comment
Just want to say what a great blog you got here!
I've been around for quite a lot of time, but finally decided to show my appreciation of your work!
Thumbs up, and keep it going!
Cheers
Christian, iwspo.net
Wednesday, September 29, 2010
Shy-Dragers
Dear Mr Teo,
I'm sure you will have a very good discussion with Dr Chew on the "Shy-Dragers" syndrome.
You are a fantastic PD patient - very resourceful to dig all the relevant medical information. Your knowledge can be as good as the medical specialist. Well done!
Take care & warm regards,
Hooi Hoon
I'm sure you will have a very good discussion with Dr Chew on the "Shy-Dragers" syndrome.
You are a fantastic PD patient - very resourceful to dig all the relevant medical information. Your knowledge can be as good as the medical specialist. Well done!
Take care & warm regards,
Hooi Hoon
reader PLikesME
Hi Teokimhoe
I would like to congratulate you on your approach to Parkinsons. I know of no-one who has had it as long as you. Your comments are very helpful and your disciplines something to be proud of.
One thing does amaze me. You take very little in the way of Parkinson’s medication (ie Sinemet and Requip). In fact people who are only at the beginning take more than you.
I am 72 years of age and have had PD for 15 years. I wonder if you could let me know how you handle the above meds. I do see from your profile you take medication for other problems of the body, probably related to your disease.
God Bless and keep on helping - it is so necessary as professionals seem to have no compassion.
Lippard (Freda Fewtrell from New Zeland
I would like to congratulate you on your approach to Parkinsons. I know of no-one who has had it as long as you. Your comments are very helpful and your disciplines something to be proud of.
One thing does amaze me. You take very little in the way of Parkinson’s medication (ie Sinemet and Requip). In fact people who are only at the beginning take more than you.
I am 72 years of age and have had PD for 15 years. I wonder if you could let me know how you handle the above meds. I do see from your profile you take medication for other problems of the body, probably related to your disease.
God Bless and keep on helping - it is so necessary as professionals seem to have no compassion.
Lippard (Freda Fewtrell from New Zeland
reader PLikesME
Hi Teokimhoe
I would like to congratulate you on your approach to Parkinsons. I know of no-one who has had it as long as you. Your comments are very helpful and your disciplines something to be proud of.
One thing does amaze me. You take very little in the way of Parkinson's medication (ie Sinemet and Requip). In fact people who are only at the beginning take more than you.
I am 72 years of age and have had PD for 15 years. I wonder if you could let me know how you handle the above meds. I do see from your profile you take medication for other problems of the body, probably related to your disease.
God Bless and keep on helping - it is so necessary as professionals seem to have no compassion.
Lippard (Freda Fewtrell from New Zealand)
Cancel
I would like to congratulate you on your approach to Parkinsons. I know of no-one who has had it as long as you. Your comments are very helpful and your disciplines something to be proud of.
One thing does amaze me. You take very little in the way of Parkinson's medication (ie Sinemet and Requip). In fact people who are only at the beginning take more than you.
I am 72 years of age and have had PD for 15 years. I wonder if you could let me know how you handle the above meds. I do see from your profile you take medication for other problems of the body, probably related to your disease.
God Bless and keep on helping - it is so necessary as professionals seem to have no compassion.
Lippard (Freda Fewtrell from New Zealand)
Cancel
differences bt bipolar and PD
Dear Dr.Okun,
I am gone to research into bipolar and Parkinson's disorders
My experience why ARE the bipolar's medication after side effects SOME OF
THE SYMPTOMS ARE pARKINSON'S DISORDERS'?
Why Bipolar disorders is curable but not the Parkinson's disorders?
THEY ARE THE SAME FAMILY WHY THEY ARE DIFFERENCES?
kindly elaborate
Regards
Bipolar and PD are two completely different diseases.
Interestingly some patients with bipolar can become Parkinsonian from chronic use of dopamine blocking drugs. Sometimes when in the manic phase the PD symptoms improve.
Where they get confused is that they share a lot of the same brain circuitry.
Michael S. Okun, M.D.
I am gone to research into bipolar and Parkinson's disorders
My experience why ARE the bipolar's medication after side effects SOME OF
THE SYMPTOMS ARE pARKINSON'S DISORDERS'?
Why Bipolar disorders is curable but not the Parkinson's disorders?
THEY ARE THE SAME FAMILY WHY THEY ARE DIFFERENCES?
kindly elaborate
Regards
Bipolar and PD are two completely different diseases.
Interestingly some patients with bipolar can become Parkinsonian from chronic use of dopamine blocking drugs. Sometimes when in the manic phase the PD symptoms improve.
Where they get confused is that they share a lot of the same brain circuitry.
Michael S. Okun, M.D.
Tuesday, September 28, 2010
bipolar disorder and parkinson's
IT IS STRANGE THE AFTER SIDEEFFECTS OF PD IS THE SYMPTOMS OF BIPOLAR DISORDEER MEDICATION
it's very interesting that you say that. When I was experiencing all of the crazy side effects from Requip I saw a neuro-psychiatrist. He told me I was bipolar and wanted to give me more medication and I quote him as saying, "It may make your Parkinson's much worse...". I was so lucky to meet my current neurologist who told me flat out that I needed to get off the drug. My life is normal again. Well, normal? Hmm, maybe that's the wrong word but I certainly have no side effects and that to me is just amazing.
Mark this post as helpful
it's very interesting that you say that. When I was experiencing all of the crazy side effects from Requip I saw a neuro-psychiatrist. He told me I was bipolar and wanted to give me more medication and I quote him as saying, "It may make your Parkinson's much worse...". I was so lucky to meet my current neurologist who told me flat out that I needed to get off the drug. My life is normal again. Well, normal? Hmm, maybe that's the wrong word but I certainly have no side effects and that to me is just amazing.
Mark this post as helpful
flunction on blood pressure level (1)
Dear Doctor
I have been diagnosed as suffering from fluctuations in my blood pressure (BP). I have done the Upright Tilt Table Test and the results confirmed fluctuations in my BP on various positions. My physician prescribed me Minirin to stablelize my BP. Due to my stress from personal issues and also the effect of Minirin, I discovered one day that my BP had increased to 210/50. I started vomitting and I was thereafter hospitalized for observation. It was there they discovered that the sodium level in my blood is low, and that further led to me falling. I was eventually discharged.
Upon discharged, my physician decreased my intake of Parkinson's daily medication from Requip (6 mg), Sinemet 25/100 (6 tablets) and Jumex (10mg) to only Sinemet 25/100 (6 Tablets). Requip and Jumex has been stopped. He had also substituted Minirin to Florinef to stablelize my BP level.
Lately I have experienced mild seizures in the sense that I temporarily cannot move my legs and limbs for approximately 5 - 10 minutes duration. This has happened nearly once everyday. This could very well be due to an immediate decrease in my BP when I stand up.
However, my worries are as follows :-
(a) Whether seizures are common amongst patients suffering from PD. If yes, is it a sign of advancement of PD progression?
( What is the exact cause for such seizures to occur?
© Has my PD medication been decreased too significantly? For your information, I have never experienced seizures before the change in medication dosages.
For your further information, I am also on medication for Bipolar Syndrome, namely, Zydis 5 mg daily, Zoloft 50 mg. Does these medication also result in side effects?
