Thursday, July 31, 2008

Forum: Is Parkinson's not a bad disease and is easy to control?

Dear Doctor,
I was diagnosed as a Parkinson's patient in the year of 2005.
Besides medications I do exercises in the gym daily. I spend two hours in the gym and I have two personnel trainers who help me to strenghten my physical mobility and body flexibilities.
I do yoga,body combat,pump, Box and kick exercise and cardio training.
I am normal and don't look like anything is wrong actually had been told by my doctor, physical trainers and members of my family. Though it is expensive to battle.
Is Parkinson's not a bad disease and is so easy to control?

PeterMidJoined: 20 Jun 2008Posts: 12
Posted: Fri Aug 01, 2008 6:30 am Post subject:


You are joking, aren't you? I excercise as much as my PD allows, and that isn't very far, I'm afraid. A walk of 150 metres is about my limit, and even then, my legs are on fire and the Oedeema is bursting eruptions through my skin. Dbviously, you work hard on your personnal fitness and I admire you for that, but to suggest PD is not a bad pox is a little extreme. What about my Diabetes? Is that not a bad disease too? Pokermid

PeterMidJoined: 20 Jun 2008Posts: 13
Posted: Fri Aug 01, 2008 7:32 am Post subject:

Oh, and by the way Teokimhoe. In the UK, personnal fitness trainers charge £50 per hour 2 x trainers for 2 hours = £200 GBP or $400 USD 7 Days = £1400 GBP or $2800 USD 1 Year = £72,800 or $145,600 USD pokermid
Back to top

teokimhoeJoined: 03 Mar 2007Posts: 106Location: Malaysia
Posted: Fri Aug 01, 2008 7:59 am Post subject:

Dear Pokermid Am I joking? Certainly not. It's obvious that you did not get the gist of my message, do you? The point is that for people suffering from PD, you could at least have the option of adjusting your lifestyle to control the advancement of the disease. Working out regularly and correctly is a way of slowing down the effect of the disease. As compared to other diseases, whose advancement are somewhat beyond your control, eg. cancer whereby save and except for very few, you will die pretty soon. In such a sense, definitely PD is a "better" disease to have. Of course given the choice, nobody would want to be suffering from any disease right? If 150 metres is your limit, I pity you. Obviously you have not been taking care of yourself well enough. Diabetes is again a result of your lifestyle. That is your own choice!!! It obvious that your lifestyle has been downright unhealthy. Too much sugar intake eh?? Working out in the gym is again an option. If you can't afford it, you can always work out elsewhere. Nobody says that working out must be limited to the gym or expensive!! My advice to you is grab a hold of your life and turn it around, rather than displaying such negative attitude. Embark on a healthier lifestyle and you will see the results._________________

CatsPajamasJoined: 06 Aug 2008Posts: 1
Posted: Wed Aug 06, 2008 5:43 pm Post subject: geez...

Perhaps this forum should be monitored. I can see why so few post here. The tone is confrontive, to say the very, very least.
Back to top

From my experience, I have learnt that all Parkinson's patient is different from each other, in many aspects such as symptomatology, rate of disease progression and response to treatment. Managing my Parkinson's patients has been made easier by respecting the differences between each Parkinson's patients - there are no "two Parkinson's patients who are identical". One day, a man came to my clinic and asked me why his 62-year-old wife, who suffered from Parkinson's, could hardly walk despite having the illness for only four years. "I read an article in the newspaper which described how an elderly Parkinson's patient, who had been having the illness for twelve years, was doing some rather strenous exercises in a gym. How come my wife can't do even 5% of this exercise?" he commented. As I have treated his wife for about six years, I could easily understand why she behaved so differently from the other "super-fit" Parkinson's patient. His wife suffered from severe anxiety and depression, while her Parkinson's was actually quite mild. In other words, what "crippled" her was her mood disorder, and not the Parkinson's. Almost all the time, she would just lie on the bed or sit on a chair. Whenever her husband tried to help her to stand up, she would complain of dizziness and feeling like falling down. In addition, she had numerous other symptoms such as blurring of vision, numbness of hands, palpitation, etc (which were the symptoms of anxiety). Her social life was almost zero - she stayed at home all the time and even refused to follow her children to the restaurant. Thus, an important factor that contributes to the varying response to treatment is co-existing psychiatric disorders. Most Parkinson's patients have anxiety or depression or both, in varying degrees, which I think are partly due to difficulty in accepting their illness (i.e. Parkinson's). Some Parkinson's patients are devastated by Parkinson's while others are crippled by the psychiatric disorders (anxiety / depression). Unfortunately, psychiatric disorders in PD are very often neglected by both the patients and doctors. Mr Teo is fortunate that he does not have any psychiatric disorder. In fact, he has a very unusually "outgoing" personality, which most Parkinson's patients do not have. Mr. Teo is an optimistic person who has accepted his Parkinson's, and he always tries his best to cope with his illness. It is this "optimistic" personality that has made him so different from other Parkinson's patients. Dr Chew Nee Kong, Kuala Lumpur.

wheelersceJoined: 02 Mar 2007Posts: 503Location: MI
Posted: Mon Aug 11, 2008 6:11 am Post subject:

Hi, CatsPajamas, Its true that this exchange seems confrontive. But like any group of people, we on this forum have a range of personalities and styles. Please add to the discussion, the way you would like to see it. I'd like to know you better--haven't seen you post before. Sue W.

cfinlaysonJoined: 29 Jun 2007Posts: 125
Posted: Mon Aug 11, 2008 10:16 am Post subject:

Hi CatsPajamas, It is nice to see your name on this forum. Like Sue said, this forum has a range of personalities, but we have all agreed to disagree at times. When it comes down to it, we do lean on each other to help us through the hard times. Some of us lean on the Lord and some of us have other ways of dealing with this disease, but we are all in it together. I know that I keep us all in my prayers every night. So please, post and let us know more about you. Candy
Back to top

wheelersceJoined: 02 Mar 2007Posts: 513Location: MI
Posted: Sat Aug 16, 2008 6:57 am Post subject:

Gautam, I was very disturbed by this response to Peter. Whether Teokimhoe or Dr. Chew wrote it, pouring out guilt on us PWPs is hardly the best encouragement. Good to see you. Sue W.
Back to top

PeterMidJoined: 20 Jun 2008Posts: 17
Posted: Sat Aug 16, 2008 7:46 pm Post subject:

No more Heroes No need to worry about Pokermid, Teo’s a hero right out of the ID. Could he be Batman, crusader of right Maybe Darth Vader whose just seen the light. Silver with surfboard? Or is he the Thing? Mr Fantastic with his rubber ding!!! What of the Lantern with green in his eyes, Or is he Clark Kent without his disguise? Could he be Hulkster who bounds through the air, Is he the Devil in red and can Dare. No-one can see the invisible man, Only Sue Richards who probably can. Is he the X-man we know as Cyclops, Is he Dick Fosbury with his famous flops. What about Spidey who likes spinning webs, Or is he James Bond who romances Debs. Could he be Torchy who “flames on” in 4, Could be a Viking that we know as Thor. OR IS HE Homer, the Simpson not Greek, Eating a donut like a little geek What is the matter with Teokimhoe, Or is he really American Joe. Chip on his shoulder? It sounds like to me, Who is this Hero? Oh who could it be? Pokerman
Back to top

PeterMidJoined: 20 Jun 2008Posts: 17
Posted: Sat Aug 16, 2008 8:06 pm Post subject:

he's probably just a "Family guy"
Back to top

teokimhoeJoined: 03 Mar 2007Posts: 108Location: Malaysia
Posted: Sun Aug 17, 2008 3:50 am Post subject:

The main purpose of my entries is to share my experience with sufferers of PD, and to get across the message that you alone can make a difference to your life by turning it around, as in my case, exercising correctly. Everybody has their own ways of expression, some confrontational and some more diplomatic. But the intention still remains the same, that is to share my experience with the hope that it may help others. If you think this is a laughing matter by throwing scorn around and making fun of others, so be it. As far as I am concerned, this matter is closed._________________to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
Back to top

GautamJoined: 01 Mar 2007Posts: 84Location: Goa, India
Posted: Mon Aug 18, 2008 12:26 am Post subject:

Teo, Sorry if I sounded rude in my post. While we all appreciate your contribution, you do have to keep in mind that PD symptoms and progression differs from person to person. While on one hand we have John Ball who participates in marathon runs despite having PD for almost 3 decades, we also have Peter and several others, including me, who have difficulty in exercising and walking. I used to walk 5 kms daily, today after walking less than half a Kilometre my ankles start twisting and gives away and I am unable to even return back home! What Peter was trying to point out was that PD is also an expensive disease, and not everybody can afford personal fitness trainers. Imagine my plight, we do not have Social security in India and the cost of medication, DBS, etc. has to be borne by the individual patients.If my MDS advices me to go in for a DBS surgery, I just cannot afford to have one as it costs almost Rs.500,000 in India! So lets appreciate and understand each other on this forum. kind regards Gautam quote="teokimhoe"]The main purpose of my entries is to share my experience with sufferers of PD, and to get across the message that you alone can make a difference to your life by turning it around, as in my case, exercising correctly. Everybody has their own ways of expression, some confrontational and some more diplomatic. But the intention still remains the same, that is to share my experience with the hope that it may help others. If you think this is a laughing matter by throwing scorn around and making fun of others, so be it. As far as I am concerned, this matter is closed.[/quote]
Back to top

PatientsLikeMe Forum

High Cholesterol can increase risk of Parkinson's

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

Late stages of Parkinson's Disease

Late Stages of Parkinson's Disease
by Matt NilsenUnknown Category
Parkinson's disease progresses into its late stages after an average of seven years. Advanced Parkinson's disease is not pleasant to think about because of the limitations associated with it. However, a strategy for the later stages of Parkinson's disease can help you have less "off" time and less discomfort. We hope this article helps you shift some of the discomfort time to satisfactory "on" time. We also want your caretakers to be able to handle their responsibilities, as well as get enough rest and relaxation.
When Am I in the Advanced Stage of Parkinson's Disease?Late stage or advanced Parkinson's disease includes these noticeable signs:
Complete reliance on others for food, bathing, dressing, and other basic activities.
Difficulty speaking or communicating
Severely compromised hand-eye coordination
Severe memory loss
Only being able to swallow soft food
Falling daily
Freezing frequently
Walking only with assistance
Experiencing unexplained pain

Strategies for late-stage Parkinson's diseaseYou will rely on your neurologist more than ever during this stage of Parkinson's disease. The expertise of a movement disorders specialist will be valuable for matching your needs with the treatments most likely to reduce your symptoms. Medications wearing off, deep depression and frustration, freezing, tremors, disorientation, dementia, and dystonia are all problems that can crop up in this stage. To address these issues your physician will likely adjust your medications. This is a time when you must be willing to test different medications at different doses and in different combinations.
COMT inhibitors are often effective in late-stage Parkinson's disease, and the new dopamine agonist patch, Neupro, has also shown some encouraging results in recent clinical trials. Apokyn (injectable apomorphine) can be effective at arresting severe Parkinson's symptoms, especially if you find your medications suddenly wearing off in a public place like a grocery store or restaurant.
Managing LifeThis is a challenging time in life. You have to rely more on other people than you can on yourself. You may get discouraged that your family time, yard work, hobbies, work, travels, and other activities diminish. Your caretaker and your physician can help you come up with strategies that help you. We also encourage you to create a relationship with a social worker experienced with Parkinson's disease.
A social worker can help you bridge some of the emotional gaps and address many of the practical issues of living. Your social worker will be able to suggest apparatuses for your home to help you and your caretaker. They can coach your caretaker in the challenges of being responsible for a person with Parkinson's disease. You may be surprised to find that your social worker can address many of the financial challenges of living with Parkinson's disease, too.
From This Newsletter

Sunday, July 27, 2008

An excellent Items: Parkinson's Disease

Living with Parkinson's disease

Coffee and Parkinson's

Posted: Wed Jul 16, 2008 1:58 pm Post subject: coffee and PD

Here is an article from a local paper relating to coffee and PD. * 4 cups (32 ounces) of java a day can cut your diabetes risk by a third, possibly by improving insulin's effects. * 3 cups (24 ounces) a day drops protects your brain, dropping your risk of Parkinson's disease by 40 per cent and Alzheimer's disease by 20 per cent. * 2 cups (16 ounces) a day keeps your liver healthy, as it filters out pollutants, makes protein, warehouses extra carbs and vitamins, and helps produce bile needed to digest fat. Comments? Jim
Back to top

Kathrynne Holden, MS, RDJoined: 22 Jan 2007Posts: 94Location:
Posted: Thu Jul 17, 2008 7:33 am Post subject:

Dear Jim, Generalizations are useful, but not law by any means. Coffee is fine, and indeed there are studies associating it with lowered risk for PD and other diseases; however, there are many thousands of lifelong coffee drinkers with PD. One could make as good a case for drinking tea, or for caffeine alone (see below). If you will search “Dietitian” archives, you will find many studies on turmeric/curcumin, as well as tea, neither of which will prevent PD, but both of which I believe are preferable to coffee. 1) Study Examines Effects of Tea Intake on Parkinson's Disease Development Tan LC, Koh W-P, Yuan J-M, et al. Differential effects of black versus green tea on risk of Parkinson's disease in the Singapore Chinese Health Study. Am J Epidemiol. March 1, 2008;167(5):553-560. Studies have shown that caffeine in coffee may improve motor deficits in patients with Parkinson's disease by blocking adenosine A2 receptors. Small case-studies have shown that tea may reduce the risk of late-onset Parkinson's disease. It is not known what ingredient in tea mediates this effect. The high prevalence of black and green tea consumption among the Chinese population makes this population ideal for evaluating the effect of tea on Parkinson's disease. This report is based on data from the Singapore Chinese Health Study, which is a population based cohort established between April 1993 and December 1998. The cohort includes 63,257 ethnic Chinese aged 45-75 years who reside in government-built housing estates. The participants completed a food frequency questionnaire that listed 165 food items or groups of commonly consumed Chinese foods. The authors developed a food-nutrient database that provided the nutrient levels of 96 components per 100 grams of cooked food and beverages. The mean daily intake of caffeine and other nutrients for each subject was computed. Cigarette smoking was also assessed. Subjects reported new cases of Parkinson's disease. Cigarette smoking was strongly associated with a reduced risk of developing Parkinson's disease. Never smokers had a higher risk, former smokers had an intermediate risk, and current smokers had a low risk. Among ever smokers, beginning smoking at an earlier age and smoking a higher number of cigarettes per day were associated with a lower risk. Approximately 50% of the subjects drank tea at least once a week, with approximately one-third drinking only green tea, one-third drinking only black tea, and one-third drinking both types of tea. However, in this cohort coffee was the main source of caffeine exposure, with 70% of the population drinking coffee on a daily basis. Total caffeine intake exhibited a significant (P = 0.002), dose-dependent inverse association with Parkinson's disease risk—the greater the caffeine intake, the lower the risk of Parkinson's disease. The caffeine content in coffee was responsible for its effect. In contrast, black tea consumption was associated with a reduced risk, irrespective of the total caffeine intake or cigarette smoking. There was no association between green tea consumption and Parkinson's disease risk. Subjects with high intake of both caffeine and black tea had the lowest risk of developing Parkinson's disease. None of the other macro- and micronutrients in any of the consumed foods or beverages had a strong dietary influence on development of Parkinson's disease. The authors conclude that ingredients in black tea, other than caffeine, reduce the risk of Parkinson's disease. The authors speculate that the protective effect of black tea may be mediated by an estrogen-related pathway. Parkinson's disease rates are lower among women (women have higher levels of circulating estrogens then men) and in the cohort circulating estrogens were highest among regular black tea drinkers and lowest in regular green tea drinkers. A limitation of the study was that it did not have any data on duration of coffee or tea intake. These results are consistent with findings in Western populations. —Heather S. Oliff, PhD 2) Green tea antioxidant may help prevent Alzheimer's, Parkinson’s An antioxidant found in green tea appears to prevent the development of amyloid fibrils, a toxic protein associated with Alzheimer's and Parkinson's disease, a new study finds. Amyloid plaque is commonly seen in the brains of Alzheimer's patients and appears to disrupt the function of cells. Strategies to prevent the development of amyloid plaque are one avenue being explored in the prevention and treatment of Alzheimer's. Now, a German team says the tea antioxidant, called epigallocatechin gallate (EGCG), has potent anti-plaque ability. ""We can use small molecules like EGCG to convert certain misfolded structures of a protein into a new type of molecule, which is less toxic or not toxic for cells,"" said lead researcher Erich Wanker, from the Max Delbrueck Center for Molecular Medicine in Berlin. The findings are published in the May 30 online edition of Nature Structural & Molecular Biology. The accumulation of amyloid plaque in Alzheimer's and other neurodegenerative diseases, such as Parkinson's, are thought to be caused by the misfolding of certain proteins, which then become toxic to cells. The way proteins fold is key to their function, the researchers explained. In experiments in the laboratory, the German team found that EGCG seems to change potentially harmful proteins into proteins that are not detrimental to brain cells. ""We are able to convert a toxic structure into a less toxic structure,"" Wanker explained. Because EGCG binds to unfolded proteins -- which are not associated with Alzheimer's -- the discovery could lead to medications that recognize the more troublesome proteins and convert them to harmless substances. ""This method could be more generally used to get rid of or remove the concentration of misfolded proteins in cells,"" Wanker said. ""This strategy should be tested with patients. If treated early on, it could prevent the formation of amyloid plaque,"" he speculated. Whether this type of treatment could reverse plaques that have already formed in the brain isn't known, Wanker said. He noted that the study remains basic science, and he was cautious about recommending green tea as a way of preventing Alzheimer's disease. ""I don't want to do a lot of speculating which could point people in the direction that could be harmful,"" Wanker said. ""We have to go step-by-step."" One expert believes the approach could yield real results, however. ""Yellow curry and green tea have suspected health benefits because of high content of antioxidants,"" said Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System, and associate director of the Alzheimer's Disease Research Center at UCLA David Geffen School of Medicine. He was not involved in the study. ""This study provides evidence that a compound called EGCG, one of the major polyphenols in green tea, may be useful for diseases like Parkinson's and Alzheimer's, because it can block the formation of the filament-forming protein aggregates implicated in causing disease,"" Cole said. One novel aspect of the study is the authors' demonstration that EGCG prevents toxic filament formation by redirecting the aggregating proteins to make non-toxic proteins, Cole said. ""This is surprising, because similar protein aggregate spheres called amyloid oligomers can be highly toxic to neurons and synapses,"" Cole said. ""It will be important for the authors to prove that the EGCG-directed proteins also lack toxicity to synapses which were not present in the systems used to test toxicity,"" he said. Assuming that the green tea compound has a stable effect and chronically blocks toxicity to real neurons and synapses, it could have genuine potential for Alzheimer's patients, Cole said. ""The major caveat is the very poor absorption and delivery of EGCG seen in some studies,"" Cole said. The fact that EGCG isn't available for patenting by pharmaceutical companies might be a problem, too, he said, since it could ""limit the investment needed for clinical trials of sufficient size to prove that it really works."" In related research, a team of American scientists said that interrupting a key signaling pathway in immune system cells allowed those cells to enter the brain and attack and remove amyloid plaque. Reporting May 30 in Nature Medicine, a team led by research scientist Terrence Town, of Cedars-Sinai Medical Center, Los Angeles, conducted their study in genetically engineered mice. The group blocked a molecule that typically suppresses a portion of the immune response. Once the system was freed up, immune cells called macrophages made their way to the brains and devoured up to 90 percent of amyloid plaques, the team said. ""If these experimental animals are representative of the clinical syndrome of Alzheimer's disease, we may have a therapeutic target that we did not have before,"" study co-author Dr. Jun Tan, of the University of South Florida, said in a statement. regards, Kathrynne Holden, MS, RD -- For a Parkinson Tip of the Day visit:
Back to top

Posted: Sat Jul 19, 2008 12:12 pm Post subject:

Kathrynne Holden, MS, RD wrote:
Dear Jim, Generalizations are useful, but not law by any means. Coffee is fine, and indeed there are studies associating it with lowered risk for PD and other diseases; however, there are many thousands of lifelong coffee drinkers with PD.I think "statistics" are often over-rated. With a world of variables - things we eat, drink, absorb, manufacture ourselves, etc - it's hard to see how researchers can assume so much based on such things as coffee consumption. And in the end statistics offer nothing of certainty or even probability in individual cases, if a person gets a disease the "odds" of them not getting it are irrelevant. :) I love a good coffee in the morning but otherwise don't drink it much. Thanks for the info. Jim

Saturday, July 26, 2008

Different medical levels and wearing off

As PD is " not going disease' i.e. a slow progression and is different from other disease i.e a self -limited sickness or injury that temporarily impact their lives as inconvenience or comfort .

Parkinson's Patient are confused on the management of this complicated illness that bother them as PD affects their mind, mood and body movement.

Patients have different syndromes when they are on different medical levels and wearing off.

Your briefs would be helpful.



Friday, July 25, 2008

Parkinson medicine and Vit. Supplements.

Glad to inform that my dizzness is going off completely by taking SERC 16, betahistine dihydrochloride 16 mg one dose three times daily.

I am still taking my Parkinson's medication and Vitamin Supplements and Hormone Therapies.

There are nothing wrong for taking the Vit. Supplements and hormones therapies together with Parkinson's medicine with the consultation with the doctors.

The dizznness was caused by Parkinson's medicine.



Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun Jul 27, 2008 6:58 am Post subject:

Tim, I'm glad you are feeling better. But actually, we don't know if there is nothing wrong taking vitamins and hormones in PD. The only way this is proven is through diligent clinical trials. And so far, all properly conducted clinical trials on vitamins (such as vit E, etc) have not shown to be efficacious in PD. There is promise however with creatine and with co-Q10. Yours,_________________Hubert H. Fernandez

Sunday, July 20, 2008


Posted: Tue Jul 15, 2008 9:32 am Post subject: Stress

Can you please explain the relationship of stress to PD? Does affect the speed with which the disease progresses? Should a person with PD be kept removed from stressful situations? If so, to what extent does one go to do this? Clover
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sat Jul 19, 2008 10:53 am Post subject:

I am actually unaware of formal studies about stress and PD. But we do know that stress almost always temporarily worsens PD symptoms...tremors, stiffness and slowness almost always will be worse when someone is stressed. The symptoms usually resolve slowly as the stressful situation goes away. Bust as to whether this is deleterious in the long run, we do not know exactly to what extend. We also know, regardles of PD presence or not, that stress is not good for general well being. Stressed individuals have a higher likelihood of heart attacks, gastric ulcers and other conditions. Yours,_________________Hubert H. Fernandez

Boxing give parkinson's fighting spirit?

