of your symptoms and hopefully shorten the duration of symptoms. If you have shingles on your face that may affect your eye, I may send you to an eye specialist.

If you have symptoms of shingles, you should make an appointment to see me immediately. Diagnosing and treating shingles as soon as symptoms start is the best way to limit the symptoms of this painful condition.

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Do You Need A Doctor’s Appointment For Your Migraine Headaches?

Posted by on July 18th, 2013

Dr. Bella Zimilevich, MD

“If you have ever had a migraine headache, you will understand how debilitating these headaches can be. These unique headaches can be triggered by sound, stress, foods and other factors. More common in women, migraines can affect your work and ability to perform even the simplest of activities. If you are experiencing migraine headaches, make an appointment to come and see me- help is available”.

-Dr. Zimilevich, MD

What is a migraine?

We’ve all had tension headaches. These headaches are usually easily managed with an over-the-counter analgesic and don’t usually affect our ability to function in our day-to-day lives. Migraine headaches are different. Migraines are severe headaches often accompanied by other symptoms such as nausea. Migraines may reoccur frequently and may or may not be preceded by an aura. These severe headaches can greatly impact your life if they occur frequently and are not well managed.

What causes migraines?

Although researchers aren’t entirely sure what causes migraines, the consensus seems to be that migraines involve blood vessels and blood flow within the brain. Blood vessels first constrict, which restricts blood flow in the brain and causes symptoms such as numbness and tingling, visual disturbances and other symptoms. Following, the blood vessels expand, which results in an increase in blood flow and severe headache. Researchers also believe there is a genetic component to migraines- if someone in your family has migraines, you are more likely to experience them.

What are the symptoms of migraines?

As mentioned, migraines are different than tension headaches. The symptoms of migraine headaches are generally more severe and may include:

  • pulsating, pounding or throbbing pain which is often felt in the temporal area (around the sides of the forehead) and may spread to include both sides of the head
  • last from hours to days (average 4 hours to 72 hours)
  • nausea/vomiting
  • lightheadedness or dizziness
  • fatigue
  • loss of appetite
  • numbness, weakness and tingling in various areas of the body
  • sensitivity to light and noise
  • irritability
  • visual aura, which often precedes the headache and may include flashes of light, temporary black spots, blurred vision or zigzag lines in the visual field
  • neck pain

The phases of a typical migraine headache. (Illustration by Hans & Cassidy.)

 What triggers migraines?

There are many triggers that are thought to bring on migraines. Triggers may be different for each affected individual. If you suffer from migraine headaches, you should attempt to determine if any of the following are a trigger for you:

  • alcohol (red wine is notorious)
  • foods (foods containing nitrates, MSG or pickled/fermented foods)
  • hunger (skipping meals)
  • hormones (migraines may occur in women around the time of their menstrual period)
  • physical or emotional stress
  • exposure to smoke (including tobacco smoke)
  • high humidity, excess heat or high altitude
  • not getting enough sleep, or sleeping too much
  • loud noises (i.e. concerts), bright lights
  • odors (such as strong perfumes)
  • excessive caffeine intake
  • certain medications

Keeping a symptoms diary might help you to keep track of triggers of your migraine headaches. Try to write down what you were doing prior to your headache beginning. Did you go out to a loud bar with friends and have a couple of glasses of wine? Were you under a lot of stress at work and not sleeping well? Trying to pinpoint your triggers may help you to avoid your personal triggers.

What can I expect at my visit?

When you come to see me I will want to know about your past medical history and any medications you are taking. Specific to your headaches, I need to know:

  • the nature of the headaches
  • how often they occur
  • how long they last
  • other symptoms associated with the headaches (i.e., nausea, loss of appetite)
  • whether the headaches are preceded by an aura
  • what has helped you and what makes your headaches worse

I may perform a neurological assessment. I may also decide to order diagnostic testing, depending on the information I get when I discuss your headaches with you. These may help me to rule out other causes of your headache.

What is the treatment for migraine headaches?

Treatment of migraine headaches is aimed at prevention of headaches and pain relief once a headache begins. There are medications that can be used to prevent headaches from occurring, and different medications to reduce pain once a headache has already occurred. When you come in to see me, we can discuss these medications and decide which might be best for you.

In addition to medication therapy, it is important that you eat properly and get enough rest. Failure to do so may trigger migraines in susceptible people. You should try to identify your personal triggers and avoid them if at all possible. Some people find that measures to reduce stress are also helpful in reducing the frequency of migraines.

Together, we can come up with a plan of attack for your headaches, both from a preventative and a treatment standpoint. If you suffer from migraine headaches, make an appointment to come in and see me.