I would be grateful for your input.
Best regards
Teo Kim Hoo
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#2 Dr. Okun
Advanced Member
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19-January 07 LocationUniversity of Florida Posted Yesterday, 03:03 PM
Teo, I will post for you. Seizures is not common in PD and seizures have a different etiology than PD.
Michael S. Okun, M.D.
I have been diagnosed as suffering from fluctuations in my blood pressure (BP). I have done the Upright Tilt Table Test and the results confirmed fluctuations in my BP on various positions. My physician prescribed me Minirin to stablelize my BP. Due to my stress from personal issues and also the effect of Minirin, I discovered one day that my BP had increased to 210/50. I started vomitting and I was thereafter hospitalized for observation. It was there they discovered that the sodium level in my blood is low, and that further led to me falling. I was eventually discharged.
Upon discharged, my physician decreased my intake of Parkinson's daily medication from Requip (6 mg), Sinemet 25/100 (6 tablets) and Jumex (10mg) to only Sinemet 25/100 (6 Tablets). Requip and Jumex has been stopped. He had also substituted Minirin to Florinef to stablelize my BP level.
Lately I have experienced mild seizures in the sense that I temporarily cannot move my legs and limbs for approximately 5 - 10 minutes duration. This has happened nearly once everyday. This could very well be due to an immediate decrease in my BP when I stand up.
However, my worries are as follows :-
(a) Whether seizures are common amongst patients suffering from PD. If yes, is it a sign of advancement of PD progression?
( What is the exact cause for such seizures to occur?
© Has my PD medication been decreased too significantly? For your information, I have never experienced seizures before the change in medication dosages.
For your further information, I am also on medication for Bipolar Syndrome, namely, Zydis 5 mg daily, Zoloft 50 mg. Does these medication also result in side effects?
I would be grateful for your input.
Best regards
Teo Kim Hoo
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
0 Report
Back to top of the page up there ^
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--------------------------------------------------------------------------------
#2 Dr. Okun
Advanced Member
Group:
Ask the Doctor Moderators Posts:
717 Joined:
19-January 07 LocationUniversity of Florida Posted Yesterday, 03:03 PM
Teo, I will post for you. Seizures is not common in PD and seizures have a different etiology than PD.
Michael S. Okun, M.D.
flunction on blood pressure level
Dear Doctor Okun,
I have been diagnosed as suffering from fluctuations in my blood pressure (BP). I have taken the Upright Tilt Test, and the results confirm that my BP fluctuates depending on the various positions I am in. As a result, my physician has prescribed Minirin to me to stablelize my BP.
Recently, owing to my stress due to personal issues and also the effect of Minirin, my BP shot up to 210/50. I vomitted and felt dizzy, and was subsequently hospitalized for observations. During my stay at the hospital, I also fell. It was discovered that the sodium level in my blood was very low. That apparently led to my dizziness and possibly blackout, which in turn led to my fall. I was given sodium solution through intravenous injection to increase my blood sodium level. I was subsequently discharged.
Subsequent to my discharge, my physician changed the dosage of my medication for both Parkinson's Disease (PD) and also the medication to maintain my BP. Minirin was substituted with Florinef. As far as PD is concerned, prior to my hospitalization, my daily dosage was Requip (6 mg), Sinemet 25/100 (6 tablets) and Jumax (50 mg). Both Requip and Jumax was stopped. I was asked by my physician to only take Sinemet 25/100 (6 tablets) daily to contain the progression of PD.
I subsequently experienced mild seizures, whereby I cannot move my hands and legs for perhaps a time span of 5 to 10 minutes. I would be frozen, so as to speak. This seizure episodes would take place nearly once everyday. It must be stressed that I didn't suffer from any seizure prior to the change in the dosage of my medication.
My worries are as follows :-
(a) Is it normal for patients suffering from PD to have episodes of seizures? Are these seizures a sign that my PD has advanced in progression?
( Is it correct for my physician to reduce the dosages of my PD medication so significantly? And does such a reduction result in my seizure, or perhaps an advance in the progression of PD?
© What are the causes of such seizures?
For your information, I am also under treatment for Bipolar Syndrome, and I am on medication of Zoloft and Zydis. Does this medication also contribute to seizures, as a side effect?
I shall be very grateful if you could revert to me on the above.
I am also considering coming over to the US for continued treatment of PD and possibly Bipolar Syndrome. I shall be very grateful if you could refer some of the good physicians for consultation, preferably in Los Angeles or San Francisco.
Best regards
Teo Kim Hoo
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
0 Report
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--------------------------------------------------------------------------------
#2 Dr. Okun
Advanced Member
Group:
Ask the Doctor Moderators Posts:
717 Joined:
19-January 07 LocationUniversity of Florida Posted Today, 05:44 PM
I have answered most of these already in your previous posts, so I would ask that you look back through those posts.
There is a NPF center of excellence at UCSF in San Fran and one at USC in LA.
Good luck.
Michael S. Okun, M.D.
I have been diagnosed as suffering from fluctuations in my blood pressure (BP). I have taken the Upright Tilt Test, and the results confirm that my BP fluctuates depending on the various positions I am in. As a result, my physician has prescribed Minirin to me to stablelize my BP.
Recently, owing to my stress due to personal issues and also the effect of Minirin, my BP shot up to 210/50. I vomitted and felt dizzy, and was subsequently hospitalized for observations. During my stay at the hospital, I also fell. It was discovered that the sodium level in my blood was very low. That apparently led to my dizziness and possibly blackout, which in turn led to my fall. I was given sodium solution through intravenous injection to increase my blood sodium level. I was subsequently discharged.
Subsequent to my discharge, my physician changed the dosage of my medication for both Parkinson's Disease (PD) and also the medication to maintain my BP. Minirin was substituted with Florinef. As far as PD is concerned, prior to my hospitalization, my daily dosage was Requip (6 mg), Sinemet 25/100 (6 tablets) and Jumax (50 mg). Both Requip and Jumax was stopped. I was asked by my physician to only take Sinemet 25/100 (6 tablets) daily to contain the progression of PD.
I subsequently experienced mild seizures, whereby I cannot move my hands and legs for perhaps a time span of 5 to 10 minutes. I would be frozen, so as to speak. This seizure episodes would take place nearly once everyday. It must be stressed that I didn't suffer from any seizure prior to the change in the dosage of my medication.
My worries are as follows :-
(a) Is it normal for patients suffering from PD to have episodes of seizures? Are these seizures a sign that my PD has advanced in progression?
( Is it correct for my physician to reduce the dosages of my PD medication so significantly? And does such a reduction result in my seizure, or perhaps an advance in the progression of PD?
© What are the causes of such seizures?
For your information, I am also under treatment for Bipolar Syndrome, and I am on medication of Zoloft and Zydis. Does this medication also contribute to seizures, as a side effect?
I shall be very grateful if you could revert to me on the above.
I am also considering coming over to the US for continued treatment of PD and possibly Bipolar Syndrome. I shall be very grateful if you could refer some of the good physicians for consultation, preferably in Los Angeles or San Francisco.
