Monday, September 29, 2008

Drugs and Older Adults

Parkinson's disease is primarily an inherited genetic disorder

Posted: Sat Sep 27, 2008 3:46 am Post subject: Parkinson's disease is primarily an inherited genetic disor

A news item from a forum member; with thanks, Kathrynne ============================ Different mutations in a single gene suggests Parkinson's disease is primarily an inherited genetic disorder Wednesday, April 16, 2008 JACKSONVILLE, Fla. – Two new international studies by researchers at the Mayo Clinic site in Florida are rounding out the notion that Parkinson's disease is largely caused by inherited genetic mutations that pass through scores of related generations over hundreds, if not thousands of years. These genetic influences, which can be small but additive, or large and causative, overturn common beliefs that the neurodegenerative disease mostly occurs in a random fashion or is due to undetermined environmental factors. These latest studies bring the total of number of disease-related mutations in an as yet poorly understood gene, leucine-rich repeat kinase 2 (LRRK2), to seven, all of which are linked, either weakly or strongly, to typical, late onset development of Parkinson's disease in people around the world. One mutation (R1628P) doubles the risk of Parkinson's disease in ethnic Chinese, according to a study published on Wednesday, April 16, 2008 in the online edition of the Annals of Neurology. The second study, published April 15 in Neurology, demonstrates that another very rare mutation (R1441C), found in people on three continents, increases risk by more than 10-fold. The R1628P was identified by the strong collaborative effort of researchers from Taiwan, Singapore, Japan, and the U.S. The research institutions included the National Taiwan University Hospital, led by Dr. Ruey-Meei Wu, Chang Gung Memorial Hospital led by Dr. Yih-Ru Wu, National Neuroscience Institute of Singapore led by Dr. Eng-King Tan and Juntendo University, led by Dr. Nobutaka Hattori. This group believes the R1628P mutation arose from a single individual in the Han Chinese population about 2,500 years ago and has since spread through generations of descendants, wherever they live. This is the second common LRRK2 mutation discovered in Asians –a mutation labeled G2385R believed to have originated 4,500 years ago was first reported in the journal 'Neurogenetics' in 2006 and subsequently confirmed by several groups. Lrrk2 G2385R and R1628P predispose over 100 million Chinese people to Parkinson's disease. "The picture that is emerging of Parkinson's disease is one in which genetic risk factors, passed down through the population for hundreds or thousands of years, add up to substantial susceptibility within a single individual, and, with some possible environmental influences, can result in disease," says Mayo Clinic neuroscientist Owen A. Ross, Ph.D., first author on the Annals of Neurology study. "These types of mutations are important because the goal of this research is to be able to screen people who are most at risk because of their genetic profiles, and design therapies that interfere with the disease process," Dr. Ross says. The stronger R1441C mutation, also currently being reported, originated from several different "founders" and is now found in 20 families on three continents. It is relatively causative in nature, meaning the majority of people with the mutation are likely to develop the disease. "Parkinson's disease is fascinating to study because we can now roughly trace when and where mutations occur, and how they travel through offspring and in populations," says Kristoffer Haugarvoll, M.D., a visiting scientist at Mayo Clinic and lead author on the Neurology study. "It also shows us that disease that appears to be the same in the majority of patients can originate from different genetic mutations – either genes that increase risk substantially, or by several risk factors, genetic and environmental, that each have minor but additive effects." Same mutations in familial and sporadic forms of the disease Only about 10 percent of patients diagnosed with Parkinson's disease have a strong family history of the disease, and Mayo Clinic researchers in Florida have been part of a worldwide effort to discover whether common genes may explain the origin of the other 90 percent, the so-called "sporadic" form. In 2004, they were part of a team that discovered that the LRRK2 gene is linked to both familial and non-familial cases of the disease. Since then, they have found LRRK2 mutations that can cause the same clinical manifestations of Parkinson's disease in people with and without a family history – discoveries that "have caused a paradigm shift in the field," says Dr. Ross. For example, a mutation labeled G2019S causes both familial and non-familial Parkinson's disease in a high number of Berber Arabs and Ashkenazi Jews. "This shows that the effect of mutations in different areas of the Lrrk2 protein lead to the same disease, although it may not manifest in each generation and so did not appear to be familial," he says. In the latest study, Dr Ross and colleagues studied 1079 ethnic Han Chinese diagnosed with Parkinson's disease, of which 44 reported a family history of the disease. These patients were compared with 907 ethnically matched Han Chinese who did not have Parkinson's disease, and results showed the R1628P variant was approximately twice as frequent in Parkinson's disease patients as in the control population. From this, the researchers estimated that for every 100 Chinese, 3 will have the gene variant. Further research then suggested that the R1628P carriers were related to a single common founder that dated from about 2,500 years ago. The researchers then searched for evidence of the mutation in Japanese patients and controls – but did not find it. "The theory is that this mutation arose in China after the Japanese and Chinese segregated their populations, which explains why the G2385R mutation, which is 2,000 years older than R1628P, is found in both populations and is more common," Dr. Ross says. "Inheriting one or both of these mutations doesn't mean that a person will develop Parkinson's disease, but that an individual's risk is increased," he says. "The basis of population genetics is that disease is familial; people are so distantly related that they don't know they may have inherited specific genes. While there may be an environmental component to development of the disease, none have been identified that have risks as large as those seen by the LRRK2 gene mutations." Generations that carry rare but critical mutations In the Neurology study, Dr. Haugarvoll, who is from Norway, worked with researchers from a number of countries to collect genetic information from discrete populations of people representing three continents who had previously been found to be carriers of the R1441C mutation. "This was a completely collaborative effort," he says. "Rare mutations affect relatively few patients, but if we join forces in a worldwide initiative, we have larger samples to look at, and that is the only way you can advance the science." The scientists identified 33 affected and 15 unaffected R1441C mutations from 20 families, including four patients with no family history of Parkinsonism. These patients all developed disease that mimicked the typical, late onset disease normally seen in non-familial, sporadic Parkinson's disease, Haugarvoll says. The scientists believe the same disease-causing mutation has occurred independently on several occasions; however, most patients seem to originate from two different founders. One variant was found in Italian, German, Spanish, and American patients. The second was discovered in patients from Belgium and from a single American family, located in Nebraska. Dr. Haugarvoll says the region of R1441C appears to be "a hotspot for mutation events" because other mutations occur in this general area. What is most interesting, he says, is that "even though there are familial mutations in different locations of the gene, it produces the same effect, the same disease." "It seems like mutations are occurring in a few founders, and that these founders have a lot of offspring over generations that carry the mutation. Even in sporadic disease, then, familial genes are inherited but symptoms may skip some generations, making the disease appear sporadic" Dr. Haugarvoll says. Major funding for both studies came from NIH (including the Morris K. Udall Center for Excellence in Parkinson's Disease Research at the Mayo Clinic) and several international funding agencies. ### To obtain the latest news releases from Mayo Clinic, go to is available as a resource for your health stories.
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Friday, September 26, 2008

