Tuesday, December 30, 2008

parkinson's and eye blinking

Parkinson’s disease does not affect the eyes’ ability to see but there can be some eye-related concern.

Due to the mask-like face that some patients can experience, there can be a decreased rate of automatic blinking .

Though Eye movement disorders do not always cause functional problem many people as they age may not bother.

However,lack of eye coordination, people experience double vision when looking in certain direction. Some people who have this problem do not complain of double vision, but say that their eyes tire quickly when they read

I had cataract removal surgery in 2001. As the result my cornea is wide and thin besides I have dry eyes(no tears). I am not a candidate to do lasar surgery. Further I have parkinson’s disease. I use eye drops 4 times a day to clean my dry eyes as it relieves eye tiredness and is helpful for my vision. Eye blinking 3-4 times a day help you increase your rate of automatic blinking thus you have better vision from tiredness.

Wednesday, December 24, 2008

What exercise ideal for PD?

A combination of stretching, weightlifting, and cardiovascular exercises is ideal. Exactly which and how much will depend upon your own abilities. Refer to your qualified physical therapist. The PT can assess your strength and abilities and help you design the best possible program for your individual needs.

As for me I use to work two hours daily in the Gym Fitness Centre. I take part in classes : Body combat, yoga, spinning and weightlifting. I have two PT trainers who guide me. They design the best possible program suitable for me., a combination of stretching,weightlifting , and cardiovascular exercises.

ahimsajackJoined: 25 Apr 2007Posts: 652Location: Hudson Valley
Posted: Fri Jan 16, 2009 12:17 pm Post subject:

Teo, I have long admired your vigor and positive outlook. Certainly any exercises we can do have got to be beneficial not only physically but for our self worth as well. John Ball runs marathons and takes long bicycle rides even though he has had PD about 30 years. I actually believe that what you are doing with your exercises helps to postpone the more serious aspects of this beast. I find that I can walk about three miles, and do calisthenics. That is my limit, but it helps. Shanti Jack

Sunday, December 21, 2008

Breathing difficulty with PD

Breathing difficulties with PD i.e tightness and contraction in the throat weaken muscles that control breathing .The breathing is not in full i.e the chest wall doesn't move i.e reducing sense of smell that dampen the appetites contributing the malnutrition.Therefore people have PD find difficulty/ reducing sniffing i.e desperately difficulties breathing large amount of air. There are 40% at the older age die on pneumonia worsen made by PD itself.In general breathing problems in PD are not prominent, although late in the disease we worry about immobility and swallowing dysfunction leading to aspiration pneumonia.

Breathing exercise help me strength and flexibility during my PT training and class exercise program in the gym . My trainers are pleased with my progress. I am pleased that I am able to do posture balance in my yoga classes.


Shoes for parkinson's patients

There are shoes helpful for parkinson's patients:
It helps you walk upright and swing your arm whilst go jogging.
1.Improve posture and Giat.
2. Activates neglected muscles
3.Tones and shape the body.
4. Can help with back,hip, leg and foot problems.
5.Reduce stress and knees and hip joint.
I am putting on "MBT" shoes
I am sure there are shoes besides "MBT" suitable for Parkinson's patient.
However it is individual choice.

difficulty swallowing

Drooling (or sialorrhea) is common in PD.
For the most part the cause is not increased saliva production but slowed reflex in automatically swallowing the natural saliva that accumulated in the mouth throughout the day.You see, a person without PD does not even notice that saliva is constantly being produced (it is done so to lubricate the whole mouth for talking, eating)
This is because after a certain volume is accumulated, this is automatically swallowed without even thinking about it.
But in PD, this automatic swallowing is sometimes lost, thus the saliva pools and drools on the side of the mouth.

I have experience saliva drooling due to poor automatic swallowing of my throat as the result I feel uncomfortable.
I some times lost appetite and difficulty to swallow either to eat or drink as the saliva is constantly being produced. I have a feeling that food or liquid is sticking in the throat during or after a meal. As the result I have coughing or choking



signs of alzheimer's disease

The seven warning signs of Alzheimer's disease are:
1. Asking the same question over and over again.
2. Repeating the same story, word for word, again and again.
3. Forgetting how to cook, or how to make repairs, or how to play cards - activities that were previously done with ease and regularity.
4. Losing one's ability to pay bills or balance one's checkbook.
5. Getting lost in familiar surroundings, or misplacing household objects.
6. Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
7. Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.
Updated Oct. 16, 2008
WebMD Public Information from the U.S. National Institutes of Health

Saturday, December 20, 2008

pilates good for you

Parkinson's disease is progressive disease that impairs muscles and movement. There are medications that ease the symptoms.

Pilates could also improve your body stiffness,rigidity caused by the disease.

Pilates is a series of controlled movements in which the muscles are moved inch by inch. The small movements could make a big difference for people with Parkinson's disease.
There are a growing number of Parkinson's patients who are regularly doing Pilates to improve symptoms of the disease such as tremors, slowness of movement, poor balance and rigidity. Pilates exercises do not strain the body, so it works well for people who don't exercise at all.
I take part pilate when I was diagnosed at an early stage of Parkinson’s. I really work on me as it does not strain the body. It works on breathing and do wonder on your core muscles movement besides pilate equipments.


Antixodant and you

One of the causes of Parkinson's disease is over in oxidative damage and low in antioxidant.
-- A natural antioxidant may slow the progression of Parkinson's disease in men, say researchers from the MassGeneral Institute for Neurodegenerative Disease (MGH-MIND) and Harvard School of Public Health.
Scientists examined data from an earlier study and found recently diagnosed Parkinson's patients with the highest levels of urate, an antioxidant, had a significantly slower rate of disease progression during the two-year study period.
Some mineral such as Copper, Selenium and manganese are an important part in antioxidant enzyme production ( SOD or superoxide dismutase) which is a protective mechanism.

Is Levodopa slowdown the progression of Parkinson's

Although there is no medication currently available that can cure or slow down the progression of Parkinson's disease, several medications are available that can help relieve symptoms of this condition. Levodopa is the most common medication used for treating Parkinson's disease.
Levodopa clearly has changed the lives of millions of PD patients. They now live longer and more rewarding lives and have much less and slower disability compared to before its availability. This positive effect is felt for many years...even up to 11-15 years and beyond. However, levodopa is not a cure. It does not relieve all symptoms. Not all patients respond to it beautifully, although most do respond well. It also has it side effects.

Proper diet

PD is a complicated disease, that affect each person differently,but there are needs for nutrition to sustain the body and stay healthy.
Though there are no special diet required for people with parkinson's.

With the proper diet, our bodies work more efficiently, we have more energy, and Parkinson's disease medications will work properly.

Fiber Fiber is very important because some Parkinson's patients have problems with constipation.

Protein "...Protein can interfere with the uptake of levodopa into the body and the brain and, as a result, reduce the effectiveness of the drug..."

Water Drinking at least 8 glasses of water per day helps to flush impurities through your system and also softens the bowel to combat constipation.

There are some possible causes due to medication they have nauses, loss of appetite, depression, eating very slowly. fear of choking - difficulty swallowing.
Therefore consult the dietitan to optimize nutrition to determine whether any of the above conditions occur.

Proper diet help me to slowdown Parkinson’s disease as I use to consult the detitan twice in a year by taking blood test on my antioxidant; vitamin and mineral level. The detitan optimizemy nutritional level by supplements.

Choice ?

PD patients have to choose an exercises that gets their muscles moving i.e stretching in order to overcome the muscles stiffness, rigidity and slow movement.A physiotherapy, doctor or personnel trainer may be consulted as how to start on an exercise routine. When doing these exercises patients should not experience an pain.
Who do you prefer to start an exercise routine a personnel trainer,doctor or physiotherapy?

It depends on what stages of Parkinson's and the preference of individual choice.

Friday, December 19, 2008

Is parkinson an expensive disease?

As parkinson's is a chronic disease. It is not ageing disease
PD patients are different from what we define themself as "patient" i.e only during acute, self-limited illness or injury that temporarily impact their lives as an inconvenience or comfort.
It is estimated out of 2-3% at the age above 50 years old are Parkinson disease suffers. Unfortunately we are shortage of PD specialists. As the result some are wrongly diagnosed as ageing and no medications are given to slowdown the disease.

Theref0re Parkinson is an expensive disease.

The reasons are as follows:

The treatment of the symptoms of PD is complex for several reasons.

First, PD is a progressive disease, getting worse over time, so that the medications and doses that work well early in the disease are insufficient later on.

Second, the most effective drugs have long-term side effects that are troubling and difficult to control.

Third, there are a lot of different treatment options, and finding the right combination can be time consuming.