Best regards
Teo Kim Hoo
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
0 Report
Back to top of the page up there ^
MultiQuote
Reply Edit
--------------------------------------------------------------------------------
#2 Dr. Okun
Advanced Member
Group:
Ask the Doctor Moderators Posts:
717 Joined:
19-January 07 LocationUniversity of Florida Posted Today, 05:44 PM
I have answered most of these already in your previous posts, so I would ask that you look back through those posts.
There is a NPF center of excellence at UCSF in San Fran and one at USC in LA.
Good luck.
Michael S. Okun, M.D.
Friday, September 24, 2010
uplight tilt table test
Due to my upright tilt table test conclusions
Asymptomatic through passsive tilting & given S/L GT
Postural hypotension 168/81 dropped to 91/51mmHg
Negative tilt table test
My doctor advises me to stop taking my medication Requip, Jumex due to sideeffect on me.
I have been with these medication more than 5 years.
As the result I have duminess leg and could not stable on standing up.
Besides I have low blood pressure. I have negative upright tilt table test report: postural hypotension 168/81 mmHg dropped to 91/51 mmHg
My doctor prescribed me Slow -K 600mg tablets two dosage daily.
I received first times compond sudium lactate Intravenous B.P Three bottles daily to increase my blood pressure five days stays in the hospital
i am advised to consult Psychiatrist as I have bipolar disorder due to depression and anxiety up and down and off and on days.
The bipolar disorder affecting my up and down blood pressure, not the PD medications.
Regards
TEOKIMHOE
Asymptomatic through passsive tilting & given S/L GT
Postural hypotension 168/81 dropped to 91/51mmHg
Negative tilt table test
My doctor advises me to stop taking my medication Requip, Jumex due to sideeffect on me.
I have been with these medication more than 5 years.
As the result I have duminess leg and could not stable on standing up.
Besides I have low blood pressure. I have negative upright tilt table test report: postural hypotension 168/81 mmHg dropped to 91/51 mmHg
My doctor prescribed me Slow -K 600mg tablets two dosage daily.
I received first times compond sudium lactate Intravenous B.P Three bottles daily to increase my blood pressure five days stays in the hospital
i am advised to consult Psychiatrist as I have bipolar disorder due to depression and anxiety up and down and off and on days.
The bipolar disorder affecting my up and down blood pressure, not the PD medications.
Regards
TEOKIMHOE
Bipolar
I was admitted because my doctor wrongly prescribed Minirin as I had a difference on my upright tilt table postural hypotension from 169/81 mmHg dropped to 91/81 mm Hg
As I had T.I.A two years back I have to do Brain MRI and x ray as my sodium dropped by 120/138 in antipation there might be a second stroke. Besides I had vomitted and dizzinness.
I have to stay at hospoital five days to push up my sodium to normal level.
My doctor advises me to consult psychiatrist that I had Bipolar disorders.
My negative blood pressure are caused by bipolar disorder where I have anxiety and depression up and down on and off days resulted mu blood level.
Therefore there are reason for stopping taking the requip and Jumax'
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
As I had T.I.A two years back I have to do Brain MRI and x ray as my sodium dropped by 120/138 in antipation there might be a second stroke. Besides I had vomitted and dizzinness.
I have to stay at hospoital five days to push up my sodium to normal level.
My doctor advises me to consult psychiatrist that I had Bipolar disorders.
My negative blood pressure are caused by bipolar disorder where I have anxiety and depression up and down on and off days resulted mu blood level.
Therefore there are reason for stopping taking the requip and Jumax'
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
Wednesday, September 22, 2010
Does dehydration affect PD?
Does dehydration affect my Parkinson’s disease symptoms?
Dehydration is one of many stressors that may affect the symptoms of Parkinson’s disease. Although there is very little scientific data available on the subject, most expert practitioners advise patients to drink 6-8 glasses of plain water a day, and to stay out of the sun. One of the symptoms that dehydration has been closely associated with is dizziness (and dizziness upon standing). This is a symptom that is particularly important to avoid as it may lead to falls and to fractures. A good rule of thumb, especially during summer months, is to always have a bottle of water with you. Many patients will purchase “runner’s belts” that have a specific place for a bottle to be conveniently carried.
Michael S. Okun, M.D.
Dehydration is one of many stressors that may affect the symptoms of Parkinson’s disease. Although there is very little scientific data available on the subject, most expert practitioners advise patients to drink 6-8 glasses of plain water a day, and to stay out of the sun. One of the symptoms that dehydration has been closely associated with is dizziness (and dizziness upon standing). This is a symptom that is particularly important to avoid as it may lead to falls and to fractures. A good rule of thumb, especially during summer months, is to always have a bottle of water with you. Many patients will purchase “runner’s belts” that have a specific place for a bottle to be conveniently carried.
Michael S. Okun, M.D.
Thursday, September 16, 2010
reader PLikesME
would like to congratulate you on your approach to Parkinsons. I know of no-one who has had it as long as you. Your comments are very helpful and your disciplines something to be proud of.
One thing does amaze me. You take very little in the way of Parkinson's medication (ie Sinemet and Requip). In fact people who are only at the beginning take more than you.
I am 72 years of age and have had PD for 15 years. I wonder if you could let me know how you handle the above meds. I do see from your profile you take medication for other problems of the body, probably related to your disease.
God Bless and keep on helping - it is so necessary as professionals seem to have no compassion.
Lippard (Freda Fewtrell from New Zealand)
One thing does amaze me. You take very little in the way of Parkinson's medication (ie Sinemet and Requip). In fact people who are only at the beginning take more than you.
I am 72 years of age and have had PD for 15 years. I wonder if you could let me know how you handle the above meds. I do see from your profile you take medication for other problems of the body, probably related to your disease.
God Bless and keep on helping - it is so necessary as professionals seem to have no compassion.
Lippard (Freda Fewtrell from New Zealand)
Tuesday, September 7, 2010
Minirin side effecst
Group:
Members Posts:
272 Joined:
03-March 07 LocationMalaysia Posted Today, 03:01 AM
As urination incontinence is one of the symptom of Parkinson's caused by parkinson medication.
Therefore People with Parkinson's have low blood pressure caused urination incontinence.
My doctor prescribes me one dosage of Minirin 4mg daily to increase my blood pressure at normal level.
Minirin relief patients with dizziness and dehydration also.
Kindly elaborate
TEOKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
Group:
Ask the Doctor Moderators Posts:
650 Joined:
19-January 07 LocationUniversity of Florida Posted Today, 09:43 AM
This is what is availavle on drugs.com. I have never used desmopressin (Minirin) and therefore cannot comment with particular expertise, except to say that it is important if you use this to be monitored by your doctor.
Minirin
Generic Name: desmopressin (Nasal route, Oral route, Injection route)
des-moe-PRES-in
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Injection routeSolution
Desmopressin acetate is not indicated for the treatment of hemophilia A with factor VIII coagulant activity levels equal to or less than 5%, or for the treatment of hemophilia B, or in patients who have factor VIII antibodies .
Desmopressin acetate is not indicated for the treatment of hemophilia A with factor VIII coagulant activity levels equal to or less than 5%, or for the treatment of hemophilia B, or in patients who have factor VIII antibodies .
Commonly used brand name(s):
In the U.S.