Parkinson's Like Me Forum Posts

Is there a cure for parkinson's disease?

Parkinson's Blogs worth mentioning

Posted: Thu Sep 25, 2008 7:33 am Post subject: Parkinson's Blogs worth mentioning

Parkinson's Blogs Worth Mentioning by Taryn SimpsonEmotional Impacts It seems that everyone is on the Internet these days! As I was searching for some information last week, I came upon a Parkinson’s disease blog network with blogs written by Parkinson’s disease sufferers about medication, symptoms, and so on. Some bloggers keep an online diary of getting around and coping with the symptoms. Others write about medication that works for them. I found it extremely interesting. There are senior citizens, young onset patients, men, women, newly diagnosed patients, patients who have lived with the disease for many years, and doctors who blog about their experiences with Parkinson’s disease; there are financiers who play poker for PD; support groups; and podcasts that cater to the Parkinson’s community. Once you start reading, it will captivate you. I found more than four pages of blogs that relate to Parkinson’s disease. We are fortunate to live in an age when we are able to reach out and connect with others so easily. I remember the days of making a trip to the library and perusing encyclopedias and other reference books to learn more about Parkinson’s disease. Now, accessing information is as easy as a click of a mouse. Whether you have questions about medication, a doctor’s perspective, a personal journey, or symptoms, these blogs are a great place to begin your journey. Who knows? It may inspire you to start your own blog about Parkinson’s disease. You’ll learn a great deal about yourself and others. You will “meet” people from literally all over the world and make new friends. Take a look; I think you will enjoy these Parkinson's diseas
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Thu Sep 25, 2008 3:26 pm Post subject:

Thanks for this nice post. These blogs are neat!_________________Michael S. Okun, M.D.
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Posted: Thu Oct 02, 2008 4:32 am Post subject:

We are fortunate to live in an age when we are able to reach out and connect with others so easly as click of a mouse. Whether you have questions about medication, symptoms,sideeffect,doctor's perspective these blogs are helpful. Parkinson's disease blogs are worth mentioning as it takes time for the bloggers to write their experience how they confront the diseases and combat with the diseases with determination and consistance as well as how they overcome the sideeffect of the medication either emotional or non emotional bahaviour on them. The sideeffects of the medication are different from one by the others and the syndromes are all not the same. It leaves the sufferers are at difficulty times. Therefore the blogs are helpful. The parkinson's blogs are encouraged us to be more positive thinking towards the diseases as it is a chronic disease and it takes our lifetimes to slowdown. We are not alone. Blogs can give patients useful insight into health conditions and treatments. And, they can provide a supportive forum as a patient endures on-going treatment. Meds react differently with different people. What some folks experience while taking a drug does not mean everyone will experience the same negative or positive effects. TEOKIMHOE
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Thu Oct 02, 2008 1:22 pm Post subject:

Thanks_________________Michael S. Okun, M.D.

