Monday, December 21, 2009

Mild shaking of right hand third finger


Posted: Wed Dec 16, 2009 2:34 pm Post subject: Mild shaking of right hand third finger


Why Mild shaking of right hand third finger and still no difficulty doing weight lifting,Yoga and Muay Thai exercise daily?

Is it Parkinson's Progression?

Back to top

Dr. Fernandez

Joined: 20 Jan 2007
Posts: 90

Posted: Thu Dec 17, 2009 11:09 pm Post subject:


The general belief is that PD is a universally progressive, over time, patients typically get worse.

Having said that, the speed of progression varies widely between patients. in fact, just yesterday I saw a patient, who I still believe has PD, but has had minimal progression in the last 7 years. Now this is not typical and probably exceptional, but it does exists.

Your PD seems to be very slow and benign. In many ways, you should count your blessings! Happy holidays!

Hubert H. Fernandez

can sinenetsow the progression of pd?

Posted: Sat Dec 19, 2009 5:59 pm Post subject: Post of the Week: Can sinemet slow disease progression?
Does levodopa slow the progression of Parkinson disease?

Levodopa has changed the lives of millions of Parkinson’s disease patients. Patients now live longer, and have more rewarding lives with much less and even slower progressing disability in some cases (when compared to the pre-levodopa era). The positive effects of levodopa can be felt for many years, however, levodopa is not a cure. Levodopa does not relieve all symptoms of Parkinson’s disease. Additionally, not all patients respond to levodopa with consistent results, although most respond very well. Levodopa may also have side effects—and some patients in the Parkinson’s disease population seem to be more susceptible to side effects than others---so therapy needs to be tailored to the individual.

As to whether levodopa slows disease progression in Parkinson’s disease, the jury is still out. The data are conflicting. We have a large clinical trial that showed that those on the highest dose of levodopa had the best motor function, and the slowest decline. The imaging arm of that study however revealed that the basal ganglia (the part of the brain that is sick in Parkinson’s disease) had significantly less amounts of surviving dopaminergic brain cells. We have been unable to definitively explain this discrepancy between the clinical finding and the imaging results. Most authorities believe however that levodopa does not affect disease progression, but this remains a controversial topic. More research may shed light on this controversy (Clarke 2004; Olanow 2004; Castro, Valldeoriola et al. 2005; Fahn 2005; Fahn 2006; Fahn 2006; Suchowersky, Gronseth et al. 2006; Chan, Nutt et al. 2007; Schapira 2007; LeWitt and Taylor 2008).
Hubert H. Fernandez

sinemet and prevard


Posted: Sat Dec 05, 2009 9:44 am Post subject: sinemet and prevacid


Dear Kathrynne,

Will taking Sinemet and Prevacid interfere with the absorption of the Sinemet?

If they are both supposed to be taken on an empty stomach, how does one do this?

Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Sat Dec 05, 2009 11:46 am Post subject:


Dear Friend,
If you are taking the prevacid once daily, try to schedule it in between Sinemet doses. For example, if you take Sinemet at 7:00 am, 11:00 am, 3:00 pm, and 7:00 pm, and have your meals at 8:00 am, 12:00 noon, and 5:00 pm, ask your prescribing doctor if you can take the Prevacid at 7:30 am. That will give the Sinemet 30 minutes to clear the stomach; then the Prevacid will have 30 minutes to clear; then at 8:00 you should be able to have your breakfast without concern.

Let me know if you have further questions, or if this did not help.
Best regards,
Kathrynne Holden, MS

Monday, December 7, 2009

PD,B6, B12 and Folate What is the connection?


Joined: 22 Jan 2007
Posts: 94
Posted: Thu Dec 03, 2009 5:05 pm Post subject: Parkinson's, B6, B12, and Folate - What's the Connection?



Parkinson's, B6, B12, and Folate - What's the Connection?
Kathrynne Holden, MS, RD
Copyright 2008

Ms. Holden is a registered dietitian specializing in Parkinson's
disease. She has published research, books, articles, and manuals on
nutrition and PD, including "Eat well, stay well with Parkinson's

In the past decade, there has been increasing interest among
researchers about the effects of three B vitamins - B6, B12, and folate.
We now know that deficiencies occur with greater frequency than ever
suspected previously, particularly in older adults. We also now know
that deficiencies, if not corrected, can result in irreversible damage
in some people. Some health professionals are beginning to suspect that
these three vitamins may be significant factors in Parkinson's disease.

What are B6, B12, and folate, and what do they do?

These are essential nutrients, meaning that they are vital to life.
These three vitamins work both independently and together in many of the
body's systems.

Vitamin B6 assists in making hormones, new proteins, and
neurotransmitters ("messengers" between nerve cells) for the body's use.
It also helps release stored sugar when we need it for fuel. It works
together with B12 and folate to remove homocysteine from the blood.
Homocysteine is a substance increasingly associated with a number of
diseases; more about this later.

Vitamin B12 plays a role in the synthesis of DNA, needed for formation
of new red blood cells. It takes part in the manufacture of the myelin
sheath - the protective coating that surrounds nerve cells. With B6 and
folate it removes homocysteine from the blood.

Folate, also called folacin or folic acid, is a partner with B12 in DNA
synthesis and in removal of homocysteine, and is required in many other
vital processes. Without folate, B12 would be unable to complete many of
its functions, and vice versa. Folate is the form found in foods, folic
acid is the form in dietary supplements.

How much do we need of these vitamins?

Nutrient needs are broken down by gender, age group, pregnancy, and
lactation. New guidelines have also established a Tolerable Upper Intake
Level. So, for example, while the RDA for vitamin B6 for males and
females age 19-30 years is 1.3 mg/day, the Tolerable Upper Intake Level
for both is 100 mg/day, making it easier to provide recommended amounts.

RDA* Tolerable Upper Intake Level ** +

Vitamin B6*** + 1.7 mg/day 100 mg/day (age 19 and older)

Vitamin B12 + 2.4 mcg/day Not Determined

Folate + 400 mcg/day 1000 mcg/day

* Recommended Dietary Allowance
** The Tolerable Upper Intake Level is the maximum level of daily
nutrient intake that is likely to pose no risk of adverse effects, and
represents the total intake from food, water, and supplements.
*** Adults age 51 and older
+ not applicable if pregnant or lactating

Why do deficiencies occur, and what are signs of deficiencies?

Vitamin B6. Mild deficiencies of B6 are fairly common in the U.S.,
mostly because of dietary deficiencies, but sometimes due to use of
certain medications which interfere with B6, including hydralazine,
isoniazid, MAO inhibitors, penicillamine, and theophylline. (Conversely,
large amounts of B6 can interfere with the absorption of levodopa, an
important medication for Parkinson's disease. Current use of the
combinations of carbidopa-levodopa or benserazide-levodopa offset this
interaction for the most part; but use of supplements containing more
than 15 mg of B6 can overwhelm the protective effects of the carbidopa
and benserazide.)

Good food sources of B6 include chicken, fish, eggs, nuts and seeds,
dried beans and peas, soybeans, wheat germ, bananas, avocados, and
brewer's yeast. Also, some foods, including a number of breakfast
cereals, are fortified with B6.

Signs of B6 deficiency include irritability, depression, and confusion;
sore tongue, sores or ulcers of the mouth, and ulcers of the skin at the
corners of the mouth.

Vitamin B12. The human body stores this vitamin so well that it can
take a long time to deplete, sometimes several years. Nevertheless,
there are several reasons why people sometimes do experience deficiency.
Animal foods are the only source of B12, therefore people who eat few or
no animal products (meat, fish, poultry, eggs, milk) are at risk unless
they use vitamin supplements.

Another problem is that B12 in foods cannot be absorbed by the body
until it is freed from the proteins in the food; the stomach produces an
acid that removes this protein. However, with age, we produce less and
less of this stomach acid. Many older adults don't produce enough acid
to allow them to absorb B12. Further, people who have acid reflux often
use medications that reduce stomach acid, which unfortunately also
decreases absorption of B12. Vitamin B12 is one of the few nutrients
that is better absorbed in pill form than from dietary sources.

Signs of B12 deficiency include numbness or a tingling "pins and
needles" sensation, or a burning feeling; a red, sore, or burning
tongue; loss of appetite; gait abnormalities, personality changes, an
Alzheimer-like dementia, psychosis, depression, and agitation,
particularly in older adults. Other signs are megaloblastic anemia, and
elevated serum homocysteine, in people of all ages. Researchers believe
that as many as 42% of people aged 65 and older may have some degree of
B12 deficiency. Many people with PD are age 65 or older, and should be
considered at risk and tested for B12 deficiency.

Folate. Folate is available in many foods: lima beans, brewer's yeast,
orange juice, dried beans, green peas, asparagus, beets, Brussels
sprouts, broccoli, corn, spinach and other dark green leafy vegetables,
soybeans, nuts and seeds. Further, the U.S. government requires that
food manufacturers fortify processed grain products with folic acid.
Yet, deficiencies of folate are not uncommon. This could be in part
because folate is another of the few nutrients in which the synthetic
form is absorbed much better (about 40 percent better) than the natural

Because of the possibility of deficiency, women, including women with
PD, who are pregnant or wish to become pregnant are advised to take
supplements of folic acid; deficiencies can result in neural tube
defects in the unborn child.