Medical, Parkinson's and Smoking

Posted: Wed Jul 16, 2008 3:41 am Post subject: Medical, Parkinsons, Smoking

Medical, Parkinsons, Smoking I stumbled upon this article from Xinhua stating that smokers and coffee drinkers are less likely to develop Parkinson’s disease. Quoting the article: Smoking cigarettes and drinking coffee may protect people from Parkinson’s disease, according to a new study in the April issue of Archives of Neurology out Tuesday. “What this study tells us is there is something about cigarette smoking and consuming caffeine that alters the biology underpinning of Parkinson’s disease,” said Professor William Scott,a leading researcher at the Institute of Human Genomics at the University of Miami
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sat Jul 19, 2008 11:12 am Post subject:

Yes, it is true that there have been several epidemiological studies that showed lesser occurence of PD among patients who routinely consume caffeine and those who smoke. However, these are epidemiological studies that are subject to a lot of biases and not a direct causal relationship. Moreover, we have no reason to think that smoking and caffeine can improve the symptoms of those who already have PD. Supposedly, the mechanism of caffeine's protection in developing PD is its role in the adenosine 2A receptors. I'm not sure baout smoking...but I am so biased towards the evils of smoking (the its clear risk factor for stroke, heart attacks and cancers) that I would avoid it at all cost, regardless of what epidemiological studies show regarding its relationship to PD. Yours_________________Hubert H. Fernandez

Murray Janet said...
Heart attacks are less likely for non-smokers as compared to the smokers. According to WHO, individuals who quit smoking decrease their risk of CAD one year later by 50 %. If you have quit smoking, for 15 years, your risk of dying from CAD is almost as low as a life time non-smoker.

Two diagnose of Parkinson's disability rating scales

Posted: Wed Jul 16, 2008 3:45 am Post subject: Two diagnose of parkinson's disability rating scales

There are two diagnose of Parkinson’s disability rating scales are made :- Conventionally diagnose is assessed on the current symptoms how they respond to treatment :-whether symptoms are improved by adding levodopa. It involves over time or how you will respond to treatment. In clinical assessment, doctor may use one of two disability rating scales - Hoehn & Yahr, named after the two doctors who devised it in 1967. The Hoehn & Yahr scale allocates stages from 0 to 5 to indicate the relative level of disability the parkinson’s are experiencing. TEOKIMHOE
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sat Jul 19, 2008 11:16 am Post subject:

Thanks! I'm not a big fan of rating scales for clinical use. To me the most important is how my patients feel. We use them a lot however in clinical trials because this is one of the most objective way of determining whether a drug or intervention is working or not. None of the current scales we use is perfect. They do not capture all the signs and symptoms of PD. Yours,_________________Hubert H. Fernandez
Back to top

Sunday, July 13, 2008

parkinson's study group

The medication (levodopa) for treating PD was discovered only in the 1960's. Before the 1960's, one study showed that untreated patients lived for an average of 10 years after diagnosis. As the physical disability in PD worsened with time, eventually patients became bed-ridden and succumbed to lung infection. This contributed to the shorter life span of Parkinson patients compared with those without PD

Five stages of accepting an illness

Five Stages of Accepting an Illness

Though symptoms of chronic illnesses differ, people with them are united by the denial, anger, fear, hope, and acceptance and other feelings they bring. Below are the five stages that people typically go through when they find out they have a chronic illness. Not everyone goes through these stages in the same order and it is common to go back and forth between stages as your physical health improves or worsens.
No matter what stage you are in, just accept that this is where you belong, go with it, and feel all the emotions you need to feel in order to move to the next stage. Don't rush this process. Let it happen naturally.
If you believe that you are stuck in one of the first four stages permanently, you may want to consult with a therapist. We all have problems that we need to cope with besides this illness, and they can sometimes prevent this process from occurring naturally.
Denial. Any change or loss in your life is likely to bring denial, and learning that you have a chronic disease can bring large doses of it. Someone in denial may believe a disease can't hurt them. They may ignore their doctors' advice that could help keep the disease under control. In the case of people with diabetes that may mean refusing to take medications or eat a proper diet. On the other hand, some people quickly accept a disease and turn their attention toward healing. These people stay abreast of medical advances and work with doctors to keep the disease in check.
Anger. What often fuels denial is anger--anger that an individual was the "one in 1,000" to get a disease. Anger may also be directed inward, with an individual blaming himself or herself for having the illness. The best way to minimize anger is to find outlets for it. Writing in a journal, attending a support group or meeting with a counselor are constructive ways to express anger. Anger is normal and can take a long time to work through. Sometimes a small part of anger stays with you throughout the entire illness.
Fear. Often underlying anger is the fear that comes with having a disease that can't be cured. People with chronic illnesses may start to view life through a "telephoto lens" instead of a "wide-angle lens". They stop planning ahead or making life changes because they believe they won't be around much longer. Fear is often enhanced when people know little about a disease, so combating it often begins with education. The more a person learns about a disease, the more they feel in control of it. Fear also occurs when you lose faith in your ability to fight and to believe in the plan of the Universe. This is the most important stage to work through. Fear does no good. It only causes toxins in your body that will make you sicker. Believe in the Master Plan and let the fear go as soon as you can. It will come back, but don't let it take over. Tell it that it is a useless feeling and that you are stronger than it is.
Grief. Feelings of grief and loss are common because chronic diseases bring life restrictions that others don't have to face. These may include no longer being able to participate in activities once enjoyed, like eating a favorite meal or playing catch with a grandchild. Grief can cause feelings of inadequacy and lead to withdrawal and isolation. Focusing on activities that remain unaffected by an illness can help people overcome these feelings. Those who refuse to think of themselves as 'sick' will have a more positive outlook. Joining a support group can also help. Groups allow people to meet others with the same disease who are still active and accomplishing goals.
Acceptance. Though managing a long-term illness can bring emotional upheaval, it also brings the triumphant feelings and strength that come with overcoming obstacles. Success comes in a variety of forms, whether it's controlling a disease with positive thinking, biofeedback, or physical therapy so well that less medication is needed or accepting that the illness has irrevocably changed your life and some of it is very, very good. With each success comes the confidence that you're able to live a full, rewarding life and maybe even a more meaningful life than if you hadn't gotten the illness.
If you are interested in learning more about these stages, look up Elizabeth Kubler-Ross at the library or on any search engine. She is the pioneer in studying the stages of grief.


Source PatientsLikeMe

Saturday, July 12, 2008

Commonly asked questions about Parkinson's

commonly asked questions about parkinson's

a) When you have PD, you only have several months left to live

The medication (levodopa) for treating PD was discovered only in the 1960's. Before the 1960's, one study showed that untreated patients lived for an average of 10 years after diagnosis. As the physical disability in PD worsened with time, eventually patients became bed-ridden and succumbed to lung infection. This contributed to the shorter life span of Parkinson patients compared with those without PD.
Following the introduction of levodopa, the chances of survival of treated patients had significantly increased. With the use of levodopa, another study showed that patients' quality of life had significantly improved and their life span was almost the same as the healthy population.
Nowadays, there are more and more Parkinson's patients who succumb to other common illnesses of old age such as stroke and heart attack, rather than succumbing to PD itself.