Posted: Tue Sep 30, 2008 12:45 pm Post subject: Parkinson blogs

How do I access the Parkinson blogs mentioned by Taryn Simpson and Dr. Okun? Can anyone tell me? It was not included in their posts. Thank you!
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Thu Oct 02, 2008 1:14 pm Post subject:

Thanks for the question. I will post for you as I was just responding and do not have specific information._________________Michael S. Okun, M.D.

How I manage the Parkinson's Disease?

Tuesday, September 23, 2008

Parkinson's is not the end

Posted: Sat Sep 20, 2008 7:39 pm Post subject: Parkinson's is not the end

Parkinson's is not the End by Staff Condition Overview It’s there if we want it, but we must reach for it. Fulfillment is not far and is entirely accessible. A diagnosis of Parkinson’s disease is not a sentence of something terrible, if we accept it as we accept without question the consequences of ageing! We must move ahead into that part of our future within our control by: Identifying our unused talents and skills. Applying them. How do we identify our latent abilities? Easy! Make a list, a long list, of goals in which you have an interest (what would you really like to do or be?), and one or two will stand out as being the most appealing because you plan to work on them first. It can get exciting! Every one of us has hidden abilities we have not yet used, as I discovered. Until I was a year or so into Parkinson’s, I had not realized I was able to write well. Now I have authored quite a few books. I discovered yet another hidden talent in writing children’s books. My new full-time avocation is keeping me busy and constantly presents new goals. Just as Satisfied With Life Now As I Was Before Parkinson's Hit! I wish to add the very important fact that I quit driving years ago— before I did something bad. This keeps me at home most of the time. My lovely bride of 37 years works full time, but that’s OK. I have plenty to look forward to, every day, as I count my blessings. Life is good.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue Sep 23, 2008 9:21 am Post subject:

Thanks for your wonderful note and you are right Parkinson is not the end._________________Michael S. Okun, M.D.

Is there a cure for parkinson's disease?

Is there a cure for Parkinson’s disease?

No. There are therapies that treat the symptoms to some degree. Nevertheless there is no cure.

There are a number of effective medicines that help to ease the symptoms of Parkinson's disease. Most symptoms are caused by lack of dopamine. The medicines most commonly used will attempt to either replace or mimic dopamine, which improves the tremor, rigidity and slowness associated with Parkinson's disease. Several new medicines are being studied that may slow the progression. Many promise to improve the lives of people with Parkinson's disease.

Source: NPF

Parkinson's disease does not mean no life or no hope

The researchers are working very hard to find a cure.

It may not too far away? It is not dream but soon will be a reality. But when? TEOKIMHOE

Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Thu Sep 25, 2008 3:04 pm Post subject:

Yes! We need to raise every dollar from every corner of the earth possible to deliver meaningful therapies, care and research._________________Michael S. Okun, M.D.

Dear Mr Teo

Yes, we may have to wait for another ten years or more for a cure for PD. But the consolation is that there are already so many new developments in the treatment of PD which can improve the quality of life of Parkinson's patients. Both the medications and DBS are very effective in relieving the symptoms of PD. There is also an increased awareness on some neglected aspects of PD, especially the associated psychiatric disorders and stem cell transplantation. Even at this point in time, here is already so much that we can do for the Parkinson's community.All of us have to combine force and work hard together.Dr Chew Nee Kong, Kuala Lumpur.

Is there still life after PD?

Posted: Wed Feb 27, 2008 8:05 pm Post subject: Is there still life after PD

Giving and serving others will bring much happiness than receiving and being served. Therefore there is still life after PD. You will no longer be alone._________________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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wheelersceJoined: 02 Mar 2007Posts: 541Location: MI
Posted: Thu Feb 28, 2008 7:54 am Post subject:

Teokimhoe, Of course, you are right that it's often "better to give than to receive." But I think we persons with Parkinson's have to understand that sometimes we simply have to focus on ourselves, and that's ok, too. We shouldn't feel guilty about it. And eventually, we will all be on the receiving end of help. There is beauty, too, in being a gracious receiver, allowing others the opportunity to give. It depends on where we are on this journey. Sue W.
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cfinlaysonJoined: 29 Jun 2007Posts: 152
Posted: Thu Feb 28, 2008 11:09 am Post subject:

I agree with you both, but I have a hard time focusing on myself. Example: Yesterday I was able to get out of the house and visit with my Granddaddy, who is in the nursing home. He just found out he is getting a private room and so excited. So, here I go (not complaining), as excited as he, to get him things for his room that he wants. In the meantime, I am also looking for my friend some furniture for her childs room. I also had to buy groceries for my family but by the time I do all my running around and get to Wal-Mart, I give completely out, start shaking, feet dragging, my speech is slurred because I am exhausted. I decided to sit and rest and maybe I wil get my strength back to finish, but I didn't. I even had people come by and laugh at me. I finally had to call my dear husband to my rescue (once again). I was so frustrated with myself, but it happens so fast. I just can't figure out this balance of helping others but also taking care of myself. This disease is so unpredictable and real pain in the ___, but I am still blessed!!! Candy

Exercise facts for Parkinson's disease

Exercise Facts for Parkinson's Disease
by StaffUnknown Category
Research has also proven the benefits of exercise, even in the short term, specifically for people living with Parkinson's disease. The list of benefits that scientists have discovered includes improved:
Motor performance
Trunk rotation
Hand-eye coordination
Stability and balance while walking
Non-motor symptoms
Muscle volume and strength
Perhaps one of the most compelling studies about the benefits of exercise came from researchers at Osaka Medical School in Japan. Research nurses visited 438 patients for an average of four years. During that time, 71 of the patients died. They found that patients who did not exercise were about 80 percent more likely to die.
It is probable that exercise increased the health of the study patients and contributed to their longer lives. Likewise, if the rest of your body is relatively healthy, you will benefit from that overall health in your battle with Parkinson's disease.
Reasonable Ideas about Exercise in Parkinson's
The benefits of exercise usually far outweigh the potential side effects. Nevertheless, there are some facts that you should know about exercise, and some risks you should be aware of.
Research has not proven that exercise slows down Parkinson’s. People living with Parkinson's disease report improving their physical and emotional health through physical activity. However, we cannot report that exercise will miraculously protect precious brain cells.
Benefits of exercise in Parkinson’s may be somewhat short-lived. Most of the studies exploring the effect of exercise on people with Parkinson's disease have only followed patients for a few months. There is limited information about long-term benefits.
Some people develop unwelcome conditions and injuries from exercise including sprains, arthritis, and heel spurs just to mention a few. Work with medical professionals to identify safe and effective exercises.
Exercise can be expensive, but it does not have to be. You can pay a premium for gyms, trainers, and equipment. However, there are many ways to exercise such as walking, or participating in activities at community centers, that are less expensive.
Exercise is hard work, especially if you are not used to it. Some people may need to start with short and easy activities, and build strength gradually.
There is not yet definitive proof that exercise improves depression or reduces falling.
Making Life Better
You do not need the validation of a scientist that life with Parkinson's disease is extremely challenging, and often discouraging. Because of the overwhelming evidence of the benefits of exercise, we want to encourage our readers who do not currently exercise to find activities they can safely enjoy. Your activities will be a source of strength.
People who exercise sharpen their mental and physical abilities. Working out with Parkinson’s can be an exercise for the mind as well as for the muscles. The eventual benefits may include improved independence and quality of life.

Monday, September 22, 2008

Is exercise is an end or tool for Parkinson's Patient?I think exercise is the end to maximise our physical mobility and flexibility with the combination of the PD medication (Sinemet, Comtan, Zelopar, Mirapex, amantadine), they are the tool to relief our physical stiffness and rigidity._________________to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their iwheelersceJoined: 02 Mar 2007Posts: 408Location: MIPosted: Wed Apr 02, 2008 5:23 am Post subject:It certainly seems that everyone can agree, exercise is valuable! Your posts are interesting, Teokimhoe, though I'll admit I'm often at a loss as to how to make a worthwhile response. Thanks for being part of the forum. Sue W.