Deficiencies of folate are also being increasingly studied for a
possible role in other diseases:

. A low intake of folic acid is associated with risk for colon cancer.
Chronic constipation, experienced by many people with PD, also increases
risk for colon cancer; it is prudent for those with PD to control
constipation and to be sure the diet is adequate in folate.
. A low level of folic acid in the blood is associated with higher
levels of serum homocysteine, a substance in the blood that may
contribute to heart disease, stroke, and dementias.
. Animal studies point to a link between low levels of folic acid and
Alzheimer's disease; and people with Alzheimer's are often found to have
low levels of folic acid. Some people with PD develop an Alzheimer-type
dementia. Again, prudence dictates consumption of adequate folate.
. Another study using mice found that folic acid deficiency led to
increased levels of homocysteine and symptoms of Parkinson's disease.
Researchers speculate that homocysteine may damage DNA in the substantia
nigra, the area of the brain affected in Parkinson's disease.
. There are reports of improvement in restless leg syndrome (RLS) with
use of folate supplements; this has not as yet been studied thoroughly,
so it is too early to say whether there is a definite link. However,
people with PD often complain of RLS, and physicians should rule out the
possibility of folic acid deficiency.
Signs of folic acid deficiency include appetite loss, weight loss,
burning tongue, fatigue, weakness, shortness of breach, memory loss,
irritability, megaloblastic anemia, and increased levels of serum

Should people with PD be concerned about these vitamins?

Although there are concerns, as mentioned above, that deserve further
study, it's too early to say definitely that these three vitamins are of
significance to people with PD. However, if you are over age 50 these
vitamins are of importance independently of PD. Furthermore, studies
have demonstrated that some people who use levodopa, considered the best
medication for PD, develop elevated levels of serum homocysteine, due to
the way in which the medication is metabolized. It is certainly a good
idea to ask your doctor to test levels of serum homocysteine annually,
and to check for signs of B vitamin deficiencies.

Should you take supplements?

There is growing agreement that older adults are at risk for nutrient
deficiency, whether PD is present or not, and that supplements can help.

. One study of older adults found that a multivitamin containing 100% of
the Daily Value improved low levels of several nutrients, including
vitamins B6, B12, and folate.
. A recent study in the United Kingdom suggests that folic acid intake
should be about three times that of the current recommendation for
elderly people.
. Other studies indicate that up to 10% of older adults with low-normal
levels of B12 are actually deficient and could benefit from supplements.
Because folate supplements can mask a B12 deficiency, it becomes extra
important to get enough B12 daily.
. The American Heart Association recommends a folate-rich diet to lower
homocysteine levels, and supplements of 2 mg B6, 400 mcg folic acid, and
6 mcg of B12 if dietary means are not sufficient to lower the

For people with PD who use a medication that contains levodopa (such as
Sinemet, Madopar, Syndopa, Larodopa, etc.), you should be aware that
large amounts of vitamin B6 (more than 15 mg) can affect the absorption
of levodopa, by converting levodopa to dopamine in the stomach and
bloodstream. Dopamine cannot cross the blood-brain barrier, so it is
effectively blocked from its purpose.

Sinemet and Madopar contain either carbidopa or benserazide, which
"protect" the levodopa from B6; so ordinary supplements of B6 should not
be a problem for most people. However, very large amounts of B6, greater
than 15 mg (and in sensitive persons, possibly as low as 10 mg), could
overwhelm the protective effects of the carbidopa or benserazide. Such a
supplement should be taken at bedtime with a light snack, or with meals
at least two hours separately from levodopa.

In summary, older adults are acknowledged to be at increased risk for B
vitamin deficiencies. People with PD who are age 50 and over, therefore,
are at increased risk also. Whether younger people with PD should be
concerned about such deficiencies remains to be seen. A prudent and
rational approach for all those with PD is to:

. Discuss the possibility with their physicians, and to request tests
for B vitamin deficiencies
. Be aware of the signs of B vitamin deficiency
. Take a multivitamin/mineral supplement daily. Unless anemic, choose a
supplement that does not contain iron
. Take a B complex supplement if deficiencies occur; and take the
supplement separately from levodopa by at least two hours, preferably
with meals or a snack.

Knowledge is strength; awareness of dietary needs can prevent illness,
malnutrition, suffering, and hospitalization. If you have questions
about B vitamins or other nutrition or dietary needs, please visit the
National Parkinson Foundation website:

The above article may not be reproduced in any form except with
permission from the author.


Giovannucci, E. et al. Alcohol, low-methionine-low-folate diets, and
risk of colon cancer in men. Journal of the National Cancer Institute.
1995; volume 87: pages 265-273.

Kruman II, Kumaravel TS, Lohani A, Pedersen WA, Cutler RG, Kruman Y,
Haughey N, Lee J, Evans M, Mattson MP. Folic Acid deficiency and
homocysteine impair DNA repair in hippocampal neurons and sensitize them
to amyloid toxicity in experimental models of Alzheimer's disease. J
Neurosci 2002 Mar 1;22(5):1752-62.

Lobo A, Naso A, Arheart K, Kruger WD, Abou-Ghazala T, Alsous F, Nahlawi
M, Gupta A, Moustapha A, van Lente F, Jacobsen DW, Robinson K. Reduction
of homocysteine levels in coronary artery disease by low-dose folic acid
combined with vitamins B6 and B12. Am J Cardiol 1999 Mar 15;83(6):821-5.

Malinow, M.R. et al. Homocyst(e)ine, diet, and cardiovascular diseases:
a statement for healthcare professionals from the nutrition committee,
American Heart Association. Circulation. 1999; volume 99: pages 178-182.

Muller T, Werne B, Fowler B, Kuhn W. Nigral endothelial dysfunction,
homocysteine, and Parkinson's disease. Lancet. 1999 Jul

Muller T, Woitalla D, Hauptmann B, Fowler B, Kuhn W. Decrease of
methionine and S-adenosylmethionine and increase of homocysteine in
treated patients with Parkinson's disease.
Neurosci Lett. 2001 Jul 27;308(1):54-6.

Naurath HJ, Joosten E, Riezler R, Stabler SP, Allen RH, Lindenbaum J.
Effects of vitamin B12, folate, and vitamin B6 supplements in elderly
people with normal serum vitamin concentrations. Lancet 1995; 346:85-89.

O'Keeffe ST. Restless legs syndrome. A review. Arch Intern Med.
Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

Back to top


Posted: Thu Dec 03, 2009 7:49 pm Post subject:


Nuts and seeds cure all ills ... ;o)

Nice detailed recap of the B Vitamins


Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Fri Dec 04, 2009 8:51 am Post subject:


Tut, Rich, you did not read the part about B12: "Animal foods are the only source of B12.....meat, fish, poultry, eggs, milk..."

See? dietitians aren't just about nuts and seeds.
Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

Back to top

Forced exercises

MDS 2009: Forced Exercise Provides Benefit Similar to Levodopa in Parkinson's Disease

June 15, 2009 (Paris, France) - Patients with Parkinson's disease (PD) who exercise on a stationary tandem bicycle with a healthy partner during a single 40-minute session experience a 35% improvement in motor function and increased brain activation similar to that found with levodopa treatment, new research shows.

The study, by researchers at the Cleveland Clinic in Ohio, found that maintaining a steady rate of 80 to 90 revolutions per minute (rpm) on the bicycle not only improved function in lower extremities but also in upper extremities.

The improvement was dramatic and similar to that achieved by levodopa therapy, said 1 of the researchers, Jay L. Alberts, PhD, from the Center for Neurological Restoration at the Lerner Research Institute, in Cleveland.

"It looks like there are global effects in terms of the improvement in motor function," he told Medscape Neurology. "It suggests to us that maybe we're changing central motor function or maybe we're actually changing brain function through something very noninvasive."

The study was presented during the Movement Disorder Society's 13th International Congress of Parkinson's Disease and Movement Disorders.

A previous published study by this Cleveland research group found that the same forced exercise intervention administered 3 times a week for 8 weeks provided a similar 35% improvement in motor function.

"Couple these new findings with our longer-term data, and for us it's very encouraging," said Dr. Alberts. "Maybe if we can alter brain function, we can potentially alter the course and potentially slow the progression of this disease."

Tandem Exercise

For the study, researchers selected 11 male and female patients ranging in age from mid 50s to early 70s who had mild to moderate PD but no cardiac concerns. They tested these patients under 3 random conditions: not on medication, on medication (levodopa), and not on medication but completion of the forced-exercise intervention.

When on a stationary bicycle, PD patients normally pedal at a sustained rate of about 40 to 60 rpm. In this intervention, however, the patients sat on the back of a tandem bicycle while a healthy young adult trainer occupied the front seat and regulated the pedaling rate, ensuring that it remained between 80 to 90 rpm for 40 minutes.

Researchers monitored each patient's heart rate and made sure it stayed within 60% to 80% of his or her age-determined target range.

Patients also performed a force-tracking task and a bilateral finger-tapping task to demonstrate their level of control and coordination. Similar grasping tasks are necessary to perform daily activities such as buttoning a shirt or tying shoe laces, said Dr. Alberts.

The researchers found that the forced exercise and the levodopa produced similar significant reductions in Unified Parkinson's Disease Rating Scale (UPDRS III) motor scores, 35% with exercise and 38% with levodopa. Data from functional magnetic resonance imaging (fMRI) showed increased activation in the supplementary motor area (SMA) and primary motor cortex (M1) regions of the brain in response to both interventions.