DDAVP
DDAVP Rhinal Tube
Minirin
Stimate
Available Dosage Forms:
Solution
Spray
Tablet
Therapeutic Class: Endocrine-Metabolic Agent
Pharmacologic Class: Vasopressin (class)
Uses For Minirin
Desmopressin is a hormone taken through the nose, by mouth, or given by injection to prevent or control the frequent urination, increased thirst, and loss of water associated with diabetes insipidus (water diabetes). It is used also to control bed-wetting and frequent urination and increased thirst associated with certain types of brain injuries or brain surgery. Desmopressin works by acting on the kidneys to reduce the flow of urine.
Desmopressin is also given by injection to treat some patients with certain bleeding problems such as hemophilia or von Willebrand's disease.
Desmopressin is available only with your doctor's prescription.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, desmopressin is used in certain patients to determine the cause of Cushing's syndrome.
Before Using Minirin
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of nasal desmopressin in children and infants. However, infants may be more sensitive to the effects of nasal desmopressin, which may require caution in patients receiving this medicine .
Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of oral desmopressin in infants and children with diabetes insipidus. However, safety and efficacy have not been established in children below 6 years of age with bed-wetting problems .
Appropriate studies have not been performed on the relationship of age to the effects of desmopressin injection in infants below 3 months of age for the treatment of hemophilia A or Von Willebrand's disease, and in children below 12 years of age with diabetes insipidus. Safety and efficacy have not been established in these age groups .
Geriatric
Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of desmopressin in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment of dosage in patients receiving desmopressin .
Pregnancy
Pregnancy Category Explanation
All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.
Breast Feeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
Blood clots—Use with caution. Desmopressin injection may worsen this condition .
Cystic fibrosis or
Dehydration or
Fluid or electrolyte imbalance or
Heart failure—Loss of sodium from the blood and serious side effects may be more likely to occur in patients with these conditions .
Headache, severe, or migraine or
Heart or blood vessel disease or
High blood pressure—Large doses of desmopressin can cause an increase or decrease in blood pressure.
Hyponatremia, or history of or
Kidney problems—Desmopressin should NOT be used in patients with these conditions .
Stuffy nose caused by cold or allergy—May prevent nasal desmopressin from being absorbed through the lining of the nose into the blood stream.
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Proper Use of desmopressin
This section provides information on the proper use of a number of products that contain desmopressin. It may not be specific to Minirin. Please read with care.
Use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of side effects.
Your doctor may want you to decrease the amount of fluids that you drink while you are using this medicine .
For patients using the nasal solution form of this medicine:
This medicine comes with patient instructions. Read and follow these instructions carefully.
Before using the medicine, gently blow your nose to clear the nostrils.
If you are using the nasal spray for the first time, you will need to prime the spray. To do this, press the pump down four times or until some of the medicine sprays out. If you have not used the medicine for one week or longer, re-prime the pump by pressing once.
Do not use the nasal spray more times than the number indicated on the label. If you do, you may not receive the correct amount of medicine.
After using the nasal spray, wipe the tip of the bottle with a clean tissue and put the cap back on.
The Rhinal Tube is a soft plastic tube with numbers (doses) marked on the side. Draw the drops into the tube until the liquid reaches the number of your dose. Put one end of the tube into your nose and the other end into your mouth. Blow gently until all the medicine has sprayed into your nose. Do not let any medicine run down through the tube into your mouth.
After using the rhinal tube, wash it with water and shake thoroughly until no more water is left. Put the seal back on the dropper tip and close the bottle with the plastic cap .
For patients using the tablet form of this medicine:
Do not drink water or any other liquids from 1 hour before to 8 hours after taking the tablets .
For patients using the injection form of this medicine:
A nurse or other trained health professional will give you this medicine. Sometimes you, a family member, or a friend can also be taught to give your medicine .
Dosing
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For nasal dosage form (nasal solution):
For preventing or controlling diabetes insipidus (water diabetes):
Adults and teenagers—0.1 to 0.4 milliliters (ml) or 10 to 40 micrograms (mcg) given as a single dose or divided into two or three doses a day .
Children 3 months to 12 years of age— 0.05 to 0.3 milliliters (ml) or 5 to 30 micrograms (mcg) given as a single dose or divided into two doses a day .
Children up to 3 months of age—Use and dose must be determined by your doctor .
For oral dosage form (tablets):
For preventing or controlling diabetes insipidus (water diabetes):
Adults, teenagers, and children—At first, 0.05 milligram (mg) two times a day. Then, your doctor may change the dose to 0.1 to 0.8 mg. The dose may be divided into several doses a day.
For controlling bed-wetting:
Adults, teenagers, and children 6 years of age or older—At first, 0.2 mg once a day at bedtime. Then, your doctor may increase the dose to as much as 0.6 mg a day.
Children up to 6 years of age—Use and dose must be determined by your doctor .
For parenteral dosage form (injection):
For preventing or controlling frequent urination:
Adults and teenagers—2 to 4 mcg injected into a vein or under the skin. This dose is usually divided into two doses a day, one given in the morning, and the other given in the evening.
Children up to 12 years of age—Use and dose must be determined by your doctor .
For treating some bleeding problems such as hemophilia or von Willebrand's disease (Type I):
Adults, teenagers, and children 11 months of age or older weighing more than 10 kg (22 pounds)—The dose is based on body weight and must be determined by your doctor. It is usually 0.3 micrograms (mcg) per kilogram (kg) (0.14 mcg per pound) of body weight mixed in 50 milliliters (mL) of 0.9% sodium chloride. This solution is injected into a vein slowly over fifteen to thirty minutes. Your doctor may repeat this treatment if needed.
Children 3 months of age or older weighing 10 kg (22 pounds) or less—The dose is based on body weight and must be determined by your doctor. It is usually 0.3 micrograms (mcg) per kilogram (kg) (0.14 mcg per pound) of body weight mixed in 10 mL of 0.9% sodium chloride. This solution is injected into a vein slowly over fifteen to thirty minutes. Your doctor may repeat this treatment if needed.
Children up to 3 months of age—Use and dose must be determined by your doctor .
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Has a bulleted list describing how to handle missed doses for various possible dosing schedules.
Storage
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store as directed on the label or by your health care professional.
Precautions While Using Minirin
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Urine tests may be needed to check for unwanted effects .
This medicine lowers the amount of sodium in your blood. Check with your doctor right away if you have confusion, nausea, vomiting, muscle cramps or spasms, or unusual tiredness or weakness .
Check with your doctor right away and stop using this medicine if you have fever, severe vomiting or diarrhea, or other conditions that may make you thirsty (such as during hot weather or having a strenuous exercise). This medicine may cause fluid or electrolyte imbalance which can lead to seizures and other serious conditions .
Do not take other medicines unless they have been discussed with your doctor, especially medicines that can make your mouth dry. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements .
Desmopressin may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash; itching; swelling of the face, tongue, and throat; trouble breathing; or chest pain after you use this medicine .
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Minirin Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Chills
confusion
convulsions (seizures)
decreased urination
drowsiness
fast heartbeat
fever
headache (continuing)
shortness of breath, tightness in chest, trouble in breathing, or wheezing
skin rash, hives, or itching
weight gain (rapid)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common or rare
Abdominal or stomach cramps
flushing or redness of skin
nausea
pain in the vulva (genital area outside of the vagina)
With intranasal (through the nose) use
Cough
nosebleed
runny or stuffy nose
sneezing
sore throat
With intravenous use
Pain, redness, or swelling at place of injection
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.