Fourth, the PD patient is likely being treated for other conditions associated with advancing age, and these conditions or their treatment may interfere with treatment of PD.

Finally, a major treatment option for late-stage PD is surgery, but the risks of surgery are significant, and determining when and what kind of surgery to perform is a complicated decison.

Since PD therapy continues to undergo rapid advances, it may include specialists of speech/language, a geriatric medicine to coordinate other medical and social issues, a neuropsychologist for expertise on cognitive aspects of PD and a neurosurgeon when there is necessary.


Wednesday, December 17, 2008

guidlines for parkinson's patient

Consult your physician if symptoms of Parkinson's disease appear, if symptoms get worse, or if new symptoms occur include:
Involuntary movements
Nausea and vomiting
Changes in alertness, behavior or mood
Severe confusion or disorientation
Delusional behavior
Loss of mental functionsAlso call your health care provider if the condition gets worse and the caregiver is unable to care for the person at home.

Riding the waves of PD?

You are right Parkinson's symptoms come and go. It is a chronic disease. It is not" going away" disease
Doctor make difficulty to diagnose them especailly at the early stage of Parkinson's.
Patients have to learn on how to manage the movement disorders disease . There are mental and physical work, the symptoms are "not going away "and they come and go. They affect our family lifestyle. It is like we are on " long march" and are endless. We are Riding the waves of PD

dry eye or blurred vision

People living with Parkinson’s often have trouble with their eyes

Parkinson's disease can short-circuit nerve signals between your eyes and your brain. It can so impair the muscles and nerves that control eye movement.

I have dry eyes/without tears that caused my eye tired and sensitivity to light when I am driving or reading.

To alleviate eye problems I use more light when you read besides I use tears eye drop daily

Dry eyes are caused by a lack of tears. Tears are necessary for the normal lubrication of your eyes and to wash away particles and foreign bodies

It's hard to distinguish between Parkinson's disease-related eye problems and natural, age-related changes in vision.

Tuesday, December 16, 2008

What are the inital signs of parkinson's disease?

one of the first signs of Parkinsons
'Loss of Sense of Smell/tastes: you lost your appetite and don't feel to eat even there is flavour , salty or spicy on food.

Is MRI safe for Parkinson's patient?

An MRI is not harmful. A person just can't have any metal objects on them such as jewelry or belt buckles or due to the magnetism it can be dangerous (the heavy magnetism will pull metal objects towards the machine, its perfectly safe for people, the only people who can't undergo it are people who have any form of metal implant.

Diet and Dopamine

Dear Dr. Chew,

How big a role does diet play in the bodies production of dopamine? Are there foods I should and should not be eating. I am currently on 8 mg Requip 2mg, 1 Jumex 5mg, 2 Sinemet CR per day .

Monday, December 15, 2008

Have you experience one sided near paralysis?


Muay Thai

It is a good exercise for Parkinson Patient.
I am taking this Box and Kick Exercises (Thai Boxing) for two and half years in my fitness centre besides body combat. I engage a trainer to guide me two times a week and each training last for a hour.
It is advisable to engage a trainer as PD patients would find difficulty to do box and kick exercises as it involves your body balance and mobility. You needendurance and flexibility.
After years spending three hours in gym daily I do not look like Parkinson patient was told by my doctor ,friends and fitness members.
I am a PD fighter and hero. I battle with Parkinson for two and half years. The credits are my consistencies, preservation,endurance and discipline towards exercises and medications.

Vivid dreaming

Vivid dreaming

Digestive Problem

This digestive problems are caused by medications.
I am problem too.
In order to help my digestive function
!.I do exercises at gym centre daily (2-3 hours)
2 Drink 2 litre water daily and take fruits, veg in meal.
3. It I still find difficulty I take Senoko digestive fiber 6 doses at one time a day

Sunday, December 14, 2008

Which one have a greater impact in your life?

Dear Dr.Chew,

It is increasingly recognised that the non-motor effects of PD including depression and cognitive dysfunction can have a greater impact on patients' quality of life than the movement symptoms. Do you agree

People with Parkinson's diseaseshare two very basic emotions - fear and frustration. We arefrustrated that we can no longer do all the things we used to do,or do them as well as we used to, and we are afraid that we willcontinue to get worse and be able to do less and less. Thesefeelings are present no matter what symptoms are manifesting inyour body. Manyconservative therapists will either ignore the emotional state oftheir patient, concentrating solely on the physical, or prescribeanti-depressants. The former exacerbates our frustration because wereally do want to talk about it and find strategies to overcome it;the latter merely covers up an emotional situation that can be usedto bring about a healthy life change.
Emotional counselors of many modalities can be of enormous help tous. People who have or are working with me have found help from psychologists, trained counselors, Pranic healers, hypnotherapists,ministers of religion experienced in counseling, flower essence counselors, and many others.

Facial expressionless with Parkinson's

Facial expressionless with Parkinson'sBecause the facial muscles also become rigid, people with Parkinson's disease may look expressionless, as though their face is a mask.As the disease progresses, the mouth may hang open, and the patient may drool or choke because the muscle stiffness progresses to the throat and makes swallowing difficult. Other symptoms include abdominal cramps, rapid speech with little expression in the voice, problems with sleeping, the inability to control the flow of urine (incontinence), and constipation.Some people have difficulty with voice and speech as don't talk loud enough. They have had shortness of breath as they have difficulty monitoring how loud they are speaking. This is one of the main symptoms of Parkinson's diseases. Therefore people with Parkinson's develop facial expressionless..I am one of the unfortunate patient with facial expressionless that look disinterested or unhappy even though this not truly how I feel. There are way to help you with increase your muscle around the mouth. Exercise with tongue in your mouth to massage your muscle around the mouth. Blowing air deeply into your balloon to increase your muscle around mouth
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Muscle fascia

Muscle fascia and parkinson’s

Falling backwards and off balance

you have to take more stronger doses to offset medication wearing off.

Walk with support in water pool from front and backwards several times help you to strengthen your muscle movement.

Deep breathing exercises and mediate yourself either sitting on the floor or standing against the wall help you to balance your off postures


I have difficulty driving as I have poor vision.
It occurs to me after my medication for two years.

I am fortunate I do not have difficulty reading.
This is the sideeffect of the medication.
Learing to deep breathing and mediation help you concentrate your reading.

Numbness of fingers

I have numbness of fingers too

It occurs when there is a cold place but is in few second


Masked Face

People with masked faces is a signal for neurological conditions and emotions disorder People with masked faces is expressionless appearance of individuals with disorder . There are ways to diminish masked faces as follows:1 MST training (muscle strength training) for people with masked faces to improve respiratory strength and mobility of muscle around the mouth.2. Blowing air into a balloon help to relax your stiffness and rigidity of muscle around your mouth.3. Gargle yourself with water in your throat and blow air through it without swallowing it ,by twisting your head left and right, up and down to increases your facial muscle strength to relieve and improve people with problems of respiratory and swallowing

Saturday, December 13, 2008

Attention deficit disorders

Most parkinson’s patients have deficit awareness of the parkinson’s diseases without acknowledge the diseases.

deficit awareness/disorders of Parkinson’s are as follows:
Lack of attention to details
Failure to complete tasks
Easily distracted
Poor listening skills
Moves constantly
Talks excessively
Interrupts others

Attention Deficit disorder is a condition in which an individual exhibits a decreased attention span. He or she can become easily distracted, and have difficulty focusing on tasks. ADD is often associated with hyperactivity -- fidgeting, excessive talking, excessive activity level, impulsive and disruptive behavior.
ADD has also become a catch-all classification for a group of symptoms describing undesirable behavior

Do you have the symptoms?
Most of the patients, families and caregivers do not understand the cause of the symptoms that affecting their lifestyle. Few articles have mentioned

Friday, December 12, 2008

Comment on my blog

Though he was Chinese educated and determined to write this medical book in English from general knowledge together with research from medical websites, believes that his self diagnosis and suffering is more accurate than analysts from medical practitioners.
T Q Tan Kim Yam

Wednesday, December 3, 2008

Is parkinson Disease curable?

Posted: Fri Nov 28, 2008 4:51 am Post subject: Is Parkinson Disease curable ?