"In terms of the fMRI data, we found that there was an increase in the level of cortical activation in the 2 motor areas - the SMA and the primary motor cortex - and this increase in activation looks very similar to the increase you see when you administer L-dopa," said Dr. Alberts.

For the force-tracking task and bilateral finger tapping, motor performance was 35% better following forced exercise compared with no exercise.

"Overdriving" Central Nervous System

These findings suggest that the exercise and the drug treatment elicit the same underlying mechanisms that provide similar symptomatic relief from PD symptoms, said Dr. Alberts.

The researchers surmise that the exercise may facilitate central motor control processes in Parkinson's patients. "For lack of a better word, we may be 'overdriving' the central nervous system by providing an increase in the quantity and quality of sensory information provided to the patient," said Dr. Alberts.

He added that this type of intervention could also be carried out on a treadmill, but it may be riskier and less practical than on a tandem bike. "We can't increase someone's walking rate 30% without having them in a harness and even then, I think you'll find that their feet would be dragging."

The next step in this line of research, he said, is to develop a motor-assisted cycle that will allow patients to do this type of exercise at home.

Many Beneficial Effects

Asked for a comment, Kapil D Sethi, MD, professor of neurology and director of the movement disorders program at the Medical College of Georgia, in Augusta, said the research highlights additional benefits of exercise. "Exercise has many beneficial effects both physical and psychological," he told Medscape Neurology. "There is evidence in the animal models and now in humans that exercise may have beneficial effects in PD. The exact mechanism is unclear, and the exact paradigm is unknown."

Mark Hallett, MD, from the National Institute of Neurological Disorders and Stroke, in Bethesda, Maryland, added in a press release that the finding of similarities between exercise and drug treatment "is certainly interesting and may indicate that exercise, in the short term, causes dopa release."

Dr. Alberts has no disclosures. Dr. Sethi is a member of the editorial advisory board for Medscape Neurology. He has disclosed he has served as an advisor or consultant to and received grants for clinical research from Boehringer Ingelheim Pharmaceuticals, Schering-Plough, GlaxoSmithKline, Allergan, Novartis Pharmaceuticals, and Solvay. He owns stock, stock options, or bonds in and has received grants for educational activities from Pfizer and Elan Pharmaceuticals.

Movement Disorder Society's 13th International Congress of Parkinson's Disease and Movement Disorders: Abstract LB-13. Presented June 10, 2009.

Saturday, December 5, 2009

Low blood pressure and PD

Posted: Fri Dec 04, 2009 4:19 am Post subject: Low blood pressure


Dear Doctor,

I have different low blood pressure at time either sit and stand.

I feel slightly dizziness and nearly losing my balance.

My Blood test:

*RBC* 4.3 X10 12/L (below normal level Male 4.5-

Haemoglobin 13.7 g/dL,PCV 40 %
MCVC 32 pg,MCH 91 fl,MCHC 35 g/dL,

*Platelets* 141 X10 9/L, (below normal 150-400 ),

WBC 6.2 X10/9L,Neutrophils 70 %,
Lymphocytes 28 %, Monocytes 1,below normal 2-10
Eosinophils 1 ,Baspphils 0

My medication:

Sinemet regular 1, Sinemet CR 3, Requip 6 mg,Jumex 10mg Plavix 75mg, Zantac 300 mg daily

Xatral XL 10mg, Stilnox 5 mg, Xanax 0.25 mg,Seroquel 12.5 mg
Lexapro 5mg *nightly*

I had T.I.A 2008, gastrointestinal disorder and insomina, bladder dysfunction.

Kindly advise

Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Fri Dec 04, 2009 9:03 am Post subject:


Dear Friend,
I am not a doctor, rather a nutritionist, and I recommend you address your question to “Ask the Doctor” on the Discussion Corner. However, I can make some comments:

Certainly your lab tests are somewhat low with regard to iron, and anemia can cause dizziness, and lightheadedness.

However, Requip can also cause dizziness as a side effect; Jumex (selegiline) can cause both dizziness and hypotension (low blood pressure, especially when changing position, such as rising, or lying down).

Further, PD itself can, in some people, cause hypotension.

If the dizziness is due to hypotension, one possible course of action is to add salt to the diet and drink plenty of water. This increases blood volume and helps to correct the blood pressure. However, this must only be done under the care of your doctor, because the dizziness might be due to some other cause. And the addition of salt is potentially harmful in some cases, such as for persons with congestive heart failure.

I believe the doctors on “Ask the Doctor” can provide much better help than I, and I would also discuss this with your own neurologist and/or primary care physician. You might need an adjustment in your medication regime.
Best regards,
Kathrynne Holden, MS

Low blood pressure


PostPosted: Fri Dec 04, 2009 10:09 am Post subject: Low blood pressure Reply with quote
Dear Doctor,

My low blood pressure measurement varies from each time either sitting and standing

I feel slightly dizziness and nearly losing my balance.

My Blood test:

*RBC* 4.3 X10 12/L (below normal Male 4.5-6.5)

Haemoglobin 13.7 g/dL,PCV 40 %
MCVC 32 pg,MCH 91 fl,MCHC 35 g/dL,

*Platelets* 141 X10 9/L, (below normal 150-400 ),

WBC 6.2 X10/9L,Neutrophils 70 %,
Lymphocytes 28 %, Monocytes 1,below normal 2-10
Eosinophils 1 ,Baspphils 0

My medication:

Sinemet regular 1, Sinemet CR 3, Requip 6 mg,Jumex 10mg Plavix 75mg, Zantac 300 mg daily

Xatral XL 10mg, Stilnox 5 mg, Xanax 0.25 mg,Seroquel 12.5 mg
Lexapro 5mg *nightly*

I had T.I.A 2008, gastrointestinal disorder and insomina, bladder dysfunction.

Kindly advise
Back to top

Dr. Okun

Joined: 19 Jan 2007
Posts: 251
Location: University of Florida

PostPosted: Fri Dec 04, 2009 3:56 pm Post subject: Reply with quote
If it is low blood pressure and dizziness:

Ask your doc about getting rid of dopamine agonists, hydrating (6-8 glasses of water a day), stiockings, and in some cases midodrine or florinef.
Michael S. Okun, M.D.

Wednesday, December 2, 2009


Singing is the therapy that help your swallowing.

Speaking and swallowing use many muscles and nerves in common, much as those of the lower
face, lips, tongue, voice box, and throat. The nerves and muscles of these structures are often
affected by the Parkinson's disease process. The speech and swallowing problems of Parkinson's
mirror other movement problems associated with the disease.
2 people marked this post as helpful.

What factors be considered before medication?

I am newly diagnosed with Parkinson’s disease, what factors are considered by my doctor when starting me on a medication?

You ask a very important question. Several factors require consideration when initiating symptomatic drug therapy in Parkinson’s disease. The choice of pharmacotherapy depends on the patient’s age, degree of disability, and cognitive status, as well as the impact of dosing, possible impact on the patient’s employment, domestic responsibilities, and lifestyle. Potential drug side effects must also be considered. Thus there are a lot of factors to consider!

The patient’s age is an important factor in predicting how well certain medications might be tolerated, as the risk of developing dyskinesia and motor fluctuations, especially with levodopa use, increases with earlier/younger onset Parkinson’s disease (most especially those who get it before 50 to 60 years old). Dopamine agonists, which delay the risk of dyskinesia and end-of-dose wearing off, may be offered as a first-line treatment option for younger patients. However, in older patients (which in our field means greater than 70 years old), the dopamine agonists have a higher risk for producing psychiatric and cognitive side effects. In addition, dopamine agonists have a complicated initial titration schedule before a therapeutic dose can be achieved. They require multiple dosing throughout the day, making the use of these agents challenging for many patients but especially so for patients 70 and older, who may be on several therapies for other conditions. Morover, the elderly patient is less likely to develop motor fluctuations and dyskinesias compared to the younger patient. Thus, in the currently published treatment algorithm, it is suggested that for the older patient, levodopa may be a better choice as initial first-line therapy compared to dopamine agonists.

The good news is that recent data suggest that an alternative option for initial monotherapy for early PD patients is rasagiline, a selective monoamine oxidase type B (MAO-B) inhibitor that offers effective control of symptoms and appears to be have a much lower incidence of the dopaminergic side effects seen with dopamine agonists and levodopa.

In one large placebo-controlled, multi-center clinical trial, after 5 years of levodopa use and as Parkinson’s disease progressed, about 50% of patients who were given levodopa from the onset developed motor complications compared to only 20% of patients who were first started on dopamine agonists for their early symptoms. However, the traditional view that treatment of Parkinson’s disease should begin only when symptoms become functionally significant has been challenged by some recent studies suggesting that initiation of treatment at the time of diagnosis results in better clinical outcome later in the course of the disease.

The patient’s perception of their level of disability and its impact on their lifestyle is also a driver of initial choice of therapy. Patients at the early stage whose major presenting symptom is tremor and who have minimal slowness or stiffness may respond to drugs such as anticholinergic agents or amantadine before their symptoms worsen. Rasagiline, selegiline, dopamine agonists or levodopa may be added as the disease progresses.