The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.
Read more: http://www.drugs.com...l#ixzz0ylDmkuUf
Michael S. Okun, M.D.
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03-March 07 LocationMalaysia Posted Today, 03:01 AM
As urination incontinence is one of the symptom of Parkinson's caused by parkinson medication.
Therefore People with Parkinson's have low blood pressure caused urination incontinence.
My doctor prescribes me one dosage of Minirin 4mg daily to increase my blood pressure at normal level.
Minirin relief patients with dizziness and dehydration also.
Kindly elaborate
TEOKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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19-January 07 LocationUniversity of Florida Posted Today, 09:43 AM
This is what is availavle on drugs.com. I have never used desmopressin (Minirin) and therefore cannot comment with particular expertise, except to say that it is important if you use this to be monitored by your doctor.
Minirin
Generic Name: desmopressin (Nasal route, Oral route, Injection route)
des-moe-PRES-in
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Injection routeSolution
Desmopressin acetate is not indicated for the treatment of hemophilia A with factor VIII coagulant activity levels equal to or less than 5%, or for the treatment of hemophilia B, or in patients who have factor VIII antibodies .
Desmopressin acetate is not indicated for the treatment of hemophilia A with factor VIII coagulant activity levels equal to or less than 5%, or for the treatment of hemophilia B, or in patients who have factor VIII antibodies .
Commonly used brand name(s):
In the U.S.
DDAVP
DDAVP Rhinal Tube
Minirin
Stimate
Available Dosage Forms:
Solution
Spray
Tablet
Therapeutic Class: Endocrine-Metabolic Agent
Pharmacologic Class: Vasopressin (class)
Uses For Minirin
Desmopressin is a hormone taken through the nose, by mouth, or given by injection to prevent or control the frequent urination, increased thirst, and loss of water associated with diabetes insipidus (water diabetes). It is used also to control bed-wetting and frequent urination and increased thirst associated with certain types of brain injuries or brain surgery. Desmopressin works by acting on the kidneys to reduce the flow of urine.
Desmopressin is also given by injection to treat some patients with certain bleeding problems such as hemophilia or von Willebrand's disease.
Desmopressin is available only with your doctor's prescription.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, desmopressin is used in certain patients to determine the cause of Cushing's syndrome.
Before Using Minirin
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of nasal desmopressin in children and infants. However, infants may be more sensitive to the effects of nasal desmopressin, which may require caution in patients receiving this medicine .
Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of oral desmopressin in infants and children with diabetes insipidus. However, safety and efficacy have not been established in children below 6 years of age with bed-wetting problems .
Appropriate studies have not been performed on the relationship of age to the effects of desmopressin injection in infants below 3 months of age for the treatment of hemophilia A or Von Willebrand's disease, and in children below 12 years of age with diabetes insipidus. Safety and efficacy have not been established in these age groups .
Geriatric
Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of desmopressin in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment of dosage in patients receiving desmopressin .
Pregnancy
Pregnancy Category Explanation
All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.
Breast Feeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
Blood clots—Use with caution. Desmopressin injection may worsen this condition .
Cystic fibrosis or
Dehydration or
Fluid or electrolyte imbalance or
Heart failure—Loss of sodium from the blood and serious side effects may be more likely to occur in patients with these conditions .
Headache, severe, or migraine or
Heart or blood vessel disease or
High blood pressure—Large doses of desmopressin can cause an increase or decrease in blood pressure.
Hyponatremia, or history of or
Kidney problems—Desmopressin should NOT be used in patients with these conditions .
Stuffy nose caused by cold or allergy—May prevent nasal desmopressin from being absorbed through the lining of the nose into the blood stream.
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Proper Use of desmopressin
This section provides information on the proper use of a number of products that contain desmopressin. It may not be specific to Minirin. Please read with care.
Use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of side effects.
Your doctor may want you to decrease the amount of fluids that you drink while you are using this medicine .
For patients using the nasal solution form of this medicine:
This medicine comes with patient instructions. Read and follow these instructions carefully.
Before using the medicine, gently blow your nose to clear the nostrils.
If you are using the nasal spray for the first time, you will need to prime the spray. To do this, press the pump down four times or until some of the medicine sprays out. If you have not used the medicine for one week or longer, re-prime the pump by pressing once.
Do not use the nasal spray more times than the number indicated on the label. If you do, you may not receive the correct amount of medicine.
After using the nasal spray, wipe the tip of the bottle with a clean tissue and put the cap back on.
The Rhinal Tube is a soft plastic tube with numbers (doses) marked on the side. Draw the drops into the tube until the liquid reaches the number of your dose. Put one end of the tube into your nose and the other end into your mouth. Blow gently until all the medicine has sprayed into your nose. Do not let any medicine run down through the tube into your mouth.
After using the rhinal tube, wash it with water and shake thoroughly until no more water is left. Put the seal back on the dropper tip and close the bottle with the plastic cap .
For patients using the tablet form of this medicine:
Do not drink water or any other liquids from 1 hour before to 8 hours after taking the tablets .
For patients using the injection form of this medicine:
A nurse or other trained health professional will give you this medicine. Sometimes you, a family member, or a friend can also be taught to give your medicine .
Dosing
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For nasal dosage form (nasal solution):
For preventing or controlling diabetes insipidus (water diabetes):
Adults and teenagers—0.1 to 0.4 milliliters (ml) or 10 to 40 micrograms (mcg) given as a single dose or divided into two or three doses a day .
Children 3 months to 12 years of age— 0.05 to 0.3 milliliters (ml) or 5 to 30 micrograms (mcg) given as a single dose or divided into two doses a day .
Children up to 3 months of age—Use and dose must be determined by your doctor .
For oral dosage form (tablets):
For preventing or controlling diabetes insipidus (water diabetes):
Adults, teenagers, and children—At first, 0.05 milligram (mg) two times a day. Then, your doctor may change the dose to 0.1 to 0.8 mg. The dose may be divided into several doses a day.
For controlling bed-wetting:
Adults, teenagers, and children 6 years of age or older—At first, 0.2 mg once a day at bedtime. Then, your doctor may increase the dose to as much as 0.6 mg a day.
Children up to 6 years of age—Use and dose must be determined by your doctor .
For parenteral dosage form (injection):
For preventing or controlling frequent urination:
Adults and teenagers—2 to 4 mcg injected into a vein or under the skin. This dose is usually divided into two doses a day, one given in the morning, and the other given in the evening.
Children up to 12 years of age—Use and dose must be determined by your doctor .
For treating some bleeding problems such as hemophilia or von Willebrand's disease (Type I):
Adults, teenagers, and children 11 months of age or older weighing more than 10 kg (22 pounds)—The dose is based on body weight and must be determined by your doctor. It is usually 0.3 micrograms (mcg) per kilogram (kg) (0.14 mcg per pound) of body weight mixed in 50 milliliters (mL) of 0.9% sodium chloride. This solution is injected into a vein slowly over fifteen to thirty minutes. Your doctor may repeat this treatment if needed.