Source: PatientsLikeMe

well i dont believe you only got ten years to live . i have been living twith pd for 15 yearsall my doctors tell me that pd will not kill me

Jul 11, 2008 10:24AM

There are many online sources that discuss the "life span" question; here's one that should cheer you up:
Although it causes disability, PD does not appear to significantly shorten the lifespan of its sufferers. PD can be thought of as an illness that people live with, rather than die from.

b) PD is caused by stroke

As PD and stroke usually occur in the elderly people, naturally some people think PD is caused by stroke. Actually both this illnesses are totally unrelated to each other.
Stroke is characterized by sudden weakness of body (usually one side of the body) caused by blockage of blood vessels in the brain and thus, reduced amount of blood going to the brain.
In contrast, PD is due to a progressive loss of certain cells in the brain that lead to slowness of movement. The symptoms of PD begin very slowly over months to years, unlike in stroke. Very often, Parkinson's patients themselves may not remember exactly when the subtle symptoms of PD had started. In fact, many Parkinson's patients do not realized that they have PD until the early symptoms are noticed by family members of friends.

c) PD often leads to mental disability

Some people think that the changes in the brain of Parkinson's patients will lead to mental disability such as dementia, a condition whereby patients have progressive memory loss and change in behaviour. In fact, PD is often mistaken for Alzheimer's Disease (AD), a common cause of dementia. One of the main reasons why PD is often mistaken as AD is because both illnesses are usually seen in the elderly people.
The symptoms of AD are exactly opposite of that in PD. In the early stage of AD, patients have poor memory but good body movement. In contrast, in the early stage of PD, patients have good memory but poor (slow) body movement.
However, in the late stage of PD, some Parkinson's patients do subsequently develop dementia (PD Dementia or PDD). Fortunately, PDD occurs in only about 15% of Parkinson's patients.

d) Parkinson's patients will be bed-ridden very soon after diagnosis

As mentioned earlier, the physical disability of Parkinson's patients does worsen as time goes by. Until today, there is still no cure for this illness. Thus, many Parkinson's patients did become bed-ridden many years ago when there was no effective treatment for this illness.
However, with the advent of more effective treatment (drugs and brain surgery) for PD, the scenario has changed for the better. The available treatment has made it possible for many Parkinson's patients to much better symptom control and physical mobility for the rest of their lives. In fact, it is very unlikely for a Parkinson's patient to be wheelchair-ridden. Nowadays, many Parkinson's patients continue to be reasonably active in their daily life and career for up to 10-15 years after having the illness

e) PD is caused by unhealthy food

The role of unhealthy diet (high cholesterol or fat intake) in stroke is well established. In contrast, the role of dietary factors in the causation of PD remains speculative.
Some studies have shown that PD has been associated with inadequate intake of vitamin E. In a local study on Parkinson's Disease in University Hospital, Kuala Lumpur, it was revealed that there were disproportionately higher number of Malaysian Chinese patients than other races. It was postulated that it could be due to the dietary habit of Malaysian Chinese, who preferred raw or half-cooked vegetables that may contain pesticides (chemicals that may cause changes in the brain leading to PD).
Interestingly, people who regularly drink coffee and black tea have been reported to have lower chance of developing PD.
In conclusion, it has to be emphasized that all these are merely observations and we cannot confirm a direct role of diet in the causation of PD.

f) The children of Parkinson's patients have a strong possibility of inheriting the illness

The role of genetics (inheritance) in the causation of PD has been well established. In other countries, it has been reported that 6-24% of Parkinson's patients have family members who affected by the same illness. However, in the local study at University Hospital, Kuala Lumpur, only 2% of Parkinson patients have family history of similar disorder. Thus, the possibility of children of Parkinson's patients in Malaysia inheriting the same illness is very small and should not be a major cause of concern.

g) PD can be transmitted to family members by an infective process

This is a cause of concern among the immediate family members of Parkinson's patients. Some people think that PD is a form of virus infection (such as flu) that can be transmitted to other family members through close contact. This belief is unfounded as PD is not an infective process.


The misconceptions regarding PD, which stem from ignorance, are very common in Malaysia. Lack of information on PD is a major problem in this country. It is hoped that the Lloyd Tan website will help the Malaysian Parkinson's community have an adequate understanding of the nature of PD, in order to avoid unnecessary anxiety and fear.

Source Selfless Warrior by Dr.NK Chew

Who are at risk for getting PD?

Who are at risk for getting PD?

PD does not spare any race or ethnic group - it is seen in any country in this world. PD can affect any age group but it is most common in elderly people. It is known to affect even children and teenagers (hereditary parkinsonism) but this is very rare.

Age is an important risk factor for PD, with the incidence rising with age. Thus, PD is generally an illness of elderly people.

However, a small percentage of PD patients are relatively young. A study which was carried out at University Malaya Medical Centre, Kuala Lumpur (1998) on 153 PD patients showed that the onset of symptoms was at age 20-45 in 20.9% of patients (one patient had onset of symptoms at age 24

Source Selfless Warrior by Dr. NK Chew

Friday, July 11, 2008

What is means by treatment wearing off?

Posted: Tue Jul 08, 2008 8:09 am Post subject: What is means by treatment wearing off?

Is wearing off refer the worsening of a parkinson’s disease symptom occurring two or three hours after a dose of levodopa medication?As parkinson’s disease is a movement disorder attention has focussed on problems with movement. However there are symptom are not related with movement they are classified as non-motor symptoms. Some non motor symptoms may interpret as part normal course of disease. However they are bothersome than motor symptoms. Non-motor symptoms can include changes in thoughts and feelings, sensations and sense of well-being and changes in autonomic nervous system functions (e.g. sweating). TEOKIMHOE
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Thu Jul 10, 2008 2:35 pm Post subject:

Agree!_________________Hubert H. Fernandez

Thursday, July 10, 2008

Difficulty diagnosis on early symptoms of Parkinson's

Difficulty diagnosis on early symptoms of parkinson's disease are as follows:

1. Lack of public awareness of the Parkinson's disease
People are not well informed about the early symptoms by public media. There is hardly any publicity on PD in the media.

2. the lack of neurological services

As far as I know there are shortage of neurologists who are specialised with movement disorders not to mention the uneven distribution of the specialists . Consequently, most sufffers of Parkinson's are first seen by general practitioners who may not be familiar with the diagnosis of PD.

3.The nature of the onset of early parkinson's

The early symptoms of PD starts very slowly and in a silent manner.
Notice of early Parkinson's are slowness of without knowing exact cause,
smaller in handwriting, mask face without smile, blurred vision, slurred speech, stoop posture

Source: Understanding Parkinson's Disease by Dr.NK Chew

Wednesday, July 9, 2008

Managing complicated Parkinson's

Posted: Wed Jul 09, 2008 5:59 am Post subject: Complications of Parkinson's

Many people do not realize that Parkinson’s Disease (PD) is one of the most complicated medical illnesses to manage. The complications of Parkinson’s are motor and non motor symptoms Motor symptoms consisting: 1. “wearing off” effect At the early stage of illness, patients generally feel “good” (the “on” period) for up to 12 hours after each dose of levodopa. However, the duration of the “on” period gradually shortens with time. When the “on” period becomes shorter than four hours, the patient is considered to have wearing off. ii) “on and off” effect The movement of patients fluctuates rapidly, sometimes within minutes, from “smooth” movement to “feeling stiff”. This occurs regardless of the time of ingestion of levodopa. iii) “delayed on” effect The effect of levodopa comes on only after more than half an hour (usually levodopa begins to work within half an hour after ingestion). PD is an illness that affects the body, mind and mood. Apart from the motor symptoms, there are non motor symptoms - hallucination, constipation, insomnia, fainting , weight loss and depression. About 10% of falls in elderly people result in injuries such as fractures of the hip or other bones. More than 75% of Parkinson’s patients have some form of sleep disorders These can be in the form of difficulty in falling asleep, reversal of sleep cycle (sleeping during daytime and being awake during the night) and excessive daytime sleepiness caused by medication. Difficulty in swallowing, which occurs in up to 40% of Parkinson’s patients, is usually mild to moderate in severity. It is commonly present when the effect of levodopa has worn off (?off period?). Cancer As most Parkinson’s patients are elderly people, and the risk of developing cancer increases with age, cancer should be seriously considered when a Parkinson’s patient loses weight. Any growth in the stomach or intestine leads to loss of appetite and weight. Other symptoms which are suggestive of underlying cancer are constipation, blood in the stool and abdominal pain. Therefore Parkinson’s patients do not die on parkinson’s but other illness.