The potential of therapies to produce untoward side effects based upon the patient age and comorbid conditions is another important factor in choosing initial Parkinson’s disease therapy. As mentioned, dopamine agonists are not a good first choice in older patients due to concerns of leg swelling, cognitive impairment, and hallucinations. In patients in whom excessive sleepiness and drowsiness may affect daily activities, dopamine agonist use may also not be appropriate.

Hubert H. Fernandez
Back to top
View user's profile Send private message

PostPosted: Tue Nov 17, 2009 8:43 am Post subject: Reply with quote
Good recap ... thanks!

Back to top

Dr. Fernandez

Joined: 20 Jan 2007
Posts: 90

PostPosted: Thu Nov 19, 2009 7:37 pm Post subject: Reply with quote
You are welcome!
Hubert H. Fernandez
Back to top
View user's profile Send private message

PostPosted: Sat Nov 21, 2009 11:01 am Post subject: Reply with quote
Let me pull out a small portion of your post that is very important - the fact that motor complications occurred more often with the patients on sinemet than on the dopamine agonists after five years.

For those just beginning therapy you must realize that many of these motor complications can be very very minimal. I for example will have movement of my feet first thing in the morning when my sinemet hits my brain. The movement is minimal and causes no problems. No the dopamine agonists did not cause a problem like this but they caused me to faint at least 15 times a day. I did not change because I was afraid to take dopamine.

My point is - don't be afraid to try sinemet (dopamine). It really does work amazingly well (it stopped ALL my PD problems from drooling to freezing to tremor) and the side effects can be controlled one way or another by adjusting dosage and adding or subtracting other things. If the dopamine agonists work for you - GREAT. But if they don't - DON'T WAIT. Get on sinemet. I lost three years of my life because I waited too long to get on dopamine because of the older articles that said that taking it caused the disease to progress faster. From what I understand this is no longer thought to be true.

Good luck all!
Back to top

Dr. Fernandez

Joined: 20 Jan 2007
Posts: 90

PostPosted: Sat Nov 21, 2009 5:46 pm Post subject: Reply with quote
Thank you for your comments!
Hubert H. Fernandez


Amanatadine initially was an antiviral medication against influenza, but its main use now is as a type of pain reliever as it inhibits something called an NMDA receptor.

The NMDA receptor is a nervous system receptor that can bind to aspartate (or more specifically to N-methyl-D-aspartate) or glutamate to create chronic pain. Even worse, when glutamate or aspartate binds to this receptor, a stimulus that is normally not painful actually becomes painful.

By coincidence it was found to help the symptoms of Parkinson's disease. It may be used alone or in combination with levodopa or dopamine agonists. Amantadine reduces symptoms of fatigue, tremor and bradykinesia.

I was taking 2 Sinemet CR and 1 Sinemet 25/100, 12 Requip (2 mg) daily in the year of 2006 and to my surprise when added 3 Amantadine (100mg ) it caused reddish mottling on few part of my body and legs which was sideeffect of Amantadine and I apply Antiseptic cream to stop itchiness. I had stopped the medicine.

In general sideeffects of this medication may cause stomach upset, nausea, drowsiness, constipation, headache, dizziness, anxiety, or purplish-red blotchy spots on the skin during the first few days as your body adjusts to the medication. If these symptoms persist or become severe, inform your doctor promptly. Notify your doctor if you develop: slurred speech, shortness of breath, swelling of the ankles/feet, unusual fatigue, vision disturbances, difficulty urinating, skin rash, mental/mood changes (sometimes severe, including rare thoughts of suicide), muscle stiffness, uncontrolled muscle movements, unusual sweating, fast heartbeat, unexplained fever. If you notice other effects not listed above, contact your doctor or pharmacist.

Double vision

Double vision in Parkinson’s is often caused by problems in moving the eyes and, in particular, by
problems of tracking. ‘Tracking’ refers to the eyes moving in alignment from side to side, for
example moving across a page when reading. Impaired co-ordination and fatigue of the muscles
that move the eyeballs can mean that the eyeballs do not move together in alignment. This can
cause double vision.

The problem of double vision is usually improved by anti-Parkinson’s medication. Resting the eyes
when double vision occurs is wise and should provide relief.

There can be other causes of double vision that are unrelated to Parkinson’s. If the problem persists,
consult an ophthalmologist (doctor who specialises in the care of the eyes).

Any medication that blocks dopamine in the body can cause Parkinson's symptoms.

Any medication that blocks dopamine in the body can cause Parkinson's symptoms.

By Louis Neipris, M.D., Staff Writer, myOptumHealth

You may have heard of Parkinson's disease (PD), a movement disorder. Someone with it may have characteristic signs, such as a pill-rolling tremor in the fingers or a hunched forward posture. You may recognize someone with this disease from the faltering, tiny steps they take when they walk or by their rigidly emotionless face.

The cause of Parkinson's disease is mostly unknown. Some people develop Parkinson's-like symptoms after treatment with certain medications. This is called drug-induced parkinsonism (DIP) or secondary parkinsonism. Certain medications can also worsen symptoms in someone who already has Parkinson's disease.

Any medication that blocks dopamine in the body can cause Parkinson's symptoms. Dopamine is a brain chemical that helps control movement. Common dopamine-blocking drugs are antipsychotics. They are used to treat certain mental illnesses or severe nausea. Less commonly, certain types of calcium channel blockers cause drug-induced parkinsonism. These drugs may be used to treat chest pain and high blood pressure, or irregular heart rate.

Other types of medications that may cause drug-induced parkinsonism are:

* Some antidepressants
* Certain anti-nausea drugs
* Some drugs used to treat vertigo
* Certain drugs used to treat epilepsy
* Some anti-arrhythmics (used to treat irregular heart rhythm)

Not all drugs in these classes will cause symptoms of parkinsonism.

What's the difference?

Drug-induced parkinsonism usually develops on both sides of the body, while typical Parkinson's disease does not. Also, drug-induced parkinsonism usually does not progress like typical Parkinson's.

Unlike Parkinson's, drug-induced symptoms usually go away after the drug is stopped. It may take several months, though, for the symptoms to completely stop. If the symptoms remain, then it is possible that the drug may have "unmasked" underlying Parkinson's disease.

Who is at risk?

* Female: Women are twice as much at risk as men.
* Elderly: Older people are more likely to be on multiple medications or to have underlying Parkinson's disease.
* Those with a family history of Parkinson's disease.
* People with AIDS.

What to do to prevent drug-induced parkinsonism?

The most common drugs linked to this condition are two used to treat schizophrenia or psychotic symptoms of dementia. They are haloperidol (Haldol) and perphenazine (Trilafon). Ask your doctor about parkinsonism if you or a loved one is concerned about a drug, especially these two drugs.

In general:

* Make sure you or a loved one are on the lowest effective dose.
* If you already have Parkinson's disease, then tell your doctor if the symptoms appear to be getting worse since starting the drug.
* Never stop taking a drug on your own. Talk to your doctor about any concerns.


* Parkinson's Disease Society. Drug-induced parkinsonism.
* Albin RL. Parkinson's disease: background, diagnosis, and initial management. Clinics in Geriatric Medicine. 2006;22(4):735-751.
* Alvarez MV, Evidente VG. Understanding drug-induced parkinsonism Separating pearls from oysters. Neurology. 2008;70(8):e32-e34.

Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

Singing is helpful for PD


Posted: Tue Nov 24, 2009 6:09 pm Post subject: Singing is helpful for parkinson's patients


There are few articles touch on singing as a therapy that could help parkinson's patients mobility, speech, facial masked without mile and expression, soft voice,depression, anxiety breathing and etc. Singing is part of therapy to relief the motor and non motor symptoms of PD.


Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Thu Nov 26, 2009 10:45 am Post subject:


Thanks for posting this, it's an excellent article!

Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

When to medicate?


Posted: Sun Nov 29, 2009 2:12 pm Post subject: when to medicate


Dear Kathrynne,

What to do when you have an invitation for Thanksgiving dinner at the time you are supposed to take one of your meds?

Are the pills more effective when taken with th e meal at the correct hour, or waiting for two hours after the meal, whicb will throw off your pill schedule for the whole day.

And all of this for "quality of life".

Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Mon Nov 30, 2009 11:46 am Post subject:


Dear Friend,
This is a very good question, and it’s difficult to give a perfect answer. I am assuming you refer to use of levodopa. If you take the levodopa at the correct hour and that coincides with the start of the meal, it will not have time to be absorbed and enter the bloodstream ahead of the meal. If, however, you take levodopa right after a meal, the proteins in the food are likely to block its absorption. Either way, your PD symptoms will not be well controlled.

Two hours is normally enough time for the stomach to clear a meal; but if the meal is high in fat, that will slow clearance by as much as an hour or more. A large meal also takes longer to clear. And, many folks with PD have gastroparesis (slowed stomach emptying), which means the meal takes much longer to empty from the stomach. So, two hours is not a guarantee.

The very best solution generally, if it is possible for you, would be to reschedule your day’s medications, starting about 30 to 60 minutes earlier than usual. That would allow you to take the levodopa about 30 minutes ahead of the Thanksgiving dinner, and allow them to be absorbed ahead of the food.

For example, if you normally take levodopa at 8:00 am, 12:00, 4:00, and 8:00 pm, and dinner is scheduled for 4:00 pm, you might take your first levodopa at 7:30 am, 11:30, 3:30 (then have dinner at 4:00), and at 7:30 pm. Taking it at 3:30 should allow the levodopa to clear the stomach and enter the bloodstream before the start of the meal. Hopefully, this will improve quality of life, which I know is of concern for folks with PD.