Children 3 months of age or older weighing 10 kg (22 pounds) or less—The dose is based on body weight and must be determined by your doctor. It is usually 0.3 micrograms (mcg) per kilogram (kg) (0.14 mcg per pound) of body weight mixed in 10 mL of 0.9% sodium chloride. This solution is injected into a vein slowly over fifteen to thirty minutes. Your doctor may repeat this treatment if needed.
Children up to 3 months of age—Use and dose must be determined by your doctor .
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Has a bulleted list describing how to handle missed doses for various possible dosing schedules.
Storage
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Store as directed on the label or by your health care professional.
Precautions While Using Minirin
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Urine tests may be needed to check for unwanted effects .
This medicine lowers the amount of sodium in your blood. Check with your doctor right away if you have confusion, nausea, vomiting, muscle cramps or spasms, or unusual tiredness or weakness .
Check with your doctor right away and stop using this medicine if you have fever, severe vomiting or diarrhea, or other conditions that may make you thirsty (such as during hot weather or having a strenuous exercise). This medicine may cause fluid or electrolyte imbalance which can lead to seizures and other serious conditions .
Do not take other medicines unless they have been discussed with your doctor, especially medicines that can make your mouth dry. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements .
Desmopressin may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash; itching; swelling of the face, tongue, and throat; trouble breathing; or chest pain after you use this medicine .
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Minirin Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Chills
confusion
convulsions (seizures)
decreased urination
drowsiness
fast heartbeat
fever
headache (continuing)
shortness of breath, tightness in chest, trouble in breathing, or wheezing
skin rash, hives, or itching
weight gain (rapid)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common or rare
Abdominal or stomach cramps
flushing or redness of skin
nausea
pain in the vulva (genital area outside of the vagina)
With intranasal (through the nose) use
Cough
nosebleed
runny or stuffy nose
sneezing
sore throat
With intravenous use
Pain, redness, or swelling at place of injection
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.
The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.
Read more: http://www.drugs.com...l#ixzz0ylDmkuUf
Michael S. Okun, M.D.
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Sunday, September 5, 2010
urination
teokimhoe, on 31 August 2010 - 05:00 AM, said:
I have experienced a lack control as far as urination’s concern. Firstly, when I am in the midst of urinating, I am unable to hold back or stop halfway through. Secondly, when I feel the need to urinate I must go to the toilet immediately. I will not be able to hold back at all. I have seen Urologist and was told my PSA is normal though I have slight enlarged prostate gland. My medication: one dose Harnal 400 mcg taken before bedtime daily.
Questions:
Any side effect with parkinson's medication Sinemet, Jumax and requip by causing low blood pressure and dizzinness?
Any alternative
Regards
TEOKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#7 teokimhoe
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03-March 07 LocationMalaysia Posted Yesterday, 08:29 PM
teokimhoe, on 31 August 2010 - 09:04 AM, said:
Dear Dr,Okun,
As the medication Harnal causes side effect with Parkinsons medication by causing low blood pressure and dizzinness. Therefore my doctor started with low dosage of Harnal 400 mcg.
I have experience of the low blood pressure of the above medications.
Regards
TeoKimHoe
Dear Dr.Okun,
Lately my neurologlist changes my medication Harnal 400 mcg to Minirin 0.2 mg one dosage daily to cutdown numerous of urination as the result I have low sodium level.
I had Upright tilt table test recently. Conclusions: Asymptomic through passive tilting & given S/L GTN,Postural hypotension
168/81mmHG droped to 91/51 mmHg. Negative tilt table test
After the medication my blood pressure gone up to normal level slowly
I have cutdown numerous trips to toilet..
Kindly elaborate
Regards
TEOKIMHOE
KIndly advise
TEOKIMHOE
After the medication my blood pressure goes up to normal level s
Kindly advise
TEOKIMHOE
Kindly elaborate
Regards
TEOKIMHOE
#8 Dr. Okun
Advanced Member
Group:
Ask the Doctor Moderators Posts:
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19-January 07 LocationUniversity of Florida Posted Today, 07:20 AM
All PD medications that work on the dopamine system can cause low blood pressure.
I have no specific recommendations beyond what your doctors have been doing.
Michael S. Okun, M.D.
--------------------------------------------------------------------------------
I have experienced a lack control as far as urination’s concern. Firstly, when I am in the midst of urinating, I am unable to hold back or stop halfway through. Secondly, when I feel the need to urinate I must go to the toilet immediately. I will not be able to hold back at all. I have seen Urologist and was told my PSA is normal though I have slight enlarged prostate gland. My medication: one dose Harnal 400 mcg taken before bedtime daily.
Questions:
Any side effect with parkinson's medication Sinemet, Jumax and requip by causing low blood pressure and dizzinness?
Any alternative
Regards
TEOKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
0 Report
Back to top of the page up there ^
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--------------------------------------------------------------------------------
#7 teokimhoe
Advanced Member
Group:
Members Posts:
268 Joined:
03-March 07 LocationMalaysia Posted Yesterday, 08:29 PM
teokimhoe, on 31 August 2010 - 09:04 AM, said:
Dear Dr,Okun,
As the medication Harnal causes side effect with Parkinsons medication by causing low blood pressure and dizzinness. Therefore my doctor started with low dosage of Harnal 400 mcg.
I have experience of the low blood pressure of the above medications.
Regards
TeoKimHoe
Dear Dr.Okun,
Lately my neurologlist changes my medication Harnal 400 mcg to Minirin 0.2 mg one dosage daily to cutdown numerous of urination as the result I have low sodium level.
I had Upright tilt table test recently. Conclusions: Asymptomic through passive tilting & given S/L GTN,Postural hypotension
168/81mmHG droped to 91/51 mmHg. Negative tilt table test
After the medication my blood pressure gone up to normal level slowly
I have cutdown numerous trips to toilet..
Kindly elaborate
Regards
TEOKIMHOE
KIndly advise
TEOKIMHOE
After the medication my blood pressure goes up to normal level s
Kindly advise
TEOKIMHOE
Kindly elaborate
Regards
TEOKIMHOE
#8 Dr. Okun
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19-January 07 LocationUniversity of Florida Posted Today, 07:20 AM
All PD medications that work on the dopamine system can cause low blood pressure.
I have no specific recommendations beyond what your doctors have been doing.
Michael S. Okun, M.D.
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Low Vitamin B6 Intake Associated with Parkinson's Risk
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22-January 07 Locationwww.nutritionucanlivewith.com Posted 29 August 2010 - 07:04 PM
Low Vitamin B6 Intake Associated with Parkinson's Risk
2010-08-27 - British Journal of Nutrition
http://www.npicenter...=28675&zoneid=2
Increased homocysteine levels might accelerate dopaminergic cell death in Parkinson's disease (PD) through neurotoxic effects; thus, increasing intake of B vitamins involved in the regulation of homocysteine metabolism might decrease the risk of PD through decreasing plasma homocysteine.
