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Map & DirectionsDirections6700 West Loop S Ste 330Bellaire, TX 77401 Write a ReviewWrite Review

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Phone: (713) 715-6360

Address: 6700 West Loop S Ste 330, Bellaire, TX 77401

Long Blakely

General Practitioners

Headaches
Fibromyalgia
Effexor XR® and Cymbalta® are both SNRIs. These are medications that raise levels of serotonin (5HT) and norepinephrine (NE) in some synapses. Venlafaxine has been demonstrated in two double blind placebo controlled studies to help prevent migraines at doses of 150 mg per day and above. Duloxetine is more balanced than velafaxine and in animal models of pain, the balance is important in pain relief. Therefore, Dr. Loftus favors duloxetine. They cause equal amounts of nausea but duloxetine appears to be associated with less sexual dysfunction. Cymbalta is FDA approved in depression, anxiety, fibromyalgia, pain from osteoarthritis, and diabetic neuropathic pain. Since 33% to 66% of patients with chronic migraine also have depression, the use of Cymbalta® as a first line agent makes sense for those patients with depression. The cost of duloxetine and venlafaxine ER is about $12 for one month but drops to $6 per month when bought 6 months at a time.
Sinusitis
Pain that occurs secondary to pressure within the nasal sinuses typically is located over the involved sinus area. This pain is constant, even, and not throbbing. It is also not associated with nausea, light, or noise sensitivity like migraine headache. Accompanied by fever and a purulent discharge (discolored yellow or green), the pain is usually caused by acute sinusitis. The treatment of sinusitis is somewhat controversial because the majority of the causes are not bacterial and the overuse of antibiotics is an increasing concern. When it is bacterial, antibiotic treatment as well as surgical drainage of the infected sinus may be required.
Medical Weight Loss
TopamaxÂ® (topiramate) is one of the more versatile AEDs. It is widely used for migraines, partial onset seizures, generalized seizures, and even weight loss.Â Topamax has potentially five mechanisms of action. They include the blockage of sodium channels (similar to many of the traditional epileptics), enhancement of GABA-a receptors (an inhibitory neurotransmitter), inhibitory effect on glutamate receptors, inhibition of L-type high-voltage calcium ion channels, and a diamox type effect.Â The relative importance of these mechanisms in the functioning of TopamaxÂ® is not clearly known but it does not appear that any other single AED shares these five properties.
Pediatric Care
As an AED, Topamax has been shown to be highly effective.Â Like all other AEDs studied in head to head trials, there is no AED which is more effective than any other AED when used as initial therapy for the correct seizure type.Â Guidelines published by the American Academy of Neurology recommend this medication be considered in monotherapy for patients with new onset partial epilepsy or generalized tonic clonic seizures.. It is also recommended in pediatrics as well.
Primary Care
Another study known as the SUMMIT study analyzed over 3000 patients who presented to their primary care physician (98%) with self-diagnosed or previously physician diagnosed recurrent sinus headaches. Of these, 88% had either IHS migraine or probable migraine. Exactly 8 had sinus disease. This data has only been presented in a poster format at the June 2002 American Headache Society meeting. Patients who had the HIS definition of migraine were then treated with sumatriptan and the results were that 2/3rds of patients were satisfied with their headache therapy after treatment with sumatriptan. Prior to treatment with sumatriptan, 2/3rds of patients were dissatisfied with their current treatment.
Family Practice
He has been an invited speaker to give continuing medical education (CME) talks to the Texas Association of Family Practice and the Texas Neurological Society. He is a member of the American Academy of Neurology, Texas Neurological Society, Texas Medical Association, and the Harris County Medical Society. He has served on a Quality Assurance Board of a medical hospital for 10 years.
Emergency Care
New onset headaches, headaches that have started in the last few months, or headaches that are brand new should be immediately evaluated by a physician. Headaches that are intense and begin abruptly also require emergency evaluation. If you are reading this after the new onset of a horrible headache that began suddenly, stop reading and go to an emergency room.
Constipation
Immunizations
The Tcell vaccation method currently being developed by Opexa Therapeutics Inc. and previously administered to patients under the care of Dr. Loftus has been developed from Dr. Zhang's work is known as TovaxinÂ®. Because there are different forms of Tcell vaccination methods that have been tried in the past, it is important to note that while they all share the same name, the method of making the vaccine is so different that they actually have very little in common.

Ophthalmologists

Glaucoma
A third preventative is topiramate or Topamax®. This medication, first licensed as an antiepileptic medication, is the most popular medication currently prescribed by neurologists for headache prevention. While not more effective than the other first line agents, it is the only FDA approved migraine preventative that is clearly associated with weight loss. The average obese patient can expect to lose about 10% of their body weight over one year. Since obesity is a risk factor for frequent migraines over time, a large number of migraine patients who need preventatives are medically overweight or obese. Unfortunately topiramate does have a lot of side effects. Some side effects are more of a nuisance. Carbonated drinks taste badly while taking this drug and some patients experience tingling around the mouth, finger, or toes. Renal or kidney stones occur about 1-2% of the time and is the only side effect which does not go away when topiramate is discontinued without additional therapy. A small percentage of patients have an altered ability to think on the medication that commonly expressed as a word finding problem. This returns to normal with reduction or discontinuation of the medication. Finally there is a very rare condition of acute narrow angle glaucoma that is very painful but again resolves with discontinuation of the medication and specific medical therapy. The cost of generic topiramate is as low as $10 per month. More recently, branded extended release topiramate have been marketed under the names Qudexy® ($400-500 per month) and Trokendi® ($700-1000 per month). These medications have different methods to slow absoprion. Slower absorpion allows for lower peak doses of topiramate and higher trough doses. These medications therefore imply better migraine control with fewer side effects. They have very similar pharmacokinetics (the highs and lows) but the Qudexy has a few advantages over the Trokendi. Qudexy is cheaper at all of the commonly used doses and is much cheaper at 150 mg per day dose where Qudexy has a tablet of this size and Trokendi does not. Dr. Loftus will switch patient from generic to these more expensive trade name medications if a patient gets a side effect to generic topiramate but finds the medication useful.