Source: Selfless Warrior by Dr.NK Chew

Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Thu Jul 10, 2008 3:41 pm Post subject:

thanks!_________________Hubert H. Fernandez

How to help parkinson's sufferers

Monday, July 7, 2008

Incoordination exercises

Posted: Sat Jul 05, 2008 4:07 am Post subject: incoordination exercises

Dear Doctor, Parkinson's patient find difficulties to coordinate his body work together well. There are exercises that the patient has to coordinate together with his body. . The slowness of movement contribute the incoordination well . They have to concentrate to coordinate his body on movememt exercises Kindly advise TEOKIMHOE
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun Jul 06, 2008 7:21 pm Post subject:

I'm not sure what your question is? But yes, regualr exercise is good for PD. We now have animal models that prove this theory. The more regular and vigorous (as long as it is done safely), the better for PD. Yours,_________________Hubert H. Fernandez

DBS Surgery

Posted: Mon Jun 02, 2008 8:03 pm Post subject: DBS SURGERY

I have been giving some consideration to having DBS in the near future. I understand there are some risk, but the benefits seem to outweigh the risk. I was curious that if there are any public figures that have had the surgery such as Muhammad Ali or Michael J Fox?
Back to top

Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sun Jun 08, 2008 11:29 am Post subject:

Michael J. Fox had a thalamotomy which was a small burned lesion for control of tremor. Ali has not been public about treatments. I am unaware of others on this level who have publicly disclosed the surgery. It is great for well suited candidates and also you must be screened well by an experienced team. We have a free book to download on the NPF site about DBS._________________Michael S. Okun, M.D.

Parkinson's is life altering not threatening?

Posted: Sat Jul 05, 2008 4:54 am Post subject: Parkinson's is life altering not threatening?

Dear Doctor, Parkinson's is a neurological disorder that affecting people all over the world. It is a slow progressive disorder that is life altering, but is not life threatening. It affected their activities daily life either emotional or non emotional. The Parkinson's have the same disease but movement disorders differently. It makes doctor diagnosis them difficulty though some early parkinson's do not need medication. It takes patients to life altering to slowdown the parkinson's progression but not life threatening. It is a not "going away disease" as it is your lifepartner. Patients do not die on Parkinson's but on other diseases which is not related with Parkinson's. There are changes on their memory, personality, behaviour and feelings. “At least 40% of patients are depressed because they have a very negative self image. They feel inferior to people who don't have the disease.” With the advent of medications and surgery field doctors now have better control the disease than before. Therefore Parkinson's is not a life threatening but life altering. It gives parkinson's a better quality life.

Parkinson's disease can seriously impair the quality of life in any age group. The physical and emotional impact on the family should not be underestimated as the patient becomes increasingly dependent on their support.
Treatment advances are increasingly effective in alleviating symptoms and even slowing progression of the disease. Taking many of the medications over time, however, can produce significant side effects. Newer drugs may help reduce these occurrences.
Motor Impairment
Other Problems that Impair Daily Life
A number of other problems associated with Parkinson's disease affect daily life:
Vision Problems. Vision is also affected, including impaired color perception and contrast sensitivity. These problems progress and can impair motor functioning.
Sleep Disorders. Excessive daytime sleepiness and other sleep disorders are common in PD, both from the disease itself and from the drugs that treat it. In general, patients have a 25% higher risk for daytime sleepiness, including suddenly falling asleep, than patients with other neurologic diseases.
Restless legs syndrome, an irresistible urge to move the calves, which often occurs at night, affects many patients. However, Parkinson's disease itself does not seem to increase the risk for RLS. Nor does RLS early in life predispose to Parkinson's later on. The common connection between RLS and Parkinson's disease may derive from iron deficiencies that can play a role in both conditions.
Many patients also suffer from nighttime leg cramps. And, some of the medications cause vivid dreams as well as waking hallucinations.
Impaired Sexuality. Although Parkinson's disease and its treatments can cause compulsive sexual behavior, the disease can also affect patients' self-esteem and inhibit sexuality. This is an area not often studied but which is important for many patients' well-being. A 2000 study reported that not only did sexual dysfunction occur, but also affectionate touching and expression of feelings were reduced, even though both partners maintained a desire for intimacy.
Worsened Sense of Smell. The sense of smell is impaired in about 70% of patients.
Increased Risk for Other Medical Conditions
Osteoporosis . Parkinson's disease may increase the risk for low bone density and osteoporosis. Both men and women are at risk. Experts recommend that patients with Parkinson's disease get tested for osteoporosis, especially if they have problems with walking.

2008 University of Maryland Medical Center (UMMC). All rights reserved. UMMC is a member of the University of Maryland Medical System

Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun Jul 06, 2008 7:29 pm Post subject:


Teo._________________Hubert H. Fernandez

Posted: Tue Jul 15, 2008 9:09 pm Post subject: Parkinsons...NOT LIFE THREATENING??

to whom ever said this statement... My father was just put on Hospice 4 days ago...and they said he was dying...of not eating, drinking and mental deteration!! They said he qualified for Hospice. I have been a little reluctant to have him on Hospice, as I felt they (Our Dr's in the area) have just given up on him...and do not know how to treat his anxiety and "sever toe cramping and dystonia's and on/off periods!! PLEASE...where can I take him to have someone who could tell me if he is dying...or not! If much of his anxiety and extrememly painful distortions are from too much sinemet...or not enough...or from the new drugs he is on...and the abrupt taking off of his old. He takes at 7am: One and a half 25/100 sinemet 1/2 Zoloft, 2 Seneca-s, 1/2 Resperdal .25mg 10am: 1 sinement 25/100 1:00; 1 sinemet 25/100 3:00 1/2 Resperdal 4:00 1 sinemet 25/100 7pm 1/2 resperdal, 1 clonopin, 1 sinemet SOmetimes he will take 1/2 clonapin PRN during the days if he gets real anxious. My father (16 years or more with Parkinson's) was not doing as bad 4 weeks ago before he was in the Hospital and they took him off everything...and then put him on this new routine. He was on Seroquil for about 5 days...and that aabout killed him. They they switched to they saw how sensative my father is to meds. However, my gut feeling is this is making hiim CRAZY too. SOmething is...but he is about to end it all himself because he cannot handle it anymore! Please help advise me where to turn next....I am his only advocate! My mother, his wife, is too distraught at this time dealing with him to be of any real help now! Sincerely...MEK
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sat Jul 19, 2008 11:06 am Post subject:

Dear MEK,

I hope you took your dad to another doctor for a second opinion. It would be best if you bring him to a PD specialist who is connected to a hospital (not just in a clinic) so that the doctor can follow him in the in-patient setting if he needs to be admitted. In general, we do not like giving risperdal (risperidone) to PD patients as it can worsen their PD and make them look really bad. Seroquel is our usual choice, but if he did not tolerate this, there are other options. I obviously can tell for sure what is going on without the full story and without examining him, but there are several reasons why a PD patient would deteriorate suddendly: 1. the risperdal can be contributing to this and should be discontinued 2. the adjustment on PD medications could have been too drastic for him 3. he could have an underlying infection making him look worse 4. he could have some metabolic problem--electrolyte imbalance, etc that could be contributing 5. other brain disorders, such as a stroke, can occur also. He basically needs a thorough work up and evaluation by a doctor very familiar with PD and general neurology. Yours,_________________Hubert H. Fernandez

Are there any surgery with minor stroke?

Posted: Fri Jul 04, 2008 6:26 pm Post subject: Are there any surgery with minor stroke?