However, epidemiological evidence for the association of dietary B vitamins with PD is sparse, particularly in non-Western populations. We conducted a hospital-based case–control study in Japan to examine associations between dietary intake of folate, vitamin B6, vitamin B12 and riboflavin and the risk of PD. Patients with PD diagnosed using the UK PD Society Brain Bank criteria (n249) and controls without neurodegenerative diseases (n 368) were recruited. Dietary intake during the preceding month was assessed at the time of study recruitment using a validated, self-administered, semi-quantitative, comprehensive diet history questionnaire. After adjustment for potential dietary and non-dietary confounding factors, intake of folate, vitamin B12 and riboflavin was not associated with the risk of PD (P for trend = 0·87, 0·70 and 0·11, respectively). However, low intake of vitamin B6 was associated with an increased risk of PD, independent of potential dietary and non-dietary confounders. Multivariate OR (95 % CI) for PD in the first, second, third and fourth quartiles of vitamin B6 were 1 (reference), 0·56 (0·33, 0·94), 0·69 (0·38, 1·25) and 0·48 (0·23, 0·99), respectively (P for trend = 0·10). In conclusion, in the present case–control study in Japan, low intake of vitamin B6, but not of folate, vitamin B12 or riboflavin, was independently associated with an increased risk of PD.
http://www.npicenter...=28675&zoneid=2
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Kathrynne Holden, MS
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#2 Beachdog
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30-September 09 LocationCape Cod Massachusetts Posted 30 August 2010 - 09:21 AM
I'm not a researcher but this study looks fuzzy. Looking at only one month's worth of diets for PWPD and normal people, adjusting for "nonconfounding" factors, and reaching a conclusion feels like a stretch. IMHO at least
Rich
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#3 Kathrynne Holden, MS
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You are right on target, this is by no means conclusive. However, there have been a number of studies associating various B vitamins with various aspects of PD, and I am very glad whenever researchers elaborate on some aspect. Trouble is, they so often present fascinating data but then no one ever follows up on it. Drat!
Best regards,
Kathrynne Holden, MS
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#4 teokimhoe
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03-March 07 LocationMalaysia Posted 02 September 2010 - 07:38 AM
Kathrynne Holden, MS, on 31 August 2010 - 05:57 PM, said:
You are right on target, this is by no means conclusive. However, there have been a number of studies associating various B vitamins with various aspects of PD, and I am very glad whenever researchers elaborate on some aspect. Trouble is, they so often present fascinating data but then no one ever follows up on it. Drat!
I have once been suffered by taking more than 6 mg Vit B6 with parkinson medication Sinemet, Requip and Jumex i.e. low blood pressure, dizzinness and T.I.A (mini stroke ) still yet to be confirmed.
Kindly elaborate
Regards
TEIKIMHOE
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#5 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted 03 September 2010 - 06:02 PM
teokimhoe, on 02 September 2010 - 07:38 AM, said:
I have once been suffered by taking more than 6 mg Vit B6 with parkinson medication Sinemet, Requip and Jumex i.e. low blood pressure, dizzinness and T.I.A (mini stroke ) still yet to be confirmed.
Kindly elaborate
Regards
TEIKIMHOE
Best regards,
Kathrynne Holden, MS
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#6 Kathrynne Holden, MS
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I am not aware that use of B6 would be implicated in low blood pressure, dizziness, or stroke, particularly at that relatively low dose. Larger doses of B6 may interfere with the absorption of levodopa, but generally with use of Sinemet, most individuals can take 10-15 mg, sometimes as much as 20-25 mg of B6 without interference.
I would consult with your personal physician. You need to learn whether or not a stroke took place. Apart from that, hypotension (low blood pressure) can occur with PD independently of dietary supplements and your doctor may want to prescribe medication to help correct it.
Best regards,
Kathrynne Holden, MS
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Low Vitamin B6 Intake Associated with Parkinson's Risk
2010-08-27 - British Journal of Nutrition
http://www.npicenter...=28675&zoneid=2
Increased homocysteine levels might accelerate dopaminergic cell death in Parkinson's disease (PD) through neurotoxic effects; thus, increasing intake of B vitamins involved in the regulation of homocysteine metabolism might decrease the risk of PD through decreasing plasma homocysteine.
However, epidemiological evidence for the association of dietary B vitamins with PD is sparse, particularly in non-Western populations. We conducted a hospital-based case–control study in Japan to examine associations between dietary intake of folate, vitamin B6, vitamin B12 and riboflavin and the risk of PD. Patients with PD diagnosed using the UK PD Society Brain Bank criteria (n249) and controls without neurodegenerative diseases (n 368) were recruited. Dietary intake during the preceding month was assessed at the time of study recruitment using a validated, self-administered, semi-quantitative, comprehensive diet history questionnaire. After adjustment for potential dietary and non-dietary confounding factors, intake of folate, vitamin B12 and riboflavin was not associated with the risk of PD (P for trend = 0·87, 0·70 and 0·11, respectively). However, low intake of vitamin B6 was associated with an increased risk of PD, independent of potential dietary and non-dietary confounders. Multivariate OR (95 % CI) for PD in the first, second, third and fourth quartiles of vitamin B6 were 1 (reference), 0·56 (0·33, 0·94), 0·69 (0·38, 1·25) and 0·48 (0·23, 0·99), respectively (P for trend = 0·10). In conclusion, in the present case–control study in Japan, low intake of vitamin B6, but not of folate, vitamin B12 or riboflavin, was independently associated with an increased risk of PD.
http://www.npicenter...=28675&zoneid=2
Best regards,
Kathrynne Holden, MS
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#2 Beachdog
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30-September 09 LocationCape Cod Massachusetts Posted 30 August 2010 - 09:21 AM
I'm not a researcher but this study looks fuzzy. Looking at only one month's worth of diets for PWPD and normal people, adjusting for "nonconfounding" factors, and reaching a conclusion feels like a stretch. IMHO at least
Rich
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#3 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted 31 August 2010 - 05:57 PM
You are right on target, this is by no means conclusive. However, there have been a number of studies associating various B vitamins with various aspects of PD, and I am very glad whenever researchers elaborate on some aspect. Trouble is, they so often present fascinating data but then no one ever follows up on it. Drat!
Best regards,
Kathrynne Holden, MS
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#4 teokimhoe
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03-March 07 LocationMalaysia Posted 02 September 2010 - 07:38 AM
Kathrynne Holden, MS, on 31 August 2010 - 05:57 PM, said:
You are right on target, this is by no means conclusive. However, there have been a number of studies associating various B vitamins with various aspects of PD, and I am very glad whenever researchers elaborate on some aspect. Trouble is, they so often present fascinating data but then no one ever follows up on it. Drat!
I have once been suffered by taking more than 6 mg Vit B6 with parkinson medication Sinemet, Requip and Jumex i.e. low blood pressure, dizzinness and T.I.A (mini stroke ) still yet to be confirmed.
Kindly elaborate
Regards
TEIKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#5 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted 03 September 2010 - 06:02 PM
teokimhoe, on 02 September 2010 - 07:38 AM, said:
I have once been suffered by taking more than 6 mg Vit B6 with parkinson medication Sinemet, Requip and Jumex i.e. low blood pressure, dizzinness and T.I.A (mini stroke ) still yet to be confirmed.
Kindly elaborate
Regards
TEIKIMHOE
Best regards,
Kathrynne Holden, MS
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#6 Kathrynne Holden, MS
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I am not aware that use of B6 would be implicated in low blood pressure, dizziness, or stroke, particularly at that relatively low dose. Larger doses of B6 may interfere with the absorption of levodopa, but generally with use of Sinemet, most individuals can take 10-15 mg, sometimes as much as 20-25 mg of B6 without interference.