Parkinson's Disease: Exercise and Parkinson's Disease
Because Parkinson's disease affects your ability to move, exercise helps to keep muscles strong and improve flexibility and mobility. Exercise will not stop Parkinson’s disease from progressing; but, it will improve your balance and it can prevent joint stiffening.
You should check with your doctor before beginning any exercise program. Your doctor may make recommendations about:
The types of exercise best suited to you and those which you should avoid
The intensity of the workout (how hard you should be working)
The duration of your workout and any physical limitations
Referrals to other professionals, such as a physical therapist who can help you create your own personal exercise program
The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Generally, exercises that stretch the limbs through the full range of motion are encouraged.
Here are some tips to keep in mind when exercising.
Always warm-up before beginning your exercise routine and cool down at the end.
If you plan to workout for 30 minutes, start with 10-minute sessions and work your way up.
Exercise your facial muscles, jaw, and voice when possible: Sing or read aloud, exaggerating your lip movements. Make faces in the mirror. Chew food vigorously.
Try water exercise, such as aquarobics. These are often easier on the joints and require less balance.
Work out in a safe environment; avoid slippery floors, poor lighting, throw rugs, and other potential dangers.
If you have difficulty balancing, exercise within reach of a grab bar or rail. If you have trouble standing or getting up, try exercising in bed rather than on the floor or an exercise mat.
If at any time you feel sick or you begin to hurt, stop.
Select a hobby or activity you enjoy and stick with it. Some suggestions include: Gardening; Walking; Swimming; Water aerobics; Yoga; Tai chi.
Reviewed by the doctors at The Cleveland Clinic Neuroscience