Dear Doctor, I know that PD is incurable, but I have also heard of cases of terminal cancer being miraculously reversed and cured. Is PD really that hopeless that there has never been a documented miracle cure ? warm regards, Gerald
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Tue Dec 02, 2008 10:23 pm Post subject:

As far as what we know about PD, it is a progressive neurodegenerative disorder. However, not everyone is devastated by the illness. Some have it mild, and others have it more severe. If a PD patient miraculously recovers, my scientific mind would tell me that the patient probably did not have PD in the first place but one of the mimickers; but my Catholic faith would tell me that I should ask that patient if s/he asked for the intercession of one of the pre-saint martyrs so we can write the Pope about this miracle. Yours,_________________Hubert H. Fernandez
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Thursday, November 27, 2008

Requip and compulsive behaviours

Dear Doctor,
I understand that constant taking of the drug, Requip, may result on various side-effects, the symptoms depending on individual users.
Requip may likely cause feelings of nausea, vomiting, constipation, heartburn sensations brought about by gastric, dizziness, drowsiness, weakness, unusual sweating (without assertion), headache, blurred vision, and dry feeling in the mouth.
Some other side-effects may include difficulty in movement or walking, mental/mood changes, feelings of confusion, depression, hallucinations and difficulty in sleeping.
Requip also may cause one to experience unusual urges, i.e. sexual urges or impulsive urge to gamble.
Requip also caused one to suffer from low blood pressure and difficulty in breathing.
1. Will Requip cause one to suffer from erectile dysfunction?
2. Will Requip cause blood clot in the body system? This is pertinent because after taking Requip for 2 years, I had blood clots in my brain. This did not happen before I started taking the said medicine.
Kindly advise

Wednesday, November 26, 2008

emotional and physical symptoms

There are Parkinson's emotional and physical symptoms:-

Physician finds difficulty to treat the emotional disorders as they are complicated. They turn to psychiatrist for treatment.

Emotional Symptoms:
Sadness throughout the day, nearly every day
Loss of interest in or enjoyment of your favorite activities
Feeling of worthlessness
Excessive or inappropriate feelings of guilt
Thoughts of death or suicide
Trouble making decisions
Physical Symptoms:
Fatigue or lack of energy
Sleeping too much or too little
Change in appetite or weight
Trouble concentrating
Aches and pains

Monday, November 24, 2008

The account of inaccuracies clinical diagnosis of parkinson's symptoms

The illiteracy by patients and complacency by physicians are the inaccuracies of clinical diagnosis of parkinson’s.
People who have parkinson’s have to continue their visit for life. physician will need to monitor the effectiveness of your medication.
Too often some physicians become complacent with their patients.
There are reasons that your doctor is becoming complacent
He or she fails to answer your questions to your satisfaction.He or she seems “put out” by your questions.He or she doesn’t seem to be aware of the newest medications or procedures for your condition.He or she doesn’t seem concerned or interested that you are developing new symptoms.He or she doesn’t allow sufficient time for discussion or questions during your exam.Illiteracy by patients:Denial. Helplessness. Anger. Withdrawal from social circles. These are all forms of coping with Parkinson’s Disease that may manifest themselves on diagnoses. It’s not uncommon for patient’s to begin avoiding doctor’s appointments, or refusing to take their medication. All in the very human hope that the diagnosis is somehow not true

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Tue Dec 02, 2008 9:47 pm Post subject:

You could be right, but there are other parkinson conditions that are very similar to PD and sometimes, it really is a tough call. Sometimes, no matter how hard I look and think, I find myself scratching my head. And I know it is not because of lack of effort or complacency. Yours,_________________Hubert H. Fernandez

Sunday, November 23, 2008

Sideeffect of medication

Posted: Fri Nov 21, 2008 9:39 am Post subject: Sideeffect of medication?


My Parkinson's medication as follows:

5 tablets Requip 2mg daily
2 " Sinemet CR daily
1 " Jumex 5mg

I have dorowsy and downness after taking my medication daily. I could not drive car. I am easily to be irritated.

I manage to relieve my downness by keeping myself busy. Question:

Is it sideeffect of medication?
Is it wrong dosages of medication?

Kindly advise


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Dr. Fernandez

Joined: 20 Jan 2007
Posts: 90

Posted: Sat Nov 22, 2008 10:28 am Post subject:


All three of your PD medications can cause drowsiness. But of the three, if I were to choose which is the most likely culprit, I would say it is the the requip.

Typically, we give requip and sinemet 3 times per day. Then we can titrate further from there.

Hubert H. Fernandez

Posted: Wed Dec 03, 2008 1:21 am Post subject:

I understand that constant taking of the drug, Requip, may result on various side-effects, the symptoms depending on individual users. Requip may likely cause feelings of nausea, vomiting, constipation, heartburn sensations brought about by gastric, dizziness, drowsiness, weakness, unusual sweating (without assertion), headache, blurred vision, and dry feeling in the mouth. Some other side-effects may include difficulty in movement or walking, mental/mood changes, feelings of confusion, depression, hallucinations and difficulty in sleeping. Requip also may cause one to experience unusual urges, i.e. sexual urges or impulsive urge to gamble. Requip also caused one to suffer from low blood pressure and difficulty in breathing. Question: 1. Will Requip cause one to suffer from erectile dysfunction? 2. Will Requip cause blood clot in the body system? This is pertinent because after taking Requip for 2 years, I had blood clots in my brain. This did not happen before I started taking the said medicine. Kindly advise TeoKimHoe
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Wed Dec 03, 2008 5:32 pm Post subject:

While anything is possible, my instincts tell me that the two side effects you listed are probably unrelated to requip. Yours,_________________Hubert H. Fernandez

How is Diagnosis Made?

How is the Diagnosis Made?

Dear Doctor,

As some Neurologists are not specialised with PD, they have wrongly or inaccurately diagnosed their patients as an ageing disease. Especially when the patients are at an early stage of PD or having stress and anxiety at work.

This is very common in our country, as there is a shortage of PD doctors.

Therefore some PD sufferers die from other diseases that were made worse by PD.

Kindly detail how to make an accurate diagnosis of PD?



Dear Teo,

These are based on the four cardinal symptoms:
- Slowness
- Stiffness
- Unsteady gait
- Resting tremors

Supportive evidence:
- One side of the body is more affected than the other
- Masked facies
- Shuffling gait
- Improvement with levodopa

Dr. Ramon L Rodriguez, MD

Dear Doctor,

What if there is no resting tremor but only an action tremor, along with stiffness and slowness? Does this indicate anything different?


Dear Teo,

It is common to have a little action tremor with PD. You may also have PD and ET. It is best to see a movement disorders neurologist and get this point sorted out. ET stands for essential tremor which is a postural-action tremor rather than a resting tremor. There are also other tremors.

Dr. Michael S. Okun, M.D.

I was finally diagnosed as a Parkinson’s patient in the year 2005. It took me seven years before being diagnosed as such. I had seen three neurologists over the seven-year period in three different countries.

The first neurologist told me that I was in the process of ageing and that I was normal. I was also treated as normal by the second neurologist in another country.

I was very fortunate that I was in the early stage of Parkinson’s and my disease progression was slow. Regular exercises and medications relieve me from body stiffness and mobility. I thank Dr. Chew Nee Kong (Kuala Lumpur, Malaysia) for his excellent medications in treating my Parkinson’s disease. He is actively involved in raising the awareness of Parkinson’s in Malaysia. I give him double bonus for his unselfish service for the care and welfare of Parkinson’s patients – to help PD patients be more aware of their own illness and to encourage the setting up of support groups to educate the patients and their immediate family members.


Diagnosis of PD – Disability Rating Scales

In helping the diagnosis of PD, there are two disability rating scales used:

1. Conventionally, diagnosis is assessed based on how the current symptoms respond to treatment, ie. whether symptoms are improved by adding levodopa. It is monitored over a period of time and how the patient responds to treatment;

2. In clinical assessment, a doctor may use the Hoehn & Yahr rating scale, named after the two doctors who devised it in 1967. The Hoehn & Yahr scale allocates stages from 0 to 5 to indicate the relative level of disability that the PD patient is experiencing.


Dear Teo,

Thanks! I’m not a big fan of rating scales for clinical use.

To me the most important is how my patients feel. We use them a lot however in clinical trials because this is one of the most objective ways of determining whether a drug or intervention is working or not. None of the current scales we use is perfect. They do not capture all the signs and symptoms of PD.

Dr. Hubert H. Fernandez, MD

Checklist of Parkinson’s Disease

The following are signs that you may develop in Parkinson’s Disease:

1. Unexplained stiffness in arms, legs, feet or hands
2. Tremors in arms, legs, feet or hands
3. Muscle or joints freeze
4. Difficulty walking and balance
5. Stooped posture
6. Soft speech
7. Small handwriting
8. Insomina, anxieties and depression for the past few years
9. Masked face

Consult a Movement Disorder specialist for checkup.


Are All Tremors the Symptoms of PD?

Dear Doctor,

Are all tremors are indicative of PD?

How to screen that they are PD?

How to classify those sickness that have symptoms similar to those of PD?

What is Wilson’s disease and is it a treatable disorder?

What is Atypical Parkinson and Parkinson-plus?