If you have further questions, or if I didn’t explain this well enough, let me know and I’ll try again.
Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

Back to top


Posted: Tue Dec 01, 2009 7:13 am Post subject: when to medicate


thank you for y our prompt reply.

My problem i s that I must take my medication every 3 hrs.
And what do I do if it takes longerto finish a course?

Thank y ou so much for being there for us.

Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Tue Dec 01, 2009 11:24 am Post subject:


Dear Friend,
Thanksgiving is a problem when scheduling levodopa, for sure, for one thing because it usually lasts a good deal longer than most meals. And that makes it even more difficult to take medications on time.

I would try to work with your host/hostess ahead of time, explaining the times that you will need to take levodopa, and the importance of taking them about 30 minutes before the meal. Also, try to reschedule your levodopa for that day – for example, if you take your medications at 7:00 am, 10:00 am, 1:00 pm, 4:00 pm, and 7:00 pm, and dinner is scheduled for 4:00, try to re-schedule yourself for that day – take your first levodopa at 6:30 am, then 9:30, 12:30, 3:30. Have dinner at 4:00. Perhaps your hostess can see that you are able to complete your meal by 5:00. Then by 6:30 you will need to take your next medication. You may need to stretch the time to 7:00 pm, because if the meal is large, it may take longer than usual to clear your stomach.

It does bring up a couple of points to my mind, however.

1) Do you use Stalevo? It extends the effective time of levodopa, and might allow you to take your medications less often

2) If you already do take Stalevo (or cannot tolerate the Comtan component) you might discuss occasional use of “liquid Sinemet” with your neurologist. It does not last as long as regular Sinemet, but it is absorbed much faster and can be taken closer to meals.

3) Is it possible that you might have gastroparesis (slowed stomach emptying)? This is fairly common among folks with PD. Food stays in the stomach much longer than normal, and the medications taken while the stomach is full of food cannot clear the stomach to reach the bloodstream. PD symptoms thus are not well controlled, and the physician may prescribe more frequent doses. If you have not yet done so, I would ask your primary care physician about the possibility of gastroparesis, because if present, there are ways of eating that can help, and also some medications that can speed stomach emptying.

I hope this helps, but if not, let me know.
Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

Saturday, October 17, 2009

Antidepression: Cymbalta

Do not take Cymbalta together with thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an MAOI before you can take Cymbalta. After you stop taking Cymbalta, you must wait at least 5 days before you start taking an MAOI

1 person marked this post as helpful.

Parkinson's progression

Symptoms of Parkinson's usually begin slowly, develop gradually and in no particular order.

Everyone with Parkinson's is very different and may have a different collection of symptoms and response to treatment.

The nature and severity of symptoms and the rate at which the condition progresses will also be individual. The symptoms may take years to progress.

However, since Parkinson's is a progressive condition, symptoms will worsen over
time and new ones may appear. It is difficult to estimate how quickly or slowly Parkinson's
will progress in each person. It may progress more quickly in people who are older when the
symptoms first begin.

Currently, there is no cure for Parkinson's. However, many of the motor symptoms can be
treated with medications. Medications used to treat the symptoms either replace the lost
dopamine or mimic the action of dopamine in the brain. Medications can alleviate the symptoms,
but do not slow the progression of Parkinson's. As the symptoms change, medications will need
to be adjusted.

Friday, October 16, 2009

feature of stoop posture

Difficulty or slowness to start walking as a result of developing bradykinesia.
Shortened stride.
Bending forwards while walking, with rapid, small, shuffling steps and a tendency to run (festination). Festination may only develop at later stages of the disease and becomes more pronounced as the disease progresses.
Stiff, flexed posture is due to rigidity or increased muscular tone.
Tendency to stoop and lean forward while walking.
Difficulty in maintaining balance on turning is due to impaired postural righting reflexes.
Reduced arm swing while walking, especially on the side where Parkinson’s is more pronounced.
Tendency to fall, due to poor balance, may develop at a later stage of Parkinson’s disease.
Freezing – inability to move or start walking or stopping in mid-step, as if frozen on the spot (’statue’



Posted: Mon Jul 06, 2009 10:22 am Post subject: Slowness


I understand that two of the "hallmark" symptoms of PD are slowness and stiffness. Of course these symptoms are also common to aging. What characteristics are there to PD induced slowness and stiffness that are different than those of normal aging?


Back to top

Dr. Fernandez

Joined: 20 Jan 2007
Posts: 90

Posted: Tue Jul 07, 2009 10:53 pm Post subject:


Certainly if one is slower/stiffer on one side significantly more than the other, then that is abnormal and maybe representative of PD rather than normal aging.

If the slowness and stiffness is accompanied by tremor at rest, then it is probably PD.

If the stiffness and slowness is accompanied by other signs such as soft voice, shuffling gait, decreased eye blink, decreased facial expression, slow and small handwriting, difficulty getting up from a low seat, decrease in arm swing when walking, stooped posture, then these all point to PD rather than normal aging.

If the symptoms a gradually getting worse over time, then it may be more than normal aging.

Hubert H. Fernandez

antioxidant and you

Vitamin C
An antioxidant that may slow the progression of the disease and postpone the need for drug therapy. In a 1979 study of patients with early Parkinson's disease who were given 3,000 mg of Vitamin C and 3,200 IU's of Vitamin E daily, progression of the disease was slowed for up to three years.
Vitamin E
Works along with vitamin C to slow the progression of Parkinson's disease and postpone the need for drug therapy. These antioxidants are free radical scavengers that work to protect the brain from free radical damage. Large amounts of both vitamin C & E are recommended for the disease. These amounts can not be gotten from food sources so must be gotten through supplementation.
B Vitamins
Extremely important in brain function and enzyme activity.
Vitamin B5
Aids in speeding messages from one nerve cell to another.
Vitamin B3
Improves brain circulation. Caution: do not take B3 (niacin) if you have a liver disorder, gout, or high blood pressure.
Vitamin B6
Brain dopamine production depends on adequate supplies of this vitamin. Caution: Do not take this supplement if you are taking a levodopa preparation.
Parkinson's Kit
—$10 Savings—
(complete nutritional coverage of vitamins, minerals, amino acids, etc.)

A powerful antioxidant.
Works with magnesium. Needed for nerve impulse transmission.
Works with calcium. Needed for nerve impulse transmission.

Amino Acids:
Helps to regulate mood. Caution: Do not take this supplement if you take an MAO inhibitor drug.
Alleviates symptoms and works to counter depression. Caution: Do not take this supplement if you are pregnant or nursing; if you take an MAO inhibitor drug; or if you suffer from panic attacks, diabetes, high blood pressure, or PKU.
L-Glutamic acid
Improves nerve impulse transmission.

Nutrient Cofactors:
Ginkgo Biloba
Over time improves circulation and delivery of oxygen to improve brain function, minimize leg cramps and tremors, and increase a feeling of well-being.
Coenzyme Q10
Is a powerful antioxidant and also increases oxygenation of cells and is involved in the generation of cellular energy.

STRESS RAW FOOD SOURCES IN YOUR DIET: Make sure that three-fourths of your dietary intake comes from raw food sources (seeds, nuts, grains, raw milk for example).

INCLUDE FOODS WITH PHENYLALANINE: Since the amino acid L-phenylalanine may help alleviate the symptoms of Parkinson's disease include foods such as almonds, Brazil nuts, fish, pecans, pumpkin, sesame seeds, lima beans, chickpeas, and lentils in your diet.

CUT BACK ON PROTEIN INTAKE: Limit your the amount of protein in your diet to seven grams per day. Instead of meat and poultry eat other sources of protein such as barley, tofu, yogurt, beans, lentils, etc. If you are taking levodopa concentrate your protein consumption in the evenings as some of the amino acids in these foods may prevent the levodopa from reaching the brain.

MONITOR YOUR B6 IF YOU ARE TAKING LEVODOPA: B6 may interfere with the potency of this drug so if you are on levodopa monitor your intake of B6 foods such as bananas, fish, beef, liver, oatmeal, peanuts, potatoes, and whole grains. Do not take supplemental B6 if you must take levodopa.

STRESS CARBOHYDRATES: If you have Parkinson's disease take seven grams of carbohydrates to one gram of protein.

BEWARE THE FAVA BEAN: This bean contains dopamine and eating more than 1/2 cup of these beans along with a daily dose of the drug levodopa can cause symptoms of a dopamine overdose. The fava bean is primarily used in Mediterranean and Middle Eastern dishes.

should christians practise Yoga?

Thursday, October 15, 2009



To maintain joint mobility is done by putting each of the patient's joints through all possible movements to increase and/or maintain movement in each joint.
To prevent contracture, atony (insufficient muscular tone), and atrophy of muscles.
To stimulate circulation, preventing thrombus and embolus formation.
To improve coordination.
To increase tolerance for more activity.
To maintain and build muscle strength.

Passive. These exercises are carried out by the nurse, without assistance from the patient. Passive exercises will not preserve muscle mass or bone mineralization because there is no voluntary contraction, lengthening of muscle, or tension on bones.

Active Assistive. These exercises are performed by the patient with assistance from the nurse. Active assistive exercises encourage normal muscle function while the nurse supports the distal joint.