Sunday, September 21, 2008

  • Parkinson Disease May Affect Your Spouse As Well If you are living with a chronic disease, you know that it can affect everyone around you--including your family and friends, and especially your caregiver. Usually the caregiver is a spouse but may also be a good friend or other family member. The caregiver can be under a lot of pressure or feel rushed to "get everything done" and may even experience anxiety or depression. When you think of Parkinson (PD) disease, the classic motor symptoms come to mind: stiffness, difficulty with balance, shakiness of the hands, and slow movements. There are, however, symptoms of PD that are not related to motor function. These others symptoms may include depression, dizziness, constipation, problems with sexual function, and a change in the way you think or process information. These are called non-motor symptoms. A recent study looked at the ways in which early- to middle-stage PD can have an effect on the spouse caregiver (husband or wife). The researchers wanted to find out if there was a link between the two different types of PD symptoms (motor and non-motor) and the mental health of the caregiver. Researchers examined the motor and non-motor symptoms of people with early- to middle-stage PD and then looked at levels of depression and different types of strain experienced by caregivers. What were the results of the study? The researchers found that, although motor symptoms in the people with PD were linked with a few types of strain and depression in the caregiver, non-motor symptoms were even more strongly linked. This does not necessarily mean that symptoms of people with PD cause depression in caregivers but simply that there is a link between the two. Why is this study important? This study is important because, even though motor symptoms are more noticeable in the early and middle stages of PD, it seems to be the non-motor symptoms--the mood changes and the difficulty with thinking--of the person with PD that have an even greater effect on the caregiver at this time. What can you do? Be sure when you talk to your doctor about your PD, you share with him or her anything that has been bothering you. PD may affect more than how you are able to function physically; it may also affect your emotional and mental health--and perhaps those of your caregiver. Doctors need to treat the person who has PD, not just the disease. If your doctor doesn't ask you how you are feeling, start this discussion yourself. It is okay to ask for help, and together you can find resources in your community. If you are a caregiver who finds it difficult to function because you feel depressed or overwhelmed, please ask for help. Caring for a loved one may be a challenging undertaking, but you don't have to do it alone. Be sure to take care of yourself first. Ask for help or check out local resources and support groups that will help you feel connected. You may also wish to take part in our PD discussion forum at WE MOVE. Here you can find help and support not only from people who have PD, but also from the people who care for them. Click on the discussion tab at the top of the home page. Scroll down to the Parkinson disease forum and log in to find others who, like you, are facing the challenges and joys of living with a person with PD.
The Controversy Surrounding Driving with Parkinson's
You might think that the most controversial Parkinson’s disease-related topic involves politics like the stem cell controversy, sexual obsessions and compulsions from dopamine agonists, or a religious quandary (Why me, God?).
The most controversial issue is driving with Parkinson's disease. Writing about this emotionally charged topic feels like writing about end-stage Parkinson's disease–gut-wrenching and anxiety provoking.
Joseph Friedman, M.D. thinks the topic of driving with Parkinson's disease (PD) is so important that he devoted an entire chapter to it in his latest book Making the Connection between Brain and Behavior: Coping with Parkinson’s Disease.
Patients with PD may be unable to evaluate their own driving, while their neurologists may be overestimating their patients’ abilities to drive.
Driving involves a number of activities including perception, information processing, judgment, decision-making, coordinated limb movements, reaction time tasks, continuous tracking, and attention. PD causes a number of abnormalities in these areas.
Research on drivers with PD revealed a number of problems we all need to consider as we work to keep our abilities sharp.
Reduced physical and mental reaction time is due to bradykinesia (slowness of movement). PD patients are slow performing most tasks, and may react to emergency situations with more delay than people without PD. It may be difficult to react quickly to a road hazard.
Visual-spatial orientation problems can result in:
Problems judging distances (e.g., gauging the distance to a stop sign or traffic light)
Keeping the car in the correct lane
Driving too far to one side of the road
Difficulty scanning the road
Difficulty spotting and interpreting traffic signs
Problems identifying roadside landmarks
Difficulty distinguishing shapes
Concentration difficulties are common among people with Parkinson's disease, and they also have difficulty attending to multiple tasks. Naturally distractions from passengers, radio, and traffic can be taxing.
Fatigue and sudden sleep attacks while driving are often caused by PD medications, particularly dopamine-agonists. Patients who are excessively sleepy fall asleep suddenly, and have no recollection of being drowsy before falling asleep.
On-off fluctuations in physical symptoms due to PD medications.
Muscle stiffness contributes to:
A limited range of motion, particularly in the neck
Dystonia (muscle-cramping) in the toes
Rigid muscles that affect the ability to turn the steering wheel, use the gas pedal, push down the brake, and make quick movements
Strengthening Driving Skills
With PD, my driving skills are a little more limited, and I need to compensate. Driving is important to me to maintain my independence and self-esteem. I fear the isolation and dependency when I stop driving. To keep me and others safe on the road I've come up with some compensation strategies.
A couple of years ago, I traded my stick shift car for an automatic which has helped with my multi-tasking problems.
Some of my PD driving problems have lessened with deep brain stimulation (DBS) surgery and with proper programming of the neurostimulator. I no longer have muscle-cramped toes while driving (you can imagine how difficult it was to push down the gas pedal or hit the brake pedal). Also, my on-off fluctuations in medications have decreased.
Fortunately, the sudden sleep attacks I experienced as a passenger in a car (and thankfully not as a driver) have stopped, because I’ve discontinued taking Mirapex, a dopamine agonist.
I’ve also set limitations and choose to restrict my driving by:
Planning my itinerary before leaving the house
Driving in the day only
Driving on well-known routes and back roads, and avoiding the freeways, if possible
Driving when there is less traffic
Driving in good weather conditions, if possible–no snow, ice, or heavy rain
Driving without passengers
Avoiding distractions by turning the radio and CD player off (It’s obvious, but I should mention no eating or using a cell phone while driving.)
Researching the topic of driving with PD has scared me into enrolling in the AARP course, 55 Alive Driver Safety Program.
To improve my driving skills, I will also contact the Association of Driver Rehabilitation Specialists at 1-800-290-2344.
Once the snow stops pounding in Colorado, I intend to take an on-road driving test through a private driving organization.
I want to confront this taboo topic of driving with Parkinson's disease. By understanding and dealing with my deficits as a driver with Parkinson's disease, I can update my driving skills, or recognize when the time comes to give up driving altogether.
My article was first published in Parkinson's Hope Digest in January 2008.
High Cholesterol Can Increase Risk of Parkinson's Disease
by Camilla HodgePrevention
Adults younger than 55 years old may run an elevated risk of developing Parkinson’s disease if they have been diagnosed with high cholesterol. This trend was found in both men and women who were part of the recent Finnish study published in the May 20 issue of Neurology. Researchers gathered information on nearly 25,000 men and women. Participants had no history of Parkinson’s disease or stroke at the beginning of the study. After an average follow-up of just more than 18 years, 321 men and 304 women developed Parkinson’s disease. These men and women were found to have higher cholesterol than the rest of the participants. Patients with the highest cholesterol were 86 percent more likely to develop Parkinson’s disease than the participants with the lowest cholesterol. Interestingly, this risk applied only to participants between the ages of 24 and 54. Cholesterol levels were tested and adjusted for factors such as age, body mass index, systolic blood pressure, education, leisure-time physical activity, smoking, alcohol consumption, coffee and tea consumption, and history of diabetes. High cholesterol can have serious negative affects on health, including increased risk of heart disease and stroke. Medical professionals are careful to monitor and treat high cholesterol in their patients. While many cases of high cholesterol can be controlled with careful diet management and regular exercise, there are several medications available to help lower cholesterol levels.Statins are one such medication. In light of this new study, some experts are concerned that these results will incorrectly associate statin use (a common treatment for high cholesterol) with preventing Parkinson’s disease. In a response published in the June 4 issue of Neurology, one doctor explained that while statins are an effective treatment for high cholesterol, they may actually trigger a reaction in the brain that causes an increase in a certain cell that can “suppress the beneficial immune effector mechanism in PD.” In other words, it unclear whether using statins to treat high cholesterol will decrease the incidence of neurological disorders like Parkinson’s disease. The role of cholesterol in Parkinson’s disease has been a subject of debate in the medical community. Other studies have indicated that low cholesterol can be related to an increased risk of Parkinson’s disease. Such findings may be related to the affects of statins. The decision to treat high cholesterol with statins is one that should be discussed thoroughly with your doctor. However, statins may be contraindicated for patients with Parkinson’s disease. Sources:Neurology May 20, 2008 Neurology June 4, 2008