[Note: If you experience a severe headache that is different from your usual headaches (i.e., “the worst headache of my life”) or symptoms that are different from your usual migraine symptoms, such as difficulty walking or slurred speech, you should go to the nearest emergency room as these may be symptoms of a more serious condition such as a stroke].

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Medical Issues Regarding Dizziness (Lightheadedness)

Posted by on July 12th, 2013

Dr. Bella Zimilevich, MD

“Experiencing dizziness or lightheadedness can be an unsettling experience. Symptoms can range from mild to severe. Causes of dizziness can also range from the non-serious to life-threatening. For this reason, if you are experiencing episodes of dizziness, you should come in to the office to be examined. It’s important to rule out serious causes for your dizziness. In addition, whether there is a serious cause for your dizziness or not, I may be able to prescribe treatment to ease your symptoms”.

-Dr. Zimilevich, MD

 What is dizziness?

Dizziness can be hard to describe. Many people describe dizziness as an unpleasant sensation that makes them feel as though they might fall. People who are dizzy may feel off balance and may grasp at stable objects, such as a table or a wall,  to maintain their balance. Lightheadedness can be similar to dizziness. Vision may be affected, with the vision fading or “graying out”. Vertigo, on the other hand, is the sensation that you are whirling or spinning around (or your surroundings are), usually in one direction. Vertigo is often associated with disorders affecting the inner ear.

It can be difficult for a physician to differentiate between dizziness, lightheadedness and vertigo, which is why I have lumped them all together here.

Potential causes of dizziness

As mentioned, there can be numerous reasons why you might feel dizzy or lightheaded. Some of the more serious reasons include:

  • abnormal blood pressure– blood pressure that is very low or extremely high may cause dizziness or even fainting.
  • cardiac arrhythmias- if the heart beats too slowly or too quickly, you may feel dizzy or lightheaded. You may even faint.
  • stroke- if you experience a stroke, you may experience dizziness or lightheadedness as one of the symptoms. Other symptoms may include altered mental status or confusion, slurred speech, altered gait or difficulty feeling or moving one side of the face or body.
  • emotions/hyperventilation- when you are very upset, you may find yourself breathing very rapidly and deeply. This can cause dizziness, as well as numbness and tingling in your face, hands and feet.
  • standing up too quickly/prolonged standing- if you rise too quickly, your blood pressure may drop; likewise, if you stand in one position too long (as soldiers are sometimes forced to do) you may feel dizzy or faint.
  • medications- there are numerous medications that may make you dizzy, including sedatives, narcotics, tranquilizers, blood pressure medications, diuretics and others
  • dehydration- if you have been ill and have been vomiting or experiencing diarrhea for a prolonged period of time, you may feel weak and lightheaded, especially when upright due to low fluid volume and decreased blood pressure
  • low blood sugar (hypoglycemia)- if you are diabetic and take your insulin without eating properly, or take your diabetes medications improperly, you may experience a rapid drop in blood glucose levels, which may cause you to feel dizzy or lightheaded.
  • inadequate oxygenation- if you are not getting enough oxygen due to heart disease, lung disease or for another reason, you may feel dizzy and weak.
  • deconditioning- if you are in poor physical condition (i.e. due to prolonged illness) and attempt activity that is beyond what your body can handle, you may feel weak and dizzy
  • acute blood loss- if you are bleeding internally or externally and lose enough blood, you will feel dizzy and lightheaded. Chronic blood loss may also cause you to feel weak and dizzy, but you may tolerate the blood loss for longer before experiencing symptoms if the loss is very slow over a prolonged period of time.
  • infection- if you have a viral, bacterial or other infection, it may cause you to feel dizzy and weak
  • cancer- many cancers will cause dizziness and weakness, which may be the presenting symptoms in some types of cancer (i.e. cancers affecting the blood)

When should I be concerned about dizziness?

If you experience any of the following, you should definitely make an appointment to come in and see me as soon as possible:

  • new or severe episode of dizziness or lightheadedness
  • sudden dizziness that you can’t attribute to a cause
  • any change in your pattern of dizziness
  • worsening of dizziness
  • dizziness associated with a new medication
  • dizziness associated with preexisting serious illness, such as heart or lung disease (Note: if you are also experiencing chest pain or shortness of breath, go to the nearest emergency room)
  • dizziness that results in you losing consciousness or falling
  • dizziness associated with weakness, gait disturbance (inability to walk straight), facial drooping or slurred speech, as these may be symptoms of a stroke (Note: if you think you or a loved one is having a stroke, call an ambulance and go to the nearest emergency room) 

What should I expect when I come in to see you?