Active. Active exercises are performed by the patient, without assistance, to increase muscle strength.

Resistive. These are active exercises performed by the patient by pulling or pushing against an opposing force.

Isometric. These exercises are performed by the patient by contracting and relaxing muscles while keeping the part in a fixed position. Isometric exercises are done to maintain muscle strength when a joint is immobilized. Full patient cooperation is required.

1 person marked this post as helpful

Wednesday, October 14, 2009

christian alternative yoga

mobility and strength


Posted: Tue Oct 13, 2009 3:25 am Post subject: mobility and strength


I notice from my exercise, that I do possess strength, for example, I have the strength to hit, box and kick during my exercise. However, I do have difficulty in moving well. Mobility seems to be the problem here. I don't seem to be able to move fast with strength simultaneously. Although I can execute some moves sufficiently strongly, but I lack the speed in execution. Can any one enlighten me on why although I possess strength, I experience difficulty in mobility. I have checked with other patients suffering from Parkinson's Disease and they seem to have the same symptoms as me

Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Wed Oct 14, 2009 8:22 am Post subject:


Dear Friend,
Decreased mobility is among the most prominent features of PD. You are doing exactly the right thing in maintaining and improving your strength, even if mobility does not keep pace with your strength-building.You might in fact consider yourself as a good example of what folks with PD can attain, with determination and focus. Maintaining muscle strength and balance will stand you in good stead and will help enormously in combating the effects of PD.

I hope others with similar experiences will comment as able, and provide more insight into this effect of mobility vs strength. I'm sure all of us would welcome such information.
Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

Tuesday, October 13, 2009

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. 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.

Depression vs apathy

Depression is a common psychiatric complication in parkinson's occcuring in about 40-50% of parkinson's patients. Depression is preceding motor symptoms of parkinson's.

Despite being very common in parkinson's, depression is often under-recognized and undertreated. Doctors, caregivers and parkinson's patients are usually more preoccupied with the movement disorder of parkinson's'

The symptoms of depression are:

1 Sadness 2.Guilt,3 irritability, 4.loss of interest 5.hopelessness and helplessness 6.insomina,excessive sleep and early morning awakeningsn 7. Ruminative thoughts(thinking over the same issue again and again) 8. difficulty concentrating 9. appetite change (increased or decreased) 10. weight change 11.emotional lability (unstable emotion) 12. Thoughts of death

Apathy is a lack of interest in things or activity, you don't want to do anything because you don't get any pleasure or stimulation from anything. People with apathy are disappointed by PD treatment. They refused to medication. They are not lazy or stubborn as what the caregivers and relatives said.

2 people marked this post as helpful.

Sunday, October 11, 2009

Vote for Non motor or motor of parkinson's?

I choose non motor

The reason : We find difficulty to deal with non motor symptoms with medication. There are interaction amongst the medication that discourage patients from continue taking the medication.

The non motor symptoms refer to disorders which are not related to movement.
We need a team of doctors with different field for treatment.

Lastly some non motor symptoms become more frequent towards the advanced stage of parkinson's i.e anxiety and depression.
The non motor symptoms are complications affect the body, mind and emotions i.e psychosis, hallucination,delusion,depression,suicide,dementia,sleep disorders,constipation, anxiety, fatigue,and apathy. I would like my non-motor symptoms to be cured- My motor skills can stay. My motor skills right now are my only exercise

Anemia may be associated with development of PD

News: Anemia may be associated with development of PD

-------------------------Mayo Clinic Study Finds Anemia Might Be Associated With Development of Parkinson's Disease

Results of a new Mayo Clinic study support an association between anemia experienced early in life and the development of Parkinson's disease many years later. The findings will be presented at the American Academy of Neurology Annual Meeting in Seattle on April 30.

"We were surprised to discover that chronic anemia or low levels of hemoglobin were linked to the risk of Parkinson's disease 20- to 30-years later," says Walter A. Rocca, M.D., an author of the study and a neurologist at the Mayo Clinic.

Hemoglobin is the protein that transports oxygen in the blood, an essential element for life. "We looked at both anemia as diagnosed by a physician and low hemoglobin values," Rocca says. "Both were associated with an increased risk of Parkinson's disease. This might indicate that Parkinson's disease actually starts 20- to 30-years before we see any motor changes in the body."

(Web video and audio clips available on site)

Friday, October 9, 2009

nutrition,vitamin and parkinson's

Nutrition are importance for those with Parkinson Disease. Nutrition won't cure PD or slow its progression.

There are vitamins and mineral at certain level are harmful for Parkinson's Patients especially Folic Acid, Chromium,Copper, Ferritin,Magnessium,Selerium,Zinc and vitamin B6.

Therefore doctor who prescribes vitamins for PD has to routinely monitor them. Some of them may be good for general health and well being but not have been definitively proven to help PD. CoQ10 and creatine are currently under study. We will know about these two drugs very soon. But for the rest, they have not been proven.

In short Dietian with parkinson's experience are helpful

Thursday, October 8, 2009

“What is the Christian view of Tai Chi

Question: “What is the Christian view of Tai Chi (TaiChi)?”Answer: Tai Chi is more specifically called Tai Chi Chuan, which can be translated as “supreme ultimate force.” Tai Chi is a martial art, though it’s often called a “moving meditation” since the movements are done slowly and deliberately, and it is taught more as a meditative and health enhancing practice than as a martial art. Though its origins are unclear, the foundation of Tai Chi is the Taoist belief in a universal energy called chi (also spelled qi or ki depending on the language of origin). Chi is believed to be the binding life force in the universe, existing both externally and internally, moving through invisible channels in the body called meridians.

Taoism teaches that strengthening and reinforcing one’s inner chi will bring good health and long life as well as spiritual benefits. Certain breathing techniques, meditations, and bodily movements are taught to cultivate and enhance the chi. This belief is the basis of Tai Chi. There is no supreme God or Creator in Taoism; all originated from the Tao, which is an impersonal principle or source of creation.

From the Tao came yin and yang, two forces that manifested in creation. These forces appear opposite but actually are in a state of constant flux, merging with each other. The chi flows more harmoniously when yin and yang are balanced; this balance is brought about through special diets, herbs, exercises, breathing techniques, and bodily movements. Tai Chi therefore has a worldview at odds with the Christian worldview. It is based on a Taoist spiritual view of the body and the chi, and how to enhance the chi, a view incompatible with how the Bible tells us we were made—in God’s image (Genesis 1:27).

Jesus Christ created and holds the world together, not the Tao or an invisible force called chi: “For by Him all things were created, both in the heavens and on earth, visible and invisible, whether thrones or dominions or rulers or authorities—all things have been created through Him and for Him. He is before all things, and in Him all things hold together” (Colossians 1:16-17). Doing Tai Chi, even for physical purposes, is paying homage to a spiritual belief system at odds with God’s Word.

“What is the Christian view of yoga?”

Question: “What is the Christian view of yoga?”

Answer: For many Christians in the West who don’t understand the history behind it, yoga is simply a means of physical exercise and strengthening and improving flexibility of the muscles. However, the philosophy behind yoga is much more than physically improving oneself. It is an ancient practice derived from India, believed to be the path to spiritual growth and enlightenment.

The word “yoga” means “union,” and the goal is to unite one’s transitory (temporary) self with the infinite Brahman, the Hindu concept of “God.” This god is not a literal being, but is an impersonal spiritual substance that is one with nature and the cosmos. This view is called “pantheism,” the belief that everything is God and that reality consists only of the universe and nature. Because everything is God, the yoga philosophy makes no distinction between man and God.

Hatha yoga is the aspect of yoga which focuses on the physical body through special postures, breathing exercises, and concentration or meditation. It is a means to prepare the body for the spiritual exercises, with fewer obstacles, in order to achieve enlightenment. The practice of yoga is based on the belief that man and God are one. It is little more than self-worship disguised as a high level of spirituality.

The question becomes, is it possible for a Christian to isolate the physical aspects of yoga as simply a method of exercise, without incorporating the spirituality or philosophy behind it? Yoga originated with a blatantly anti-Christian philosophy, and that philosophy has not changed. It teaches one to focus on oneself instead of on the one true God. It encourages its participants to seek the answers to life’s difficult questions within their own conscience instead of in the Word of God. It also leaves one open to deception from God’s enemy, who searches for victims that he can turn away from God (1 Peter 5:8)

Whatever we do should be done for God’s glory (1 Corinthians 10:31), and we would be wise to heed the words of the apostle Paul: “Fix your thoughts on what is true and honorable and right. Think about things that are pure and lovely and admirable. Think about things that are excellent and worthy of praise” (Philippians 4:8, NLT).

Tags: General | Edit //

Wednesday, October 7, 2009

Can Christain practice Yoga?

God is Good

Christian approach to yoga two essential goals: becoming physically healthy and spiritually healthy. We become more spiritually healthy through the yoga practice by calming our minds and quieting ourselves to the point that we can tune out the world's frequency and tune into God's frequency.

Being quiet with God allows us to create enough psychological and spiritual space that God can truly create an inner sanctuary in us. Being quiet enough to hear our Lord's voice is not optional-- it's essential for growth. Let God bless your efforts to get closer to Him and the joy-filled, healthy life He has planned for you!