Dear Doctor, 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 advise TEOKIMHOE
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun Jul 06, 2008 7:08 pm Post subject:

I'm not sure how this is realted to Parkinson disease, but to answer some of your questions, it really depends on the source of the "blot clot" or stroke. We traditionally classify strokes into ischemic or hemorrhagic stokes. Assuming that you are refering to ischemic strokes, we sub classify them into large vessel and small vessel strokes. For small vessel strokes, future events can be prevent by anti-platelet therapy (aspirin, etc), good control of blood pressure and good control of diabetes, healthy living including regular exercise. For large vessel strokes, future events can be prevent by carotid endarterectomy (if there is significant blockage of the carotid artery), or warfarin (if the source is atrial fibrillation or clot in the heart or an inherited hypercoagulable state), or aspirin if the source of the clot cannot be found. This is a very simplified version. There are so many other scenarios that play into the proper treatment and prevention of strokes. Yours,_________________Hubert H. Fernandez

Nutrients, Vit supplement and Parkinson's

Posted: Fri Jul 04, 2008 6:32 pm Post subject: Nutrition, Vitamin supplement and Parkinson's Diseases

Dear Doctor, Nutrition are importance for those with Parkinson Disease. Nutrition won't cure PD or slow its progression. Why there are vitamins and mineral not suitable for Parkinson's Patients and are harmful for them to take? There are Folic Acid, Chromium,Copper, Ferritin,Magnessium,Selerium, and Zinc What are the normal level of these vitamins level (units)in our body? In what level are considered harmful for Parkinson's patients and how to reduce to safe level? How to monitor the vitamins and mineral level, periodly or yearly? Kindly advise TEOKIMHOE
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun Jul 06, 2008 7:12 pm Post subject:

Sorry, I don't routinely prescribe vitamins for PD. Therefore, i do not 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. Yours,_________________Hubert H. Fernandez
Back to top

Saturday, July 5, 2008

Illness but not Parkinson's

As PD is " not going disease' i.e. a slow progression and is different from other disease i.e a self -limited sickness or injury that temporarily impact their lives as inconvenience or comfort

I think your brother's problem is difficulty accepting his illness rather than apathy. One of the most challenging problems that any neurologist faces is patient's difficulty in accepting illness. As a result, these patients do not really accept the doctor's advise, e.g. medication schedule (poor compliance). I treated a man with Young-Onset PD (onset of symptoms before the age of 40) recently. He was just 38 years old, and at such age it is just natural for him to have difficulty accepting his PD. When I treated him with Pramipexole, he insisted that he had felt slower and weaker despite the medication. And he said, "since I am not getting better with Parkinson's medications, it means that I have another illlness and NOT PD" - which was his way of denying that he has PD. At one stage, he even stopped his medications as he did not believe he had PD. He even questioned my diagnosis of PD. It took me a long time to convince him to start taking Pramipexole again. Recently, I heard from his sister that he had continued taking Pramipexole - he had finallly accepted his illness. Difficulty in accepting PD is largely due to ignorance and fear. I think it helps patients to accept their PD if we tell them that they can continue to have a relatively good quality of life as the treatment of PD has drastically improved over the past decade (due to new medications and brain surgery). Dr Chew Nee Kong, Kuala Lumpur

Posted: Sun Jul 06, 2008 7:31 pm Post subject:

While that is possible, it is also possible that the patient is suffering from apathy. 20-30% of PD patients are apathetic

Yours,_________________Hubert H. Fernandez


Posted: Fri Jul 04, 2008 5:31 am Post subject: colonoscopy

Dear Dr, I am scheduled to have a colonoscopy. Are there any products that should be avoided in preparation or during the procedure my being a parkinsons patient? I am taking sinemet, mirapex and amantadine. I assume I can take my usual medications while getting ready for the test. Thank you for your help.
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Fri Jul 04, 2008 10:25 am Post subject:

Don't worry too much. Just follow the typical procedure for colonoscopy. Take your pills regulary until they tell you to stop taking all meds. Then bring your pills with you so that you are able to take it as soon as you are told that you can do so. Yours,_________________Hubert H. Fernandez
Back to top

Friday, July 4, 2008


Posted: Wed Jul 02, 2008 4:51 am Post subject: medication

Dear Doctors, I have been told that I have a dropped bladder, and have to get up many times during the night to urinate. Can I safely take Detrol with my Sinemet, Mirapex and Amantadine? Do you have any other suggestions? Thank you for always being available to us.
Back to top

Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Wed Jul 02, 2008 3:33 pm Post subject:

In general you can safely take detrol. However, call your doctor if you experience confusion, hallucinations, dry mouth, blurred vision as they could be from the anticholinergic effects of detrol. Good luck!_________________Hubert H. Fernandez

Wednesday, July 2, 2008

Vitamin and Parkinson's


Posted: Thu Jun 26, 2008 8:30 am
Post subject: Vitamins

Dear Ms. Holden;

Does taking supplements (multivitamins, B12, folic acid and fish oil) after dinner or after breakfast make a diffrence to the body's activities. Thank you

Back to top Kathrynne Holden, MS, RDJoined: 22 Jan 2007Posts: 94Location: Thu Jun 26, 2008 6:39 pm Post subject:

Dear Friend,

Only a few supplements are of importance in PD. Iron supplements and vitamin B6 in amounts larger than 10-15 mg can interfere with levodopa absorption; these should be taken separately from levodopa by about 2 hours. Otherwise, the supplements you mention are fine; and all of them are best taken after meals, either breakfast or dinner should be okay. They should not interfere with any of the PD medications nor cause any unwanted PD symptoms._________________Best regards, Kathrynne Holden

Good question!

I ran a Google search a minute ago; here's one "reliable source" (IMHO) that provides answers of sorts:
Vitamin B6 in doses higher than 5 mg per day might also impair the effectiveness of levodopa, and should be avoided.42 However, if you take levodopa/carbidopa combinations, this restriction may not necessarily apply. Talk with your physician about an appropriate dose of vitamin B6.


Other substances may also interact with Parkinson's drugs. Iron supplements can interfere with absorption of levodopa and carbidopa, and should not be taken within 2 hours of either medication.39 Amino acid supplements, such as BCAAs (branched-chain amino acids), can temporarily decrease levodopa's effectiveness, as may methionine and phenylalanine, two amino acids studied for treatment of Parkinson's disease.40,41

Hope this helps!

Testimonial from Shalom CG Members

Testimonial from Shalom CG Members

Andree Surianta

I have known Mr. Richard and Mrs. Rosalind Teo for about 2 years now. He is the kind host for our Shalom CARE group, opening the doors of his house to us every Wednesday nights to allow us to have a small mid-week gathering of church members around the area. He leads a very active lifestlye, despite his age and condition, which might be the main reason on how he can maintain his health well. Of course, he would not be able to do this alone. The support of Mrs. Rosalind Teo is clearly one of the defining factor in his fight against his condition. And of the utmost importance, I believe, is the blessing of our Lord God. His guidance and healing hands has certainly supported Mr. Teo in his fight against PD. We pray that his testimony through this book can truly be a light for people that is travelling on the same path.

Nancy Khong

Mr. Teo is definitely a God loving man, full of strong determination and a self discipline person. Due to all these factors, he managed to fight a good battle and overcome the PD.

Bravo to Mr. Teo and give praise and honour to our Lord Jesus Christ.

Peter Chow

Having known Mr. Teo for the past 7 years, his fighting spirit has been known by all in the CareGroup. His passion to help others who are struggling with parkinson disease is truly commendable. Even though I may or will not be a victim of this dreaded illness (by God's grace), it is certainly an encouragement to know that ageing does not diminish a person's fighting spirit. Mr Teo is truly a living example of this fact. God’s grace is trully sufficient for His children.