Is the treatment of PD so delicate and complicated that the doctor finds difficulty to diagnose and the late treatment aggravates the PD progression – as a result PD patients die from other diseases made worse by PD itself?

Are Essential Tremor common disorders of elderly people ? Are they classifed as PD?

What about at Young-Onset Parkinson Disease (YOPD)? Are they inherited? What is the percentage of this group?

Kindly eleborate.



Dear Teo,

You ask questions that are loaded, Teo. I’m afraid if I answer all your questions, the rest of the readers will fall asleep!

In brief, not all that shakes are from Parkinson’s. There are other shaking conditions that are not from parkinsonism –such as Essential Tremor and Wilson’s disease.

Parkinsonism is a general condition where someone either shakes, is stiff, or is slow. At least 2 of these need to be satisfied. Not all three symptoms are necessary.

The most common cause of parkinsonism is PD. But parkinsonism can also be from strokes, tumors, infections, medications, etc. In addition, PD has “brothers” that look like it, but are actually different disorders. They are more commonly referred to as atypcial parkinsonism or parkinson-plus disorders.

Sometimes, it is easy to diagnose the type of parkinsonism or the cause of tremor. Sometimes, it is more challenging and one needs the help of a Movement Disorders specialist.

Dr. Hubert H. Fernandez

Are There Different Types of PD?

Dear Doctor,

Are there different types of PD?

Are some worse than others?

Thank you


Dear Teo,

Yes, we believe PD has many subtypes and some may even be genetic. We have identified many genes such as Parkin, LRRK2, DJ1 and PINK1. We have also noticed that PD with resting tremor may have a different prognosis (better) than PD without it. Finally there are several parkinsonian syndromes which seem to respond less well to PD medications (PSP, MSA, CBD, etc.).

Dr. Michael S. Okun, M.D.

Dear Doctor,

What does resting tremor mean?

Thank you.


Dear Teo,

A resting tremor is a tremor at rest (ie. when not performing action). It is the most common tremor associated with PD. There are other types of tremors when one holds a posture or performs an action.

Dr. Michael S. Okun, M.D.

Dear Dr. Okun,

In view to your article above, I am quite interested to find out from you what are the types of PD associated with genetic? My family has three PD patients and I am sure they are all interested to find out from you i.e. many genes such as Parkin, LRRK2, DJ1, and PINK1. As they are medical terms, it is difficult for us to understand. We would be pleased if you could elaborate further.

What are the types of PD that are not responding well to PD medications?

Lord bless. Thanks.


Dear Teo,

I rarely say this, but you are asking lots and lots of general questions and I would really like to be sure that you are not diverting attention from others who have important questions to ask about themselves and about others. You will find an update on genetics that I placed with a recent abstract. Thanks for your enthusiasm.

Dr. Michael S. Okun, M.D.

Although large investments are spent on Parkinson’s, there is still shortage of PD neurologists.

There are four PD neurologists in Singapore and one in Malaysia.

As a result, PD patients were wrongly diagnosed by doctors as a process of ageing. Such wrong diagnosis caused the patients’ suffering to be aggravated.

I feel sorry for them.


Dear Teo,

I am very sorry that information, resources, and neurologists specializing in PD are all so scarce.

I very much hope that this news will spur more research, and cause more physicians to become aware of PD and the need for accurate diagnosis.

Your posts have made me aware of the great need that exists in your area of the world, and doubtless, in other countries as well.

Best regards,
Dr. Kathrynne Holden, MS, RD

Shortage of Movement Disorder Doctors

PD is a progressive and chronic disease.

Unfortunately we do not have any way of checking from where it comes to our body?

While a human grows older, the chances of having PD are higher, as their movement goes slow as well as developing a bad body posture. Tremors are the common in old age or resulting from anxiety and depression at work.

It is difficult to check on people at the age above 60 years old whether they have PD or merely showing signs of old age.

With the growth of the aged population, there is a shortage of Movement Disorder specialists in our country. It makes it even more difficult to have a correct and accurate diagnosis of our disease.

Therefore most people die from aspiration pneumonia, a fatally complicated disease.

Besides, as we do not have enough Movement Disorder specialists, it takes 2 to 3 weeks to make an appointment. This is especially worse in the remote areas.

We only have four PD specialists in Singapore and one in Malaysia.

Best regards,

Dear Teo,

I did not realize there were so few Parkinson specialists in your country; that must make it even more difficult to get an accurate diagnosis of PD.

Good for you for taking such an active part in your own health care — you have studied and researched PD and learned the best ways to fight it and stay healthy, and minimize the symptoms.

That will certainly stand you in good stead!

Best regards,

Kathrynne Holden, MS, RD

In view of the growth of aged population in Singapore, there are shortages of Movement Disorder specialists.

It takes 3-4 weeks to make appointments with the doctors in the government hospitals.

Public and private charity organizations have been encouraged to give more scholarships to medical students to pursue the course in order to cope with the shortage. Support groups and caregivers of PD have to work hard to increase public awareness of PD and they are the sources of help for all PD patients and caregivers.



Dear Teo,

I agree with you. PD is a rich man disease and I feel that the support in Singapore is not sufficient too.

If you go to the government hospital, getting an appointment can be up to 4 weeks or even longer. Doctors are unreachable and when you page for the doctors, it is at their own discretion to return your call.

Unless you have the money to go to a private clinic, where the doctors are more willing to talk to you but for the long term, this is a very heavy burden for the average income family.

My mother had PD at a young age of 40 and she is now 48. Her health is deteriorating. Her medications are expensive and she now has muscle aches, hallucination and her emotions are often unstable.

Under the extreme working pressure in Singapore, it is difficult to dedicate enough time for her.

It makes me sad that I am unable to relieve her of pain and agony. PD would require the combined care of a nutritionist, psychiatrist, physiotherapist and a good PD doctor. In Singapore, all of them are expensive.

Yours sincerely,
Angeline Lua

Dear Angelina,

You might post your questions to “Ask the Doctor.”

The doctors are all excellent PD specialists, and may be able to give you some guidance for your mother’s next doctor appointment — perhaps questions to ask her doctor, comments regarding the kind and amounts of medications she is using, etc.

If you have nutrition-related questions, I will help if I can.

Best regards,
Dr. Kathrynne Holden, MS, RD

Dear Teo,

I hope very much that your information and posts will help to raise public awareness of PD in your country. You might like to let the support groups know that National Parkinson Foundation will send informative booklets at no cost, and will also answer questions here on the “Discussion Corner.” I wish you and the PD groups the very best!

Best regards,
Dr. Kathrynne Holden, MS, RD

Are There Resemblances between PD and Alzheimer’s disease?

Dear Doctor,

PD and Alzheimer’s Disease are related with the Body, Mind and Soul slowdown mechanism. It degenerates your nervous mechanism i.e Body, Mind and Soul.

PD develops Dementia. There are about 40-80% of PD patients who are facing difficulties in making judgment, calculating and abstraction.

Are there resemblances between PD and Alzheimer’s disease?


Dear Teo,

These diseases are very different. They are similar in that they are neurodegenerative, but their course, pathology, and manifestations are very different.

Dr. Michael S. Okun, M.D.

Friday, November 21, 2008

My Medication

My Parkinson's medication is as follows:
5 tablets Requip 2mg daily - 2 tablets each before breakfast and lunch and 1 tablet before dinner2 tablets Sinemet CR daily - 1 tablet before breakfast, 1/2 tablet each before lunch and dinner1 tablet Jumex 5mg before breakfast
I feel drowsiness every time after taking the above medication. I could not drive. I am also easily irritated. I manage to relieve the above by keeping myself busy. Question:1. are the above side effects of my medication? OR2. am I experiencing the above due to wrong dosage of the above medication? FYI, I have seen a few specialists regarding this and some have advised me that the dosage is too strong whilst others have advised me that the dosage is sufficient.
Kindly advise.

Sunday, November 16, 2008

Forum:difficulty diagnose by physicians on parkinson's?

The difficulty diagnose on parkinson's were illiteracy by patients and complacency by physicians .

People who have parkinson's have to continue their visit for life. physician will need to monitor the effectiveness of your medication.

Too often some physicians become complacent with their patients.

There are reasons that your doctor is becoming complacent

He or she fails to answer your questions to your satisfaction.
He or she seems “put out” by your questions.
He or she doesn’t seem to be aware of the newest medications or procedures for your condition.
He or she doesn’t seem concerned or interested that you are developing new symptoms.
He or she doesn’t allow sufficient time for discussion or questions during your exam.

Illiteracy by patients:
Denial. Helplessness. Anger. Withdrawal from social circles. These are all forms of coping with Parkinson’s Disease that may manifest themselves on diagnoses. It’s not uncommon for patient’s to begin avoiding doctor’s appointments, or refusing to take their medication. All in the very human hope that the diagnosis is somehow not true.