Meditation and Parkinson's Disease

Meditation and Parkinson's Disease
by Taryn SimpsonEmotional Impacts
Many holistic and some medical professionals are firm believers in meditation—especially if you have stress that needs to be released. Many people may think that learning to meditate is difficult. Actually, learning how to meditate is quite easy! There are several types of meditation to choose from such as:
Simple mediation
Walking meditation
Transcendental meditation
Mindfulness meditation
Movement meditation
As we all know, stress exacerbates Parkinson’s symptoms. In order to help alleviate symptoms, meditation is a very useful tool. For our purposes here, I will explain how to do “Simple Meditation.”Simple MeditationPlan to make meditation part of your daily routine. The best time to do meditation is first thing in the morning and then again in the evening. Set aside 10-20 minutes of time for each session.
Choose a comfortable, quiet place to meditate
Choose a time when you will be uninterrupted
Sit comfortably–you may want to try different positions
Close your eyes and try to relax
Pick a focus word or phrase that will initiate the beginning of your session (reciting a poem or a phrase that gives you peace and comfort, such as Om or “I am at peace”)
Take deep breaths–breathe in slowly and breathe out slowly.
Be aware of your body. Start at the top of your body and focus on relaxing your forehead, your mouth, tongue, neck, and shoulders, and so on until you reach your toes
Once you are completely relaxed, repeat an affirmation or focus word or phrase. Block all worries or free floating anxiety from your thoughts. Instead, use the focus phrase or word such as “I am at peace, I have energy,” or “I feel rejuvenated”
Once you have completed the meditation for 10-20 minutes, allow yourself to slowly open your eyes and start to move. You have just completed your first meditation exercise!Source:Holistic Online

Saturday, September 20, 2008

Hallucinations,sleepiness and swelling in early stages of PD

Hallucinations, Sleepiness and Swelling in Early Stages of Parkinson's Disease
by StaffUnknown Category
"By identifying risk factors, it may help guide treatment decisions, allow for early intervention and possibly reduce disability," said study author Kevin Biglan, M.D., MPH, with University of Rochester School of Medicine in Rochester, NY, and member of the American Academy of Neurology.
For the study, researchers reviewed the results of a four-year clinical trial involving 301 people with an average age of 61 who had early Parkinson's disease. Half of the group received the drug levodopa; the other half took pramipexole. No one reported having hallucinations at the beginning of the study.
The study found nearly one-fifth developed hallucinations, more than one-third of the participants developed sleepiness, and nearly half developed swelling within four years of starting treatment. Dr. Biglan points out that there were some risk factors that made people with Parkinson's disease more likely to develop hallucinations, sleepiness, and swelling.
"In contrast to other studies, we found being male, having multiple health problems and taking pramipexole were independently associated with developing sleepiness," said Biglan. "This is the first time a patient's other health problems have been identified as a risk factor for drowsiness."
The study also found being older, having more multiple health problems and the presence of slight memory problems were associated with an increased risk of hallucinations; type of treatment did not affect the risk.
Being female, having heart disease, and pramipexole treatment was associated with an increased risk of swelling.
"Our results suggest that other illnesses are important, yet overlooked risk factors for the development of sleep problems, swelling, and hallucinations in early Parkinson's disease and should be considered when talking to patients about the risks of treatment," said Biglan. "When beginning pramipexole, doctors should explain the risks and monitor patients closely for sleep issues and swelling."
Source: American Academy of Neurology
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue Sep 23, 2008 9:20 am Post subject:

This was indeed an interesting study, thanks for posting._________________Michael S. Okun, M.D.

T.I.A (Blood Clot ) and Surgery Therapy

Dear Doctor,
I have blood clot (T.I.A) recently.
My medications One dose Plavix Clopidognel 75mg and Zocor 20mg daily.
After my blood clot I am active in gym exercises and my agility and flexibility are increased. I take part weight lifting, Body combat, Box and Kick exercises and body pump daily
My questions are:
Is it true once you had a stroke it would come again (major stroke) within two to three years?
I was told that once you received the Plavix/aspirin medication you have to stop taking them for one to two weeks before any surgery therapy by doctor ?

Friday, September 19, 2008

Are there any surgery with minor stroke?

Posted: Mon Apr 07, 2008 4:22 pm Post subject: Are there any surgey with ninor stroke?