Andy Eng

I think Mr. Teo has a very strong determination to fight this PD battle with much support from his loved one, family members, church and close friends around him. I thank the Lord for his grace and mercy that Mr. Teo is still holding on to a good fight as I know many would have give up easy with his conditions. So, I hope and pray that his testimony will be an encouragement to others to follow. Keep it up Mr. Teo.

Lisa Pan

I have known Mr. Teo since I joined the Shalom caregroup in the late 90s hosted by Mr & Mrs Teo at their home in Taman Desa and personally have been blessed by their kindness, generousity and warm hospitality as a CareGroup host all these years. I have witnessed how both Mr. & Mrs. Teo have grown in their Christian faith over the years. It is through their unfailing, unceasing love and faithfulness in trusting and serving our Almightly God, holding strong in their faith that has made the fight with Parkinson Disease a success. Mr. Teo has indeed fought Parkinson Disease like a true fighter with zest and positive spirit .

Khong Mei Ling

It has been a journey of discovery for all, not only for Mr. Teo, a.k.a HeroTeo, but Mrs. Teo, her family and all of us in our close knitted Shalom caregroup.

The road to recovery from Parkinson disease was full of faith, spirit, strength and belief where the vibes flow unselfishly among all. The patience, adoration and selflessness of Mrs. Teo reminds us of the vows we took “in sickness and in health” which struck chords in our hearts.

May this book brings hope to all PD patients and further strengthen our faith and trust in our beloved Lord Jesus Christ.

Wan Mei Yiun

Mr Teo has been a kind, thoughtful and helpful person. When he gets to know about a need, he will always help by way of finding information from the internet or referring to professionals or people who can provide a solution. I, as a member of his Care Group, are blessed by him in many ways and am happy that he is able to recover and share his experience from this PD that most people are ignorant and not willing to talk about. May God use his testimonies to help and encourage many PD patients out there.

Robert Wong

I got to know Mr Teo Kim Hoe since early 90s. At that time our Church Pastor John is the leader to the Care Group. As being new I'm always quiet and most of the time just an observer to the group. My first impression about Mr Teo would always be someone that is elderly and a good heart. He and his wife have always been an encouragement to us all at the CG because of their hospitality.

Few years ago Mr Teo was diagnosed with Parkinson Disease. Instead of feeling sorry for himself, he became a very aggresive person. When I say he is aggressive I don't mean his temper, but rather aggressiveness of knowing more about the Disease that he is down with. He would not give up a single chance of knowing more about the courses of having it and also the way to deal with it. He did a lot of research himself through the Internet and got a lot of advises from professional doctors that are in this field. His attitude towards fighting against this Disease has indeed helped him to come out as a 'Hero' today. This fine day he is a new man in term of physical and also mental. He has fight a good war and he has indeed won a good battle. May God continue to bless him and family for all that he is.

Chee Kai Yap and Taeko Funaoka

The Great Love of The Wonderful Earthly Host

Praise The Lord! We have been blessed with such a wonderful and marvelous host like Mr. & Mrs. Teo. We have known them for almost three years since the Lord placed us here in this Shalom CG. Mr.Teo is known for his undying spirit and persistency to fight against his Parkinson Disease (PD) which he had been diagnosed several years ago. His strong dedication in combating the PD has been witnessed by his passion in doing lots of research on PD, educating others on PD, cultivating a balance diet and a healthy exercise in the fitness centre. We also admire Mrs. Teo’s love and untiring support to Mr. Teo in combating his PD, her full submission and total obedience as a wife and also their wonderful children’s support to him. Mr. & Mrs. Teo are a lovely exemplary couple who walk in God’s love. We would like to use Romans 8:28 for this great testimony that God has work on him…” More (Mr. Teo is more) Than Conquerors…….. And we know that in all things God works for the good of those who love him who have been called according to His purpose”. We pray that God will continue to bless him and his family and his great testimony on his complete healing from PD to be shared to others so as all glories and praises will be due to our Heavenly Father. Amen!

Kenneth & Kim
Through the direction and guidance of our heavenly Father Jesus Christ, we came to know Mr Teo by joining the Shalom care group. His impression to us is a positive and very strong determination person especially fighting against the Parkinson Disease. Nevertheless, the understanding and caring wife – Mrs Teo has played an important role in winning the battle over the war of this disease. Both the hosts had shown the mercy of GOD in faith and taught us a valuable lesson and method for being kind, generous and faithful in life. The group’s spirit and bonding among all the Shalom members had brought us to another level of how we behave and treat people in our daily life. In conclusion, Mr Teo also name as Hero Teo – you are always my HERO forever. Your fighting spirit against the PD had deeply injected into our blood stream and now is being functioning actively as an immunity system for all “crying in pain” circumstances

Tuesday, July 1, 2008

yoga and parkinson's Disease by JongHau Foo

Yoga and Parkinson Disease

Yoga, what is it all about? Everyone seems to talk about it. Many people are doing yoga or at least try it once. Yoga has suddenly become a worldwide obsession. Many superstars have personal instructors while millions of people in cities and towns around the world head to their fitness centers, dance studios or yoga studios to stretch and sweat it out to become more flexible, stronger and leaner. Newspapers and magazines claim it is a solution to our stressful lives, an antidote for health malady and much more. However, the yoga that we practice today bears little resemblance to what it is 2000 years ago as it has evolved to meet the current cultures.

So what is yoga actually? Can Parkinson disease’s (PD) patient do yoga and can it improve their conditions, help them to cope with everyday lives and live better? To answer these questions let us just understand yoga a little bit better. Now, from a distance observation, yoga is a physical exercises comprising of postures and stretches, some simple while others are mind boggling. Nevertheless, it is more than that as there is a strong connection between the body, mind and spirit of the yoga practitioners. The combination of the body, mind and spirit exercises are to promote stillness and subdue distractions. By calming your mind, you will be able to bring positive aspects of life and see the joy of living, give thanks to what you have, what you are and the fact that you are still alive. In short, be aware of your well being.

Awareness is a key theme for yoga. It helps you to understand yourself better, especially when it comes to balancing postures. For instance, a normal person would usually be able to balance when he/she raises one leg up because the brain manages the action unconsciously. However, for PD patients, it’s an extremely difficult task to achieve as the connectivity between the brain the other parts of the body are some what distorted. Therefore, yoga teaches you to use your mental awareness and tap into your consciousness to gain some stability. It is a new learning process as it tries to get the brain and the body to connect. It is something like a baby trying to learn to stand for the first time.

We are living in an instant world where everyone wants things “NOW!” instant food, instant service, instant money and even instant health. We pop a pill down our throat and expect to recover instantly or at least by tomorrow. Unfortunately things don’t work this way. Yoga can indeed help to improve many illnesses, including PD, but it is also through hard work, consistency and determination. Some people may see the result after a few lessons, some in a few months but others in a few years. Eventually it all boils down to your own perseverance and patient is indeed a virtue here. Never give up and you will see light at the end of the tunnel.

Parkinson's shall have a cure?

Posted: Sun Jun 29, 2008 5:23 pm Post subject: Parkinson's shall have a cure?

The researchers are working very hard to find a cure. The people in the US are petitioning for more allocation for research. PD shall have a cure. The day may not too far away? It is not dream but soon will be a reality. But when? TEOKIMHOE

New generic Requip

Posted: Mon Jun 30, 2008 2:13 am Post subject: New generic Requip

I've read that a new generic Requip is available. Is there a once a day tablet option? Does the generic have the same compulsive tendencies associated wih it as the Requip?
Back to top

Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Mon Jun 30, 2008 2:29 pm Post subject:

In May 2008 generic requip became available and it definitely has the same side effect profile. It is unclear how similar it will behave pharmacologically to regular requip and only time and manufacturing will tell- but remember generic and regular sinemet absorb differently. Requip CR is not generic and is said to last about 14 hours or so and is usually taken once a day._________________Michael S. Okun, M.D.