First of all, you should expect that it may take a little detective work before I can tell you what is causing your dizziness! In some cases, it is possible that we won’t be able to find a cause for your dizziness, but we can rule out serious and/or life-threatening ones.

I’ll first need to know  all about the problem- when it began, what you were doing when it started, how often it has occurred, whether you lost consciousness and what you think may have caused the dizziness. Next, I will want to know all about your medical history, including any illnesses and medications you are taking (including over-the-counter and herbal remedies).

Next, I’ll need to examine you. This may require you to disrobe and put on a gown so that I have better access for examination. I’ll let you know if this is necessary. I may examine multiple areas, or I may perform a focused examination of one particular body system if I have a hunch regarding what might be causing your dizziness.

I may order diagnostic testing, which might include blood work, a heart tracing (ECG), an x-ray or another test. If I think you need to have diagnostic testing done, I promise to tell you why I think you need it and what I might be looking for.

What treatment might I receive?

Treatment will be based on what I find when I examine you and, possibly, on the results of any diagnostic testing. Treatment will depend on what I think is causing your dizziness. I will be sure to discuss your treatment with you, making sure that you understand the treatment and what needs to be done to help you feel better.

If you are experiencing dizziness, lightheadedness or vertigo, you should make an appointment to come in to the clinic. Although your dizziness may not be caused by a serious medical condition, it is important to rule out the more serious causes. Make your appointment today.

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Neurological Care (Migraines, Dementia, Neuropathy etc.)

Posted by on June 8th, 2013

Dr. Bella Zimilevich, MDNeurological conditions affect many people, including the elderly. I see patients with Alzheimer’s disease, dementia, migraines, neuropathy and other common neurological problems. If you think you have a condition requiring neurological care, I am happy to see you.” 

Neurology 101

Neurology is the branch of medicine dealing with problems affecting the nervous system. Your nervous system controls both voluntary and involuntary actions and movements. It is divided into two branches, the central nervous system, which includes the brain and the spinal cord, and the peripheral nervous system, which is comprised of nerves which communicate (send signals) between the brain and the spinal cord and the rest of your body. Different types of nerves perform different types of functions:

  • cranial nerves- connect the brain to the face, eyes, ears, mouth and other areas of your head
  • peripheral nerves- connect the brain to your extremities (arms and hands, legs and feet)
  • autonomic nerves- connect the spinal cord  to your stomach, intestines, heart, lungs, bladder and sex organs

Of course, this is a very simplified explanation of your nervous system, which is an extremely complex system. As a result of its complexity and its functioning, neurological problems can cause a wide range of symptoms.

What are common symptoms requiring neurological care?

The following is a list of common symptoms/conditions that I see in my clinic:

  • tremors/Parkinson’s disease
  • migraines/headaches
  • facial pain (trigeminal neuralgia)
  • cognitive dysfunction (Alzheimer’s/dementia)
  • numbness/tingling in the extremities (peripheral neuropathy)
  • dizziness/vertigo
  • seizure disorders
  • restless legs syndrome
  • sleep apnea
  • sciatica/back pain

What can I expect when I come to see you?

If you come in to see me with a neurological complaint (or what I suspect may be a neurological problem), I will begin by asking you about your symptoms- how long have you had them, what makes them better or worse and if they are getting worse over time. I’ll ask about your family history, your past medical history and any medications you are taking.

I will perform an exam which may be limited to a specific area or may include your entire body. I may test your reflexes, check your vision and/or hearing, watch you walk, test for sensation in your extremities or check for other signs of a neurological condition. What I  do will be largely dependent on what brought you in to see me.

I may order tests depending on your symptoms and the results of my examination. Tests may include blood work, some of which can be done here in the clinic. Sometimes specialized tests are required, such as CT scans, MRIs or other imaging exams. If I feel such a test is necessary, arrangements can be made through the clinic.

Why is seeing a geriatrician important if I have neurological symptoms?

I have completed a fellowship in gerontology, which means that I have specialized training in treating problems affecting the elderly, including neurological conditions. Chances are, I have treated other patients with your condition or symptoms. Rest assured, however, that if I can’t get to the bottom of what is causing your symptoms I can help you find a variety of different doctors in other fields to get you the comprehensive treatment you need.

If you are experiencing headaches, migraines, numbness and tingling, pain or other symptoms that you feel may be related to a neurological condition, make an appointment today to come in and see me. With some neurological conditions, it is important that you receive a diagnosis and receive the proper treatment as soon as possible, so don’t delay- make an appointment today.

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718-942-4600

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