Remember yoga alone is certainly not the path to finding peace, but true, lasting peace and contentment come only through an on-going relationship with the Lord. So let God's word and this practice together challenge you to get out of your comfort zone in worship of our Lord and Savior, Jesus Christ.

"Be still and know that I am
God." (Psalms 46:10)

Is parkinson's curable?

Best Answer - Chosen by Voters
There is no cure for Parkinson's disease. Treatment at this time is based on addressing the symptoms. There are six types of medication available: anticholinergics, amantidine, L-dopa, dopamine agonists, MAOI (monoamine oxidase inhibitors) and COMT-I (catechol-O-methyltransferase inhibitors).

L-dopa is the precursor of dopamine, the brain chemical deficient in Parkinson's disease. Though still the mainstay of Parkinson's therapy, it is not without its own problems; long-term complications include fluctuations in effectiveness, abnormal movements ('dyskinesias') and psychiatric manifestations such as hallucinations.

It is common practice at this time for younger patients to be tried on dopamine agonists first, on account of the fact that they have shown to delay the onset of early dyskinsias and fluctuations. As they have also been shown to be less effective and less well tolerated than L-dopa, older and less healthy patients are started on L-dopa at the onset.

Is parkinson's not the end?

End Stage of Parkinson's Disease

At the beginning of the Parkinson's disease, the symptoms are mild but as it progresses towards the end stages the symptoms become more severe. In the first stages slight tremors, forgetfulness and fatigue is observed. As the disease progresses to its next stages, the symptoms like loss of balance, rigidity (Muscle stiffness) and walking problems are observed. These symptoms are often noticeable to family members or friends. In the next stages, the people find so much problem in balancing themselves that they gradually fall. A change in handwriting and speech is also observed.

In the fourth and fifth stages of Parkinson's disease, the symptoms become worse. By this time, the symptoms become so severe that the person is completely disabled and has to completely depend on some one else. Muscles become so stiff that the movements become slow and the person is unable to perform his daily tasks. As the disease comes to its end stage or final stage, it is developed fully.

The end stage takes over all the physical movements of a person. The person is not able to take care of himself. He is unable to walk or stand and is restricted to chair or bed. They lose their urinary and bowel control and can't even turn around by themselves. The speech becomes very slurred. They find problems in speaking and can take long time in expressing themselves as it might take time for the thoughts to reach words.

The person with end stage of Parkinson's disease can't swallow the food due to the choking. The mouth becomes dry. Sometimes the food can even enter into the lungs, which can cause breathing problems. In some cases with the end stages of the disease a feeding tube is inserted for feeding the things. Hallucinations are also observed in some people.

Here is the brief review of all what can happen in the end stages of Parkinson's disease. End stage of Parkinson's disease may include one or more of the following symptoms:

* Progressive decline in the symptoms despite medical treatments
* Progressive weight loss
* Frequent hospitalization
* Decreased appetite
* Repeated infections
* Trouble in breathing
* Trouble in swallowing
* Decline in mental status
* Weakness
* Drowsiness
* Fatigue

At the end stages of the disease person requires a constant nursing care. The end-stage of the Parkinson's disease can lead to pneumonia, choking, severe depression, and even death. Though there is no cure for the disease, use of medication is the most common way of slowing down the progression of the disease and keeping the patient healthy.


I have always respected the things you post. not only do you have PD, but you are very intelligent and share info that heretofore has been somewhat helpful. BUT, WHY DID you post this??? Did someone ask you about the end ??? IF so, a private email would have been more appropriate.

Having seen my dad go thru the last years of his life and being there to help as his caregiver, I am not so terribly upset by what you wrote. I also KNOW for sure NOT all of those things happen to everyone. PD doesn't kill, it's effect on the body does. As others have stated.........the state of mind the PD patient has is more than half the battle. If determination to postpone the progression is not there, then one is just sitting around waiting for the next symptom. I truly believe we have some, albeit slight, control over our PD.

Sometimes ignorance is bliss. Please be more selective in the subject matter of your posts in the future.

aunti j

Parkinson's is not the end

Parkinson's is Not The End

A Good Evening to you all. For those that do not know me, I have Progressive Supranuclear Palsy. It is under the "Parkinsons Plus" umbrella. It progresses much quicker than Parkinsons and is normally terminal. It is what killed the Actor Dudley Moore. I probably have 6 months before I cannot type anymore. I am legally blind now and have all but lost my voice. I have retrocollis dystonia and fall backwards. I have eye, shoulder and neck surgery coming up. I am 49 years old. Here is my message, then a true life story of one night with this disease. My message is don't give up on one another. See one another all the way through. Have hope and know brighter days are here if you want them to be. Choose brighter days and live your life well. Don't let Parkinsons define you. Now the Story: Last night, I awoke, thinking I heard sounds coming from our living room. I heard a voice calling out "Mom". I tried to move but could not. Then tried to reach to alert Tammy, but my arms would not move. I could not speak. The sounds were still there, footsteps, shuffling around type noises. I remember yelling, though knowing that no sound was coming from me. Finally, I was able to move my legs over the side of the bed and fall to the floor. I could not stand, so crawled from the bedroom to the living room. I sat up against the wall and took a good look around. Nobody was there. I felt someone run fingers through my hair. Thinking it was Tammy, I tried to look up, but my eyes would not open (eyelid apraxia) right away. When finally my eyes opened, there was no one there. Something told me to check my blood-sugar. I crawled to the cabinet, pulled myself up and retrieved my tester. I have been diabetic for about 4 years. Never overweight, always ate smartly, it came from nowhere. The meter indicated "49", almost coma stage for me. I checked it again, and the result was the same. I felt I could walk and started toward the refrigerator. I was wrong and fell backwards hitting the floor hard. I was dazed but still conscious. I heard someone scream behind me, but something told me it was not real. I was thinking "this is it". I crawled to the refrigerator without bieng able to see. I could not reach the orange juice, but felt a can and opened was Coke. I drank it and was able to feel a bannana and ate it. Within 20 minutes, I felt much better. Diabetes and PSP almost killed me. I cannot tell you how good it feels to still be here.
Back to top

Source: NPF discussion corner

Tuesday, October 6, 2009

Chapter 26Hero Teo - the atypical Parkinson’s patientIt has been evidently documented in the facts that Parkinson’s is associated with a inexorable epitome of persona. They care for to be “introverted” and “self-controlled”. In my own nightmare, I comprise also observed such “Parkinson’s personality”. Due to their give to not up to snuff, Parkinson’s patients are the most companionable and duteous patients whom I comprise treated in my clinic. In catholic, they are not familiar. It is intractable to learn the close inception of the Parkinson’s persona - it could be the call the shots construction of the ailment, the compensation to the natural disabilities or institute (social stigma).

Most of the period, their common activities are confined to their accessible, and they acknowledge a haughtiness from the institute. Some researchers comprise neck suggested that it the lineament persona of Parkinson’s patients that has predisposed to the ailment (i.e. increased the hazard of getting Parkinson’s). However, this “Parkinson’s personality” direction certainly does not care for to all patients. These deficient Parkinson’s patients comprise neck reached unmistakable to the in the main institute, while declaring their ailment audaciously to the in the main the human race. I in covert certain a awfully unimportant bunch of Parkinson’s who are companionable, give to but awfully familiar.

In genuinely, the genuinely of such “atypical Parkinson’s personality” is a ease in reprisal for the Parkinson’s community, as these “atypical” Parkinson’s patients comprise conquer the social blot and brought avant-garde changes to the Parkinson’s anxiety in this foster country. immense So cut a strip b ease, I comprise met three such “atypical” but curious Parkinson’s patients. You comprise heard of the altruistic stories of the manure Mr.

Chee Liew Seong, who comprise been the mode players in the bust of Parkinson’s bolster collaborating with crusade in Malaysia. Lloyd Tan and Mr. The awfully genuinely that Mr.

Lloyd Tan was later on discovered to comprise parkinsonism-plus syndrome, a much more stringent ailment than Parkinson’s, made his persona neck much more curious. The third manful lead of the Malaysian Parkinson’s community is Mr. “As cut a strip b ease on due recant as 1998, he was already noticed to comprise slowness of crusade, and a hunched on due recant with his foremost mephitis catnap (stooped posture). Teo Kim Hoe, 71, who is much speculator known as “Hero Teo”. Even at that jiffy, his relatives had commented that the scheme he walked was derogatory from earlier - he had a inclination to waddle on his toes. Once, my daughters and I were looking in reprisal for him at a shopping strike.

He walked fairly on us without noticing us at all, as his foremost was mephitis catnap. But, we did not comprise any exhume hither what he was distress from,” recalled Mrs. That was how we knew something was not fairly hither him. Teo. Mr. Teo was diagnosed to comprise Parkinson’s in 2005.

At this jiffy, his symptoms were tolerably well-controlled. He was already on some Parkinson’s medications when I initially met him in 2006. It was during this initially caucus when I discovered that he had an inherited contract of Parkinson’s, which is in a general scheme rare in this part.

He has a thoroughgoing of eight siblings, two of whom also suffer from Parkinson’s. Right from the initially period I met him, I had noticed some curious characteristics in him. Just like other Parkinson’s patients, Mr.