Parkinson's Scenario


Saturday, November 15, 2008



Dear Doctor,

Is it true that nutrients’ intake must be added if we do more exercises, as exercises may reduce the level of antioxidants in our blood?

Does Jumex have an impact on the amount of nutrients intake? Jumex contains long term neuron-protective properties. However, it also increases cellular energy production that has potentially negative effects. The enhanced cellular function increases free radicals and aggravates stress. It may be necessary to periodically re-adjust the nutrients to put back the appropriate level of antioxidants in our blood.

Kindly advise.



Dear Teo,

In the case of exercises, generally only athletes need to be concerned about additional nutrients. Humans evolved to hunt, run, gather food, and otherwise, engage in physical labor, and meet their nutrient needs with their normal daily diet. Athletes, however, have a much higher activity level than normal, and may need extra nutrients.

Water is an exception. This most vital of all nutrients is easily lost by all humans and needs to be constantly replenished.

In the case of people with PD, there is an additional factor. PD is stressful and stress produces free radicals, and thus cellular damage. While there is no evidence that dietary nutrients can have an effect upon the area of the brain affected by PD, diet most certainly affects the health otherwise. Here, the first line of defense is a nourishing diet. Foods contain an array and balance of phytochemicals, flavonoids, vitamins and minerals that cannot be duplicated in pills and other supplements. Vegetables, fruits, nuts and seeds, whole grains, cooked legumes, and fish should be the backbone and mainstay of the daily diet. A multivitamin supplement is a good addition, but does not take the place of foods. An annual physical examination with lab tests will determine whether there is a need for other supplements, and this certainly can be the case as we age – vitamin B12, for example, is less well absorbed.

Jumex (selegeline), and in fact all PD medications, can have undesirable side effects that increase various kinds of stress, and here again, a wholesome diet, plus exercise, is the best way to combat these effects. You are doing exactly the right things in following a good exercise program and eating healthful foods.

Best regards,
Dr. Kathrynne Holden, MS, RD

Dear Doctor,

Thank you for your excellent reply.

However, I still believe that when we do more exercises, we would need more nutrients to protect our body from oxidative stress, whether or not we are an athlete.

The increasing energy production in the cells (from some medications, exercises, stress, etc.) will increase free radicals production. This is the natural biological process in the body.

But regular exercising will also increase endogenous antioxidant enzyme that enhances antioxidant mechanism in the overall body.

The aging process, antioxidant level and oxidative stress are dynamic processes which we have to monitor every 6 months or annually, at least, i.e. through blood test on the nutrient levels.

I understand that most PD patients have deficiencies or decreased antioxidants, folic acid and Vitamin B12 or 6, and these deficiencies occur in normal old adults too.

To improve our nutrient level in a natural and safe way, we need to have more fruits, vegetables and fish (source of co-enzyme Q10).

Kindly advise.

Best regards,

Dear Teo,

Yes, it’s very true that exercises, medications, and in fact, even metabolizing the food we eat, result in the production of free radicals. However, a healthy human body is very well adapted to combat these free radicals by producing its own metabolic pathways and enzymes to quench the free radicals. The key, first and foremost, is a high-quality diet that supports the production of such enzymes – as you say, fruits, vegetables, and fish are excellent.

Having said that however, this can change with age, disease conditions (such as PD) and many types of medications. That is why CoQ10 (co-enzyme Q10) and creatine are being studied, to see if they can help alleviate the negative effects suffered by PD patients. It is also good to remember that long-time use of levodopa can result in higher levels of homocysteine in the blood, and if this happens, supplements of B vitamins are needed.

Best regards,
Dr. Kathrynne Holden, MS, RD

Dear Doctor,

I wish to add the following to my earlier email.

The level of nutrients in our body depends on 3 factors:

1. The amounts of nutrient taken from food and supplements.

2. Ability of intestinal absorption.

3. Utilization of nutrients by our body, depending upon our level of physical activity. If we do more exercises, we will need more nutrients, hence affecting the level of antioxidants in our body.



Words by Dr.Kridakorn

It was 3 years ago that I first met with Mr. Teo. At first glance I am afraid to say that he wasn’t looking very well. I can’t blame him. He was recently diagnosed with Parkinson’s disease, a debilitating neurodegenrative disease. Current medical treatment is symptomatic and there is no know cure. This news could depress even the most optimistic person. Mr.Teo has actually been the opposite of depressed. He has taken this challenge head on!
Parkisnon’s is a progressive neuro-degenerative disease – in other words it only gets worse. It has been nothing short of miraculaous to see Mr.Teo actually improving!
I have had the opportunity to work with Mr.Teo as one of the many doctors that he consults with in his comprehensive approach to find a better way to treat Parkinson’s disease. What we do know is that Parkisnon’s wreck havoc on the nervous system through oxidative damage. We tested him and improved his antioxidant status thorough a tailor-made nutriceutical program. We worked with hormone replacement to boost is internal systems.
Mr.Teo also exercises regularly and practices yoga. I believe that this comprehensive approach has helped him to greatly improve his balance.
Another important part of his success I believe is from Ms. Lee – his wife. Few are blessed with such an exceptionally supportive life partner.
What I am most impressed with – even more so than his results – is Mr.Teo himself. He is eager to learn and ready to share the information and experiences that he uncovers. I would like to encourage all sufferers from Parkinson’s e to visit his Blog (WWW.HEROTEO.COM) .
It is an honor to be part of his doctor team.
Dr. Kridakorn Watcharachotpimai,American Board of Anti-Aging Medicine

Tuesday, November 11, 2008

Write-up by chinese press

引言: 他們用那軟弱的身軀,時刻不停地在和一種被稱之為「柏金遜(Parkinson)」的疾病戰鬥著。儘管面對著柏金遜病魔的肆虐,他們從不言放棄,並選擇在逆境中拚搏與成長。在生活的無奈與壓力下,激發出驚人的潛能與生命力。而這一群生命戰士就是--柏金遜病患者......
主文: 邁入人生第69個年頭的張金和是一名柏金遜病友。 「被柏金遜折磨了3年的我是很不幸的,但它讓我對人生有了另一番的詮釋與透徹。」張金和分享道。於2005年前,張金和是一名快樂、日子過得悠閒健康的退休人士。退休生活規律健康的張金和,經常保持良好的生活態度,度過每天的悠閒日子。與妻兒一家幾口的日子,亦過得安逸幸福。
但,意想不到的不幸卻悄悄地降臨這個幸福的家庭,3年前的張金和患上了柏金遜帕症,隨著醫生「柏金遜症」的一紙宣判,從此改變了他的人生軌跡。 獲知不幸患上柏金遜,張金和坦言,曾經一度有過自暴自棄的思想,但一想到親愛的家人,讓他有了責任、動力與希望,去戰勝一切困難的勇氣。
當張金和從書本與網上資料獲知,柏金遜病患可以採用許多治療的方式去控制,而且效果理想,為此,他買了許多有關方面鑽研柏金遜的書籍與網上收集資料,並經常上門向醫生討教,潛心研究。 「儘管柏金遜症不能完全治癒,但我希望能夠給予其他帕金森病友適時的協助與幫忙。」熱心的張金和分享道。
「現在,我的生活過得很充實。雖然我依然不能完全像一個正常人那樣生活,但我一直都在儘自己的最大努力,目的是協助同樣患上柏金遜的朋友,獻上最衷心的祝福與支持。」張金和指出。如今,只要搜獲新的醫藥資訊或個案,張金和都會把一切柏金遜的資訊放上論壇裡,與大家分享呢。 「除了自己的論壇,我也經常到其他相關的柏金遜網站與論壇,與他人分享自身的經驗與見解。」張金和積極地透露。
張金和認為,心情舒暢、無慾無求是柏金遜病友應有的心態。 「戰勝柏金遜不但要靠藥物,更要靠信心和毅力。」張金和鼓勵說.週遭的親友,甚至醫生都稱張金和為「張英雄」(Hero Teo),只因他的毅力、他的堅持、豁達的心,照亮了柏金遜這黑暗的國度,指引著其他病友,一同對抗頑固的柏金遜病魔。
欲與張金和交流有關帕金森的一切,歡迎大家遊覽其個人分享論壇movementdisorder.blogspot.com 。更多有關柏金遜的資訊,張金和建議大家可遊覽美國國立帕金森病基金會(National Parkinson Foundation) http://www.parkinson.org/
-- 副文: 一般來說,柏金遜症並不會傳染或遺傳,但有專家發現它與家族遺傳有關。這種病,一般被稱為「遺傳性柏金遜症」(Familial Parkinson』s Disease),而張金和與家中的哥哥與弟弟卻是「遺傳性柏金遜症」的一份子。 「家中除了我患上柏金遜症,哥哥與弟弟也患上同樣的病。然而,他們卻不以為然,認為不是柏金遜症。」他述說道。
張金和透露,許多被診斷出患上柏金遜的人都不願意接受現實與治療,固執與抗拒接受病情的舉動,讓柏金遜潛伏於體內繼續惡化。 「當他們不接受專業醫生的診斷,不及時治療,病情將會變得更加惡劣。」因此,張金和呼籲社會應該多關愛柏金遜病友,甚至身邊的親人,讓他們知道患上柏金遜的日子,並非面臨人生絕路。 -- 後記: 只要心中充滿愛,用愛化作行動的力量,在人們看似已絕望懸崖上,也能有意想不到的奇蹟發生;也能找到還生的稻草。張金和韌性十足的生命力,讓我看見愛的力量是偉大、超自然的;連上帝也為那些勇敢無私付出愛的人們動容,為愛放了一條生路。