Questions for my blood clot 1.Patient been once with blood clots, is it at risk (or increase) of heart attack, stroke or pneuminia? 2.What are precautions to take to reduce the risks from another blood clot? 3.Will exercise or sex increase the risk of suffering from another blood clot? 4. Is this a permanent condition? Can it be cured? 5.As antiplatelet therapy is not for people with a history of liver or asthma. peptic ulcers, bleeding disorders what are the medication available? 6. Are there any surgical available to treat the blood clot as there are high risks suffering with another stroke? Kindly brief.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Fri Apr 11, 2008 10:37 am Post subject:

Since this is a PD website, I will defer to another expert and direct you toward your internist and general neurologist for strokes and blood clots. If you are talking about a blood clot from DBS or a blood clot causing PD symptoms I would be happy to help you with a specific response, I wish you luck in getting to the right expert on stroke/blood clots._________________Michael S. Okun, M.D.

Monday, September 15, 2008

Saliva, Phlegm and Parkinson's Disease

Posted: Fri Sep 12, 2008 6:15 am Post subject: Saliva, phlegm and Parkinson's Disease

There are 15% Parkinson's patients starting the levodopa thereapy report the above diseases. Saliva and phlegm are one of the syndromes of Parkinson's Disease. Sometimes we are difficulty to diagnose them. I was told that the phlegm is actually thick saliva locked deep down in my throat.Due to PD medication the saliva become thicker and stringier. The thick saliva locked down my throat that is itching and I feel the needs to cough and clear my throat all the times In fact excess saliva in the mouth which causes drooling, is one of the syndrome and feature of Parkinson’s . Studies shown that 70-80% of people with Parkinson’s experience this problem. The condition is not due to excess production. On the contrary most people with Parkinson’s actually produce less saliva. The problem is that PD reduces the frequency of automatic swallowing, and this in turn allows saliva to accumulate within the mouth that causes saliva drooling when the mouth is opened. This is why PD have mask face (poker face) PD patients feel socially embarrassing for the above that are reluctant to go out in public TEOKIMHOE

Monday, September 8, 2008

The power of positive thinking

We’ve all been there. You’re having a bad day of symptoms and the frustration drapes over you. It’s so easy to give in to defeatist feelings—it’s human nature. But in the long run, this vicious cycle will only accomplish two things: you will feel worse and your symptoms will increase. How do you turn things around? There are many books on positive thinking, but one I read recently has really made an impact on me. The book The Secret teaches people how to think positively with a bit of a different spin. The mantra that is referred to over and over is, “Thoughts become things, choose the good ones.” That’s it. If you decide to read this book, you won’t magically stop having negative thoughts, believe me! The difference is that you will become more aware of how often you think negative thoughts. Each time you think a negative thought, you should be prompted to replace it with a good thought.For example: Negative Thought: My legs won’t work! I don’t feel well!Positive Thought: My legs will work better soon. I’m starting to feel better.Try to visualize the symptom disappearing, or try picturing yourself strong and happy. Replacing negative thoughts with positive thoughts can only make you feel better. As you increase positive thoughts, you will start to notice that you are doing things to help yourself such as eating a better diet, exercising, or just learning to relax more. Next time you struggle with your symptoms or depression, try replacing negative thoughts. Be patient with yourself and before you know it, you won’t be so focused on your difficulties.

Posted: Sat Sep 20, 2008 7:56 pm Post subject: The power of positive thinking

We’ve all been there. You’re having a bad day of symptoms and the frustration drapes over you. It’s so easy to give in to defeatist feelings—it’s human nature. But in the long run, this vicious cycle will only accomplish two things: you will feel worse and your symptoms will increase. How do you turn things around? There are many books on positive thinking, but one I read recently has really made an impact on me. The book The Secret teaches people how to think positively with a bit of a different spin. The mantra that is referred to over and over is, “Thoughts become things, choose the good ones.” That’s it. If you decide to read this book, you won’t magically stop having negative thoughts, believe me! The difference is that you will become more aware of how often you think negative thoughts. Each time you think a negative thought, you should be prompted to replace it with a good thought.For example: Negative Thought: My legs won’t work! I don’t feel well!Positive Thought: My legs will work better soon. I’m starting to feel better.Try to visualize the symptom disappearing, or try picturing yourself strong and happy. Replacing negative thoughts with positive thoughts can only make you feel better. As you increase positive thoughts, you will start to notice that you are doing things to help yourself such as eating a better diet, exercising, or just learning to relax more. Next time you struggle with your symptoms or depression, try replacing negative thoughts. Be patient with yourself and before you know it, you won’t be so focused on your difficulties.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue Sep 23, 2008 9:23 am Post subject:

Thanks for another wonderful note._________________Michael S. Okun, M.D.