The most unhidden was his viscous optimism in coping with his ailment. Teo has banal assorted complications such as dizziness well-earned to unfavourable blood constraints, insomnia and nightmares. Last year, he was admitted to my asylum in reprisal for rash plunder of slurring of harangue, dizziness and limb preference. The discernment pore over confirmed that he had suffered from caress. His “never-say-die” mephitis has helped him to seductiveness by purity of all these complications. Despite this, he persevered and recovered unconditionally within complete week.

immense lowering Another second to none in harmony lineament of Mr. Teo is his openness in vanguard his ailment. With the ease of his son-in-law, he started his derogatory blog (”Hero Teo - Chronicles of a PD fighter” - in 2005. Teo is the initially Malaysian Parkinson’s resolved (and the lonesome one) who has started a blog.

In genuinely, Mr. In his blog, Mr. Teo has described his ailment in a awfully illustrative and thorough-going good form - hardly every cheerful of Parkinson’s is included.

Despite not having any medical qualification, he has discussed assorted medical issues which are considered to be intractable in reprisal for the catholic also clientage. When I asked him why he intractable to break the ice up a blog, he said, “I comprise unexceptionally wanted to censure the the human race how I persevere a leavings aloof from my Parkinson’s. Once, he sent me an email, asking me hither non-motor symptoms of Parkinson’s, something no Parkinson’s resolved has by any chance discussed with me. By creating a blog, I hankering to send a viscous message to all the readers that there are people distress from Parkinson’s who needfulness the bolster of the catholic also clientage. Malaysians needfulness to be valuable of the genuinely of Parkinson’s, and its natural, earnest and psychotic complications. Through this blog, I can pay out my nightmare on how I contend with with and apprehend my ailment.”"Don’t you get grey hair hither revealing your ailment to the in the main the human race? I am unfaltering that you certain hither the social blot associated with Parkinson’s, and the jaundice that people penchant comprise against you,” I asked.

I certain that nowadays we comprise fecund treatment in reprisal for Parkinson’s which can ease me attain a tolerably godlike attribute of duration. “Even even though I comprise Parkinson’s, I don’t pore over myself to be a inoperative actually. Furthermore, miserly revealing my ailment to other people, it enables them to apprehend and ease me clear my problems. These are the reasons why I don’t suffer humiliated to censure the in the main the human race that I comprise Parkinson’s,” he replied. I comprise to allow that I was amazed and impressed miserly his rejoinder.

Many Parkinson’s patients pore over themselves to be inoperative or physically frighten away, neck above-stated the period when they build up the catholic pubic. The truly is, the unresponsive feeling of Parkinson’s patients as a help to their own ailment is complete of the reasons that bold to the social blot. Coupled with the fall through feeling of the catholic also clientage hither Parkinson’s, the social blot of Parkinson’s is intensified. In other words, the Parkinson’s patients’ own feeling of ailment does comprise a valuable control on their long-term evidently being and social duration.

immense lowering immense Throughout all these years, Mr. I comprise met assorted Parkinson’s patients who are affected in more cheerful natural employ programs such as Tai-chi and Wai-dan-gong. Teo was the awfully initially Parkinson’s resolved who has a awfully “physical” advance in coping with the ailment.

In grapple with, Mr. Teo attends a much more intense natural employ program in reprisal for five days in a week at a unambiguous well-being strike. During each hearing, which lasts hither 3-4 hours, he carries unmistakable all sorts of employ programs such as muscle stretching, event on treadmill, balancing employ on “fit-ball”, kick-boxing and spinning (i.e. He neck hired an guru to guru him Yoga twice a week at accessible. stationary cycling).

In genuinely, I comprise not manure hell freezes across met any Parkinson’s resolved who is so combative in carrying unmistakable natural exercises. “I coolness in that in as evidently to the Parkinson’s medications, complementary treatment such as natural employ is also functional in maintaining godlike muscle limber up, penchant and outlook. This is why I comprise hired two trainers to ease me with my employ program,” commented Mr. Even today, Mr. Teo.

Teo is undisturbed physically strike, in the build up his period and having Parkinson’s in reprisal for ten years. As I communicate with this article, Mr. Teo and his partner are preparing in reprisal for a furlough I Hong Kong. I am favourite that he is making the most desired unmistakable of his experienced days. In genuinely, he has been traveling to assorted countries across the on lonesome complete years, such as Thailand, Singapore and Australia.

Don’t monkey around with with me - Mr. Teo doing his kick-boxing employ I comprise to allow that my derogatory nightmare in treating Mr. Teo across the on two years has been genuinely bosom and encouraging.

immense lowering immense lowering immense Mr. At least I certain that there is a minority of Parkinson’s patients who are derogatory from the languish, and attempted to divulge duration speculator in reprisal for the others. Lloyd Tan, Mr. Chee Liew Seong and Mr.

Posted in Uncategorized No Comments »

Monday, October 5, 2009

Top 10 biggest brain damaging habits


1. No Breakfast

People who do not take breakfast are going to have a lower blood sugar level.

This leads to an insufficient supply of nutrients to the brain causing brain degeneration.

2. Overeating

It causes hardening of the brain arteries, leading to a decrease in mental power.

3. Smoking

It causes multiple brain shrinkage and may lead to Alzheimer disease.

4. High Sugar consumption

Too much sugar will interrupt the absorption of proteins and nutrients causing malnutrition and may interfere with brain development.

5. Air Pollution

The brain is the largest oxygen consumer in our body.

Inhaling polluted air decreases the supply of oxygen to the brain, bringing about a decrease in brain efficiency.

6. Sleep Deprivation

Sleep allows our brain to rest. Long term deprivation from sleep will accelerate the death of brain cells.

7. Head covered while sleeping

Sleeping with the head covered, increases the concentration of carbon dioxide and decrease concentration of oxygen that may lead to brain damaging effects.

8. Working your brain during illness

Working hard or studying with sickness may lead to a decrease in effectiveness of the brain as well as damage the brain.

9. Lacking in stimulating thoughts

Thinking is the best way to train our brain, lacking in brain stimulation thoughts may cause brain shrinkage.

10. Talking Rarely

Intellectual conversations will promote the efficiency of the brain.

Chinese Proverb:

"When someone shares something of value with you and you benefit from
it, You have a moral obligation to share it with others."

People don't care how much you know...Until they know how much you care!

3 people marked this post as helpful.

parkinson's blogs worth mentioning

Parkinson's Blogs Worth Mentioning by Taryn Simpson

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 disease blogs.

3 people marked this post as helpful.

Facial expressionless with parkinson's

Facial expressionless with Parkinson's

Because 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

3 people marked this post as helpful.

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

2 people marked this post as helpful.

Sunday, October 4, 2009

locate dietitian w/pd experience


Posted: Wed Sep 30, 2009 10:44 pm Post subject: locate dietitian w/pd experience


can you recommend a dietitian in San Angelo, Texas familiar with Parkinson's.?

Back to top

Kathrynne Holden, MS

Joined: 22 Jan 2007
Posts: 94
Posted: Thu Oct 01, 2009 12:57 pm Post subject:


Dear Friend,
I don't have any recommendations, but I will contact the dietetics networks and inquire. If I locate someone, I will post to the forum.

Best regards,
Kathrynne Holden, MS
For a Parkinson Tip of the Day visit:

Saturday, September 26, 2009

Apathy in PD

Dr. Fernandez

Joined: 20 Jan 2007
Posts: 90

Posted: Sun Sep 20, 2009 7:01 pm Post subject: Post of the Week: Apathy in PD


How is apathy different from depression?

Apathy is characterized by “diminished motivation, a lack or absence of feeling, emotion, interest or concern”. Technically, it has three components: cognitive (loss of interest in new experiences, lack of concern for one’s problems), behavioral (lack of effort and productivity, dependence on others for structuring daily activities) and affective (flattened affect and lack of response to positive and negative events). Thus, there is some overlap with the symptoms of depression. However, while the symptoms of apathy can also be seen in depression, they differ in the sense that depressed patients feel intrinsically “blue” or sad. They are very bothered by this condition. While apathetic patients do not feel sad, they are indifferent, and they simply “don’t care”. They are not bothered or worried by this condition, rather it is often their spouse who is irritated by their lack of concern or unwillingness to participate in activities. The incidence of apathy in Parkinson’s disease is approximately 45% (Isela et al, 2002). Apathy can therefore be a feature of depression or stand alone as a separate behavioral symptom.

Unfortunately, there have been no consistently reported effective treatments for apathy in Parkinson’s disease. Antidepressants may be tried, and improvement can be seen usually if apathy is a component of depression. But the best remedy is assurance and education. Caregivers need to be assured that their loved one’s “lack of care” does not mean lack of love, or sadness or frustration. Once the spouse is assured and the Parkinson’s patient confirms that this is indeed what he or she is feeling, tension in the household eases up significantly. There is a therapy called cognitive behavioral therapy that researchers are currently testing for treatment of apathy.
Hubert H. Fernandez

Back to top

Lloydtan-trust & Malaysia Parkinson's information centre

Thank you sooo much for this link. The care and compassion in the writings is very touching and so respectful to those who suffer with PD. When I read the article on Parkinson's Hero's I was shocked to see it was written by a doctor. He wrote more like a compassionate father then a physician.

To have someone write with so much respect and compassion made me feel like a person again not a "patient". Respect and compassion are powerful "medications" to a person who has an illness. When treated and acknowledge this way you feel as if you can do and get through anything.

Thank you for showing me how I need to treat and perceive those how have chronic illnesses.