Sunday, November 9, 2008


Posted: Sat Nov 08, 2008 4:07 am Post subject: Suicide

Dear Dr Okun / Fernandez / Rodrigue We have heard of reports on higher risk of suicide among Parkinson's patients who have undergone DBS. But excluding the post-DBS patients, the suicide rate among Parkinson's patients is lower than that of the general population. Recently, one of my Parkinson's patients committed suicide by hanging himself. He had been having auditory hallucination for some time. There was also an element of depression. In my clinical practice, I seldom encounter cases of suicide among Parkinson's patients. In view of their physical and mental sufferings, I wonder why the suicide rate in Parkinson's patients is not higher than the general population. I'd appreciate if you can give your opinion. Thanks. Dr Chew Nee Kong, Kuala Lumpur.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sat Nov 08, 2008 11:20 am Post subject:

It is unknown why the suicide rate is lower in PD than the general population but it may relate to the type of degeneration in the frontal lobes leading apathy and other findings. I would direct you to Valerie Voon's work in Brain that throughly reviews and addresses this important and potentially preventable risk following DBS. Brain. 2008 Oct;131(Pt 10):2720-8. Links A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson's disease. Voon V, Krack P, Lang AE, Lozano AM, Dujardin K, Schüpbach M, D'Ambrosia J, Thobois S, Tamma F, Herzog J, Speelman JD, Samanta J, Kubu C, Rossignol H, Poon YY, Saint-Cyr JA, Ardouin C, Moro E. National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1428, USA. voonv@ninds.nih.gov Subthalamic nucleus deep brain stimulation improves motor symptoms and quality of life in advanced Parkinson's disease. As after other life-altering surgeries, suicides have been reported following deep brain stimulation for movement disorders. We sought to determine the suicide rate following subthalamic nucleus deep brain stimulation for Parkinson's disease by conducting an international multicentre retrospective survey of movement disorder and surgical centres. We further sought to determine factors associated with suicide attempts through a nested case-control study. In the survey of suicide rate, 55/75 centres participated. The completed suicide percentage was 0.45% (24/5311) and attempted suicide percentage was 0.90% (48/5311). Observed suicide rates in the first postoperative year (263/100,000/year) (0.26%) were higher than the lowest and the highest expected age-, gender- and country-adjusted World Health Organization suicide rates (Standardized Mortality Ratio for suicide: SMR 12.63-15.64; P < 0.001) and remained elevated at the fourth postoperative year (38/100,000/year) (0.04%) (SMR 1.81-2.31; P < 0.05). The excess number of deaths was 13 for the first postoperative year and one for the fourth postoperative year. In the case-control study of associated factors, 10 centres participated. Twenty-seven attempted suicides and nine completed suicides were compared with 70 controls. Postoperative depression (P < 0.001), being single (P = 0.007) and a previous history of impulse control disorders or compulsive medication use (P = 0.005) were independent associated factors accounting for 51% of the variance for attempted suicide risk. Attempted suicides were also associated (P < 0.05) with being younger, younger Parkinson's disease onset and a previous suicide attempt. Completed suicides were associated with postoperative depression (P < 0.001). Postoperative depression remained a significant factor associated with attempted and completed suicides after correction for multiple comparisons using the stringent Bonferroni correction. Mortality in the first year following subthalamic nucleus deep brain stimulation has been reported at 0.4%. Suicide is thus one of the most important potentially preventable risks for mortality following subthalamic nucleus deep brain stimulation for Parkinson's disease. Postoperative depression should be carefully assessed and treated. A multidisciplinary assessment and follow-up is recommended._________________Michael S. Okun, M.D.

Posted: Sun Nov 09, 2008 8:59 am Post subject:

Dear Dr Okun Thanks for your opinion. Yes, I have read Valerie Voon's paper in Brain. It is an interesting study. I have to admit that all these years I myself did not really pay attention to the issue to suicide in Parkinson's. Well, Parkinson's is a very complicated subject - there is always something new to learn everyday. Dr Chew Nee Kong, Kuala
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Mon Nov 10, 2008 7:56 am Post subject:

I agree with that! Keep writing and thanks for contributing so positively to the forum._________________Michael S. Okun, M.D.
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Thursday, November 6, 2008

Creating strong immunity

The majority of health issues can be related to an immune system disorder. Your immune system loses its abilities silently.

Latest scientific research report a healthy lifestyle gives you a strong immunity.
These studies come from a wide range of disciplines, from universities and medical centers around the world.
Everything you touch, breathe, eat, and think affects your immunity.
Factors such as sleep, exercise, nutrition, stress reduction, and spiritual connection provide the foundation for a strong immune response.
They are simple, inexpensive, and safe -- and that really work.
To understand your immune and you:

Improve your immune system

1. Rest and rejuvenation,
3.Good nutrition
4.Avoid Toxins and pollution


Immune systems and the invaders


Wednesday, November 5, 2008

Men mostly die on prostate cancer?

Men mostly die on prostate cancer than any other diseases?

For the general population, a man in his lifetime has about a
16 percent chance (1 in 6) of being diagnosed with prostate cancer.
3 percent chance (1 in 33) of dying from prostate cancer.
The older you are, the greater the risk for getting prostate cancer.



Tuesday, November 4, 2008

Forum: Multivtamins The Good ,The Bad or The ulgy?

teokimhoeJoined: 03 Mar 2007Posts: 118Location: Malaysia
Posted: Tue Nov 04, 2008 3:20 am Post subject: Multivitamins Good or Bad?

Vitamins and other supplements are so popular these days that it can be hard to separate what's helpful from what's merely "hype-ful." Ideally, humans would eat wholly nutritious diets rich in protein, vitamins and minerals. On the one hand, nutrition experts agree that the best possible way to get vitamins, minerals, and other nutrients is through food. That's because your body absorbs vitamins and minerals most easily from food. But for certain people and in certain situations, supplementing with a multivitamin may be a good idea. These people do not meet all their nutritional needs through their food.

They fill up on junk food and sugary snacks while skimping on whole grains, fruits, and veggables whilst on meal


As a result, many of us rely on multivitamins and supplements to achieve more complete nutrition.

However, the marketing and producing of multivitamins are not regulated by government.
The contents of this nutritional value 'good for you' is questionable.

_________________to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families


Forum: Better health through Meditation

teokimhoeJoined: 03 Mar 2007Posts: 117Location: Malaysia
Posted: Tue Nov 04, 2008 2:26 am Post subject: Better health through meditation

Meditation is not only for religious beliefs but also the practice of focusing your attention to help you feel calm and give you a clear awareness about your life. Eastern philosophies have recognized the health benefits of meditation for thousands of years. Meditation is now widely practiced in the West, with the belief that it has positive effects on health._________________to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families

Forum: The right to Happiness

teokimhoeJoined: 03 Mar 2007Posts: 116Location: Malaysia
Posted: Fri Oct 31, 2008 8:12 am Post subject: The right to happiness?

‘ I believe that every purpose of our life is to seek happiness. That is clear. Whether one believes in religion or not, whether one believes in this religion or that religion, we are all seeking something better in life. So, I think, the very motion of our life is towards happiness…’_________________to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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bernard shawJoined: 19 Aug 2008Posts: 73Location: Austria Late UK
Posted: Mon Nov 03, 2008 1:23 pm Post subject: Happiness.