Gynecologists

Pregnancy
Labor and Delivery
In nature, pain is supposed to be a response to a noxious stimulus to teach us to not do whatever we did that caused the pain in the first place. Pain is sensed by small fibers in the peripheral nervous system. They relay the information to the spinal cord and then to the brain. Most pain medications that we think of - tylenol, aspirin, ibuprofen, codeine, morphine, and other narcotics, are tested in models of pain that do not involve damage to the peripheral nervous system itself. Common pain models include skin trauma, orthopedic surgery, childbirth, and kidney stones.

Internists

Internal Medicine
Another study of headache patients in the United States showed that only 52% of Americans with migraine headaches knew they had migraine. Of those that did not know they had migraine headache, the largest group had been misdiagnosed with sinus headaches. One reason for the large group of misdiagnosed patients is the disagreement between the ENT medical society's definition of rhinosinusitis and the International Headache Society Classification of Migraine and Probable Migraine Headaches. In fact, the patients in Dr. Cady's study probably fulfilled the ENT criteria of rhinosinusitis. The World Health Organization, as well as societies representing Internal Medicine, Family Practice Medicine, and Emergency Medicine, among others has accepted the I.H.S. system.
Kidney Stones
TopamaxÂ® is available in tablets of various sizes as well as a sprinkle form which can be used in those who cannot swallow tablets. It is typically dosed twice daily. Topamax lacks many of the more serious side effects seen with the older AEDs. It lacks known problems with bone marrow and has an extremely small incidence of liver abnormalities apparently confined to patients with prior liver abnormalities. It does have a fairly common side effect of kidney stones (between 1-2%).Â It is also one of only three AEDs that have a statistically proven propensity to lose weight ( Zonegran and Felbamate are the others).Â

Neurologists

Neurology
In order for the staff at Bellaire Neurology to eat lunch and return patient phone calls and emails, the phones are not answered between 12:20 and 1:20 pm.
Multiple Sclerosis
Multiple Sclerosis (MS) is a chronic disease of the central nervous system which strikes without warning. Multiple Sclerosis can present with virtually any symptom, but typically blindness in one eye ( optic neuritis ), focal numbness, and focal weakness are the most common presenting symptoms. The term "focal" referrs to
Epilepsy
Click here to learn more about the basis for the profile and how it is used in clinical practice. If you are not my patient, only use this scale with permission of your epilepsy physician.

Psychiatrists

Depression
Anxiety

Endocrinologist

Thyroid

Radiologist

MRI
When seeing a doctor for the first time it is important to bring prior head scans (whether they are MRI or CT) to your visit and a list of medications you take (along with dosing) and no longer take. Divide the list into medications that you take daily to prevent headaches and those that you took/take when you had a headache.
X-Rays
Chemotherapy
The onset of any new headache in patients with compromised immune systems (such as patients with HIV, cancer, leukemia or lymphoma) or on immunosuppressive therapies (such as steroids, cytoxan, or chemotherapy) should be promptly evaluated by a physician.

Surgeons

Orthopedic Surgery

Plastic Surgeons

Botox
Botulinum toxin requires binding to Zinc in order to function. Dr. Soparker and associates demonstrated that the use of Zytaze (a combination of Zinc and phytase) resulted in extending the benefit of botulinum toxin (at least Botox brand for blepharospasm and forehead wrinkles). Given the low cost, Dr. Loftus recommends all of his patients use Zytaze when using botox for hyperhidrosis.

Dermatologists

Dermatology
The best dosing for this procedure is not entirely clear. A recent study published in the April 2002 Journal of American Academy Dermatology suggested that high dose Botox - 200 units per axilla produced a longer period of time between treatments. In their study, 1 in 8 relapsed within one year, with 2 out of 3 lasting more than 19 months. The longest effect was seen in one patient who had been followed for 29 months. In contrast, studies with 50 units per axilla varied from 100% relapse after 7 months to a high percentage going beyond 8 months but not one year. In general, the treatment is priced per unit and therefore it appears to me that the most cost effective dose may be in the 50 unit per axilla range as it is not clear that the 4 times dosing gives a 4 times longer response.
Lesions
The shingles is a reactivation of the chicken pox (also known as varicella-zoster) which occurs in the distribution of usually one, but sometimes more than one, peripheral nerve. It begins with a red rash that eventually causes vesicular (fluid filled) lesions and it is very painful. When this occurs, in general, the patient should be treated with a medications that works against the virus itself such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). The duration of the vesicles is usually one to two weeks. The shingles usually reactivates when the body is being affected by another stress such as an illness, surgery, or cancer. Usually the pain subsides when the skin lesions heal.

Physical Therapists

Neck Pain

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