You are right in saying we all look for happiness in our lives but I am not so sure that real happiness is to be found in religion. A family life that is intact and fully functioning is the right path to follow for happiness. Bernard Shaw aka Bern_________________If your face wants to smile, Let it. If it doesn't, Make it.
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John ShJoined: 05 Mar 2007Posts: 177Location: Arroyo Grande, California
Posted: Mon Nov 03, 2008 8:00 pm Post subject: Real Happiness

Hi Bern, maybe you are right, religion maybe can't supply true happiness, and maybe a functioning family can...but what can a person turn to if they don't have a functioning family? John S


Monday, November 3, 2008

Dopamine Blockers and Depletors

Dear Doctor,

In your article you mentioned the drug linked to erectile dyfunction.

1.What are the Dopamine Blockers and Depletors ?
2.Will these drugs interact with any medications I am currently taking?

3.What risks are involved with long-term use of these drugs


Through Meditation Restore your Health

Better health through Meditation
Posted on November 3rd, 2008 by heroteo
Meditation is not only for religious beliefs but also helps us to restore our health.
There are signs of stress affecting our health
1.High blood pressure
2.Heart disease,
3.heatburn and gastric diseases.
4.kidney and respiratory failure.
5 Asthma and lung infection and etc
6. malfunctioning of the immune system.
7.Chronic diseases
8.Anxiety, insomina, constipation, anger,depression
9 Emotional and non emotional disorders of Parkinson’s disease
Meditation help you temporarily relief the illness indicators .
While you meditate. you’re lowering blood pressure and breathing rates, muscle tension, adrenaline production
Try and practise meditation daily to buildup your immune system for health.
Therefore Better Health through Meditaion.
Meditation sometime does wonder than treatment by medication.
It is universal that patient sometimes be asked by doctor to consider use meditation to treat incurrable disease. Therefore better health through meditation.
If you are sick, meditation can help in measurable ways. If you are not sick, meditation will help you stay healthy. It works in two main ways: it helps the body relax quickly and it settles the overwrought mind.


Drugs linked to Erectile Dyfunction?

View previous topic :: View next topic
Posted: Mon Oct 20, 2008 4:57 am Post subject: Drugs linked to erectile dyfunction

Dear Doctor, There are drugs linked to erectile dyfunction' I have experience erectile dysfunction and having problems achieving or maintaining an erection by taking the following drugs: 1.Aspirin 2.plavix The drugs help me to thinning my blood clot as I had T.I.A recently to prevent receiving another blood clot. As the result I have tried to take erectile dysfunction drugs but they are not helpful, until I make a stop taking the aspirin and plavix. My Parkinson's medications are Requip 10 mg Jumex 5mg Sinemet CR 2 tablets daily. Kindly advise: 1.Are Aspirin and Plavix the drugs linked to Erectile Dysfunction? Some medications may treat a disease or condition, in doing so they can affect a man's hormones, nerves, or blood circulation, resulting in ED or increase the risk of ED' 2. Should I continue to take aspirin and plavix? 3. What are the Drugs rule out linked to Erectile Dysfunction helpful for me to thinning the blood clot? My parkinson's medications are Requip 10mg, Jumex 5 mg, Sinemet CR 2 tablets daily. Regards TEOKIMHOE
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Mon Oct 20, 2008 8:55 pm Post subject:

Erectile dysfunction can be a complex issue that sometimes can be of multiple causes. Aspirin and plavix are not, in my experience, linked to significant ED. However, if this is your experience, they you can certainly get rid of it and see if it helps. It does not make a lot of sense to me anyway that you are on both aspirin or plavix. It should really be just one or the other. Even for stroke prevention, studies have shown that puting the two together just increases your risk for bleeding but does not add extra protection against stroke. If you did not respond to the typical medication for ED, perhaps you should see a urologist. Tests may need to be done such as your blood sugar, testosterone level, etc, etc. There are also other choices that your urologist can discuss. Yours,_________________Hubert H. Fernandez

talk about sex…because having any chronic condition is bound to affect a relationship on both a physical and emotional level. Both partners in a couple whose lives have been affected by Parkinson’s disease need to understand the disease and its progression in order to cope with any difficulties which may arise in their sex life.
Many of the symptoms associated with Parkinson’s disease are thought to be caused by lowered levels of dopamine in the brain - a chemical that transmits messages from the brain’s “relay center” to its nerve cells, enabling physical movement. It is possible that the dopamine decrease may also cause a lessened drive or interest in sex
Tags: Discussion

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What are the main treatments?
Oral drugs. The first, and best known, oral treatment is Viagra (sildenafil). It works by helping to relax the blood vessels in the penis, allowing blood to flow in. It doesn't work unless you're also sexually stimulated. The most common side-effects are headaches and facial flushing, and it can't be taken by men who are also using medicines containing nitrates (commonly prescribed for angina).
Injection therapy. This is probably the most effective and reliable way of producing an erection with drugs but, understandably, many men don't like sticking a needle into their penis every time they have sex. When injected, the drug (most commonly alprostadil, commonly known as Caverject and Viridal), relaxes the blood vessels and muscles, allowing increased blood flow and producing an erection within 15 minutes.
MUSE (medicated urethral system for erection). This method also uses alprostadil, but this time it's administered by means of a small pellet inserted into the urethra via a single-dose, disposable plastic applicator.
Vacuum pumps. The penis is inserted into a clear plastic cylinder and the air is pumped out, creating a vacuum. The penis fills with blood and, when it's hard enough, a plastic constricting ring is placed around the base of the penis to trap the blood. There are few side-effects (apart from occasional slight bruising) and the devices work for more than 90% of men. Many men find the process too unnatural and intrusive, however, and prefer to try other methods of tackling ED.
Hormonal supplements. Testosterone can be given to men in the relatively few cases where low levels are the cause of ED, especially if they also have low sexual desire. Before taking testosterone, always insist that your doctor measures your testosterone level to confirm that it really is low.
Penile implants. Now that so many other effective treatments have become available, implants have become an option of last resort and are now much less used than they were ten years ago. A mechanical device is surgically inserted into the penis. It can be either permanently rigid or have a hydraulic action, operated via a valve in the scrotum.
Sex therapy. Whatever the cause or treatment of their ED, many men could benefit from counselling or therapy. In fact, the best treatment centres provide it as a matter of course. Sex therapy will be particularly necessary if the ED has psychological causes which can't actually be "cured" with physical treatments. If a man has ED as a result of emotional conflict with a partner, for example, providing him with a drug that produces an erection isn't going to resolve that conflict; in fact, it might even make it worse. Men with physically-caused ED may also have lost a great deal of self-esteem and sexual confidence which sex therapy could help restore. It usually makes sense to also involve any permanent partner in sex therapy since the loss, as well as the restoration, of a man's erectile functioning will almost inevitably profoundly affect their relationship


Posted: Wed Oct 29, 2008 10:09 am Post subject:

Dear Doctor, Is Xatral XL 10mg linked to erectile dysfunction?
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Posted: Thu Oct 30, 2008 2:35 am Post subject:

Is Blood Sugar (FPG) level 108 lead to erectile dyfunction?
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Posted: Thu Oct 30, 2008 4:16 am Post subject: Serquel linked to raise blood sugar level?

Is seroquel linked to raise blood sugar level? Am I at the risk to have diabetes as I have Impaired Glucose Tolerance? What's about patient suffer diabetes? TEOKIMHOE
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sun Nov 02, 2008 11:04 am Post subject:

Bllod sugars in the 80-120 range are usually normal and not linked to erectile dysfunction. Diabetes and uncontrolled blood sugars can be linked to this dysfunction._________________Michael S. Okun, M.D.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sun Nov 02, 2008 11:08 am Post subject:

Xatral seems to be a drug to treat large prostate glands. I am not an expert but a search did not seem to reveal erectile issues (I will of course defer to a urologist). Seroquel and other dopamine blockers have been linked to higher blood sugars and should be watched carefully especially if you have diabetes. Watch your diabetes if you are on these meds (usually blood sugar monitoring)._________________Michael S. Okun, M.D.

Aspirin,blood clot and heart burns/Gastric

Posted: Wed Oct 29, 2008 10:35 am Post subject: Apirin, blood clot and Acid Reflux

Aspirin helps thinning your blood clot to prevent T.I.A.(mini Stroke. Is Aspirin linked to heart burn (Acid Reflux Disease) or stomach ulcer? Kindly advise TEOKIMHOE
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sun Nov 02, 2008 11:08 am Post subject:

Yes NSAIDS like aspirin can contribute to heart burn or to NSAID induced ulcers._________________Michael S. Okun, M.D.

Friday, October 31, 2008

Signs of Parkinson's Disease

Posted: Tue Oct 28, 2008 9:34 am Post subject: Signs of Parkinson's Disease

There are the following signs that you may develop the Parkinson's Disease. 1. unexplained stiffness in arms, legs, feet or hands 2. tremors in arms, legs, feet or hands 3. Muscle or joints freeze 4. Difficulty walking and balance 5 Stoop posture 6. soft speech,slur speech 7. small handwriting' 8. Insomina, anxieties, depression,constipation for the past few years 9. Mask face without smile 10. Drooling Saliva Consult movement disorder specialist for checkup.
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Parkinson's Disease
Unlike many other neurodegenerative diseases, there is effective symptomatic therapy for Parkinson's disease that can provide most patients with several years of satisfactory quality of life and response to treatment. Key points in PD therapy include:
No therapy has yet been shown to slow or reverse the disease, although clinical trials of several candidates have shown intriguing results.
Levodopa continues to be the most effective treatment for motor symptoms, and all patients eventually require it.
Long-term complications of dopaminergic therapy are a concern that drives decision-making early in the treatment program.
Non-motor symptoms, especially depression and anxiety, are important targets of therapy.
Surgical treatment has become a mainstay of late-stage management, although not all patients can afford it or are appropriate candidates.
Cell transplant therapies are still experimental.
Non-pharmacological treatments remain an important part of a comprehensive treatment program.


Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Thu Oct 30, 2008 3:33 pm Post subject:

Thanks for the post. Joe Jankovic also stresses unexplained shoulder pain._________________Michael S. Okun, M.D.

Thursday, October 30, 2008

Yoga an exercise for Parkinson Patient?

I have exercises in the gym i.e body pump, body combat, spinning, cardio, box and kick execises I consider Yoga has most benefits for parkinson’s patient.
Yoga is a mind, mood and soul exercises. It orginating from India two thousand ago and western technically scientific and modified them into physical exercise that promote mind,mood and spirit.
Parkinson’s disease is a movement and non movement disorder’s kindly consider learning Yoga as a tool to combat the diseases. It teaches you on how to relief your muscle stiffness, rigidity and stretching as well as twisting your hip bones and seat bone either standing and seating to uplifting your stoop postures.
Yoga strenthen your muscle and increase mobility in joints
It also aids patients in relaxation and have a disability and are struggling with managing your body or symptoms yoga could be a very good choice.
It also teaches you relaxation techniques on how to cool down and relief your anxieties, depression, insomina , and temper which are most helpful for parkinson’s patient and provide strength to handle other troubles that beset you.. It is also a discipline improve your emotional and spiritual health as well.
Yoga is becoming an increasingly popular means of relieving pain and increasing comfort for people with many different types of disabilities. Many patients practice adaptive yoga, which takes into consideration a patients wants and concerns as well as their limitations. Those with multiple sclerosis, sports injuries, fibromyalgia, post-surgical conditions, Parkinson’s disease, stroke, arthritis, or simply a very sedentary lifestyle have been helped by doing yoga.

Tuesday, October 28, 2008

Check Lists of Parkinson's Disease

There are the following signs that you may develop the Parkinson's Disease. 1. unexplained stiffness in arms, legs, feet or hands2. tremors in arms, legs, feet or hands3. Muscle or joints freeze 4. Difficulty walking and balance5 Stoop posture 6. soft speech7. small handwriting'8. Insomina, anxieties, depression for the past few years9. Mask face. Consult movement disorder specialist for checkup.


Saturday, October 25, 2008


Posted: Wed Oct 22, 2008 4:43 am Post subject: urination

Dear Drs, What can be done when parkinsons has reached the point of being unable to urinate?
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Thu Oct 23, 2008 9:46 am Post subject:

This is not a typical or common feature of PD. A urology consult is very important in these cases. If the subject is a man think hard about prostate issues._________________Michael S. Okun, M.D.

Characteristic in parkinson's disease

Posted: Sun Oct 19, 2008 6:46 pm Post subject: Parkinson's Patients: Mercy Killing or Senseless Suicide?

I think some patients choose to suffering Mercy Killing or Senseless Suicide as He/She has no trust and believe on the doctors and prefer what he/she is? My friend who has parkinson's disease though he is wealthy but he does not believe and trust doctor he prefers to stay what he is. As the result he is in the late stage three Parkinson's disease. He pleads mercy killing. He believes he has other diseases rather the parkinson's. I feel sorry for his decision. This is his choice to plead mercy killing/Senselesss suicide rather the treatment.

Therefore Illiteracy by him towards the diseases are the main cause of parkinson's scenario.

Denial. Helplessness. Anger. Withdrawal from social circles. These are all forms of coping with Parkinson's Disease that may manifest themselves on diagnoses. It's not uncommon for patient's to begin avoiding doctor's appointments, or refusing to take their medication. All in the very human hope that the diagnosis is somehow not true. Ultimately it is important to confront the diagnosis as timely treatment and making changes to one's lifestyle can make a huge difference in living with Parkinson's Disease


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Apathy is a characteristic of Parkinson disease. Apathetic behavior is not something the patient can voluntarily control, and it is not laziness or the patient trying to be difficult — it is a symptom of Parkinson disease.”
Apathy : indifference, unconcern, lifelessness, uninterested, dullness, listless, uninquisitiveness, lack of emotions or feeling,etc

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Mon Oct 20, 2008 8:48 pm Post subject:

I am sorry to hear this, as PD, although not curable, can be treated. A lot of our patients live very meaningful lives. Each person has a right to his or her own beliefs, but I just hope that this decision is not a result of ignorance or lack of education/information. He should at least see a Movement Disorders specialist, even just once before he makes his decision. I wish I can do more. My thoughts are with your family. Yours,_________________Hubert H. Fernandez
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Posted: Wed Oct 22, 2008 11:38 pm Post subject: suicide

My meds were "off". Statue-like in my garage; I watched all of the neighbor ladies drive by in their golf carts. In the nick of time; my sinemet started kicking in. I grabbed my crutches and hobbled to my golf cart. I drove to the starter shack and schleppe up to the starter's window.. The starter didn't say the words. They were in his eyes. I responded with, "In 15 minutes; my meds will kick in and I'll have a hole in one. You just watch!" Big Mouth!! Several people watched as I landed my tee shot 12 inches from the cup. I hollered, "Better living through chemistry and my Gator docs!" My point is this...we can still achieve wonderful accomplishments. Get past your stubborn refusal to learn how to live better, despite PD. Now my bucket list does not include climbing Mount Everest. It never did. But, still, I would love a hole in one. Many wonderful people and achievements have come to me since PD. More will come. Suicide only hurts the people who love you the most. You wouldn't be there to feel their pain. More than one member of my family has gone the suicide route; so I know whereof I speak. GROW UP!! Suicide is for self-centered cowards. Sure; it takes courage to face this disease. But, we are not alone. We have a dedicated team in our corner. You know several of them...Drs. Fernandez, Foote, Hauser, Mandel, Nieves, Okun, Rodriguez and Skidmore. These bright young medical sleuths put in 80+ hours in clinic, teaching and research a week....then volunteer stuff like "ATD" and "hawgwildcure.com". They learn from us; we from them. Every coping strategy we implement is a small win. Every new med that buys another few hours of "on" time is another win. We will win the biggest jackpot of alll when a cure is foound..during our lifetime! We just need to keep living so we're still here when a cure is found. It will be found. Betcha!!!! And, I'm not on mirapex or requip! I know that few Parkies, actually, do commit suicide. Our docs will elaborate on that...please. Ths is no dress rehearsal, Judy
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Fri Oct 24, 2008 10:12 am Post subject:

Thank you, Judy, as always! Your words can sometimes be tought to swallow, but they are real and they hit us right in the core. Yes, I believe in fighting and living life to the fullest. I believe in hope and I believe in contributing to that hope. Like you, and millions of others with PD, giving up is not in my vocabulary! Passive suicide due to ignorance is one thing, and active suicide as part of depression is another. I really believe knowledge is power. And I do hope that there will be less and less people in this world who are "giving up" simply because they do not know any better. They do not know that there are medications and strategies to make their lives better and more manageable. They do not know that PD is not a deadly disease that goes for the jugular in months. It is a slow process that can stick with you for years or even decades and ignoring it just makes your life more miserable. Depression however is common in PD. It occurs in up to 50% of PD patients. And suicidal thoughts can be part of it. In fact we featured this as our article of the month at the Movement Disorders Society Web Site (www.movementdisorders.org). The good news is that this can be treated. Our medications work! So, passive suicide from ignorance can be treated with education and active suicide from depression can be treated with medication and therapy. More power to you all! Take care,_________________Hubert H. Fernandez

Thursday, October 23, 2008

Pneumonia causes most death in Parkinson's?

There are almost 2/3 of Parkinson's patients at the age above 46 years old died on Pneumonia as they find difficulty of breathing and swallowing. They are at the late stage of Parkinson's.
My mother died on Pneumonia aspiration disease. It may be genetic or environmental factors yet to be confirmed. I may be one of the victim.