I would consult with your personal physician. You need to learn whether or not a stroke took place. Apart from that, hypotension (low blood pressure) can occur with PD independently of dietary supplements and your doctor may want to prescribe medication to help correct it.
Best regards,
Kathrynne Holden, MS
--
nutrition, vitamin and parkinson's by Dr.Kathrynne
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.
I have once blood test to measure my vitamin level in Add Life Anti Aging Bangkok. I have suffered low blood pressure by taking some of the vitamins. As the result I admitted to Hospital. I have T.I.A (mini stroke) still yet to answer.
Regards
TeoKimHoe
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
--------------------------------------------------------------------------------
#2 Kathrynne Holden, MS
•
•Advanced Member
•
•Group: Ask the Dietician Moderators
•Posts: 545
•Joined: 22-January 07
•Locationwww.nutritionucanlivewith.com
Posted Today, 06:31 PM
Thank you for your comments. I would be interested in seeing the studies on these supplements with relation to low blood pressure, if you care to send them.
Best regards,
Kathrynne Holden, MS
–
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.
I have once blood test to measure my vitamin level in Add Life Anti Aging Bangkok. I have suffered low blood pressure by taking some of the vitamins. As the result I admitted to Hospital. I have T.I.A (mini stroke) still yet to answer.
Regards
TeoKimHoe
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
--------------------------------------------------------------------------------
#2 Kathrynne Holden, MS
•
•Advanced Member
•
•Group: Ask the Dietician Moderators
•Posts: 545
•Joined: 22-January 07
•Locationwww.nutritionucanlivewith.com
Posted Today, 06:31 PM
Thank you for your comments. I would be interested in seeing the studies on these supplements with relation to low blood pressure, if you care to send them.
Best regards,
Kathrynne Holden, MS
–
Saturday, September 4, 2010
Living with PD by Dr Kathrynne
Dear Doctor,
I feel proud I come out with the book Heroteo- the chronicles of a parkinson's fighter.
while living with PD . The proceed of sales to the Malayan parkinson society.My objective is to raise
the awareness the disease to the public and support group. The accomplishments for me are demonstrated to the sufferers that they are not alone.
As Asian are shy with the disease they prefer to stay home. They do not live with quality of life.
They do not shopping, travelling, eating what western do. They have poor knowledge of PD.
As Parkinson's have emotional and non emotional disorders and there are so far no cure treatment they have to learn how to slow down the disease by taking actively in public and joining forums to enlighten their knowledge of PD to slow down the disease.
TEOKIMHOE
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#2 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted Yesterday, 06:23 PM
Mr. Teo, I certainly wish you well in your endeavors, and in your admirable goal to raise awareness of PD in Malaysia. I hope your book will help to achieve this very worthy objective, and that others will be inspired by your example.
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
I feel proud I come out with the book Heroteo- the chronicles of a parkinson's fighter.
while living with PD . The proceed of sales to the Malayan parkinson society.My objective is to raise
the awareness the disease to the public and support group. The accomplishments for me are demonstrated to the sufferers that they are not alone.
As Asian are shy with the disease they prefer to stay home. They do not live with quality of life.
They do not shopping, travelling, eating what western do. They have poor knowledge of PD.
As Parkinson's have emotional and non emotional disorders and there are so far no cure treatment they have to learn how to slow down the disease by taking actively in public and joining forums to enlighten their knowledge of PD to slow down the disease.
TEOKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#2 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted Yesterday, 06:23 PM
Mr. Teo, I certainly wish you well in your endeavors, and in your admirable goal to raise awareness of PD in Malaysia. I hope your book will help to achieve this very worthy objective, and that others will be inspired by your example.
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
nutrition, vitamin and parkinson's by Dr.Kathrynne
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.
I have once blood test to measure my vitamin level in Add Life Anti Aging Bangkok. I have suffered low blood pressure by taking some of the vitamins. As the result I admitted to Hospital. I have T.I.A (mini stroke) still yet to answer.
Regards
TeoKimHoe
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#2 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted Today, 06:31 PM
Thank you for your comments. I would be interested in seeing the studies on these supplements with relation to low blood pressure, if you care to send them.
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
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.
I have once blood test to measure my vitamin level in Add Life Anti Aging Bangkok. I have suffered low blood pressure by taking some of the vitamins. As the result I admitted to Hospital. I have T.I.A (mini stroke) still yet to answer.
Regards
TeoKimHoe
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#2 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted Today, 06:31 PM
Thank you for your comments. I would be interested in seeing the studies on these supplements with relation to low blood pressure, if you care to send them.
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
knowledge is power
Dear Doctors,
Do any PD medications slow down the disease?
I started with Q 10 when I diagnosed as Parkinson's last five years old.
It is not the parkinson's medication but a supplements as some doctors prescribe for an early parkinson's patient.
I take Sinemet regular on the third years when my movement is slow. I increase Requip medication and improve my movement after six months. Besides I take vitamin and supplements daily as I do blood test on my vitamin and mineral level twice in a year.
Diet, nutrition and exercises are important too .
I wish to thank NPF Forum and medical Panel that I learn and share with the readers on how to battle the diseases.
All are in one to slow down the parkinson's. Discipline, perservation, consistance on yourself are the power to battle the parkinson's as It is a chronic disease and expensive for treatment
TEOKIMHOE
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#2 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted Today, 06:16 PM
Indeed knowledge is power. So far as I am aware, no PD medications have been definitely proven to slow the progression of disease. There are studies underway on various supplements, including CoQ10, and when we have the results, we will certainly post them to the forums.
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/
Do any PD medications slow down the disease?
I started with Q 10 when I diagnosed as Parkinson's last five years old.
It is not the parkinson's medication but a supplements as some doctors prescribe for an early parkinson's patient.
I take Sinemet regular on the third years when my movement is slow. I increase Requip medication and improve my movement after six months. Besides I take vitamin and supplements daily as I do blood test on my vitamin and mineral level twice in a year.
Diet, nutrition and exercises are important too .
I wish to thank NPF Forum and medical Panel that I learn and share with the readers on how to battle the diseases.
All are in one to slow down the parkinson's. Discipline, perservation, consistance on yourself are the power to battle the parkinson's as It is a chronic disease and expensive for treatment
TEOKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#2 Kathrynne Holden, MS
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22-January 07 Locationwww.nutritionucanlivewith.com Posted Today, 06:16 PM
Indeed knowledge is power. So far as I am aware, no PD medications have been definitely proven to slow the progression of disease. There are studies underway on various supplements, including CoQ10, and when we have the results, we will certainly post them to the forums.
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/
Wednesday, September 1, 2010
urination
I have experienced a lack control as far as urination’s concern. Firstly, when I am in the midst of urinating, I am unable to hold back or stop halfway through. Secondly, when I feel the need to urinate I must go to the toilet immediately. I will not be able to hold back at all. I have seen Urologist and was told my PSA is normal though I have slight enlarged prostate gland. My medication: one dose Harnal 400 mcg taken before bedtime daily.
Questions:
Any side effect with parkinson's medication Sinemet, Jumax and requip by causing low blood pressure and dizzinness?
Any alternative
Regards
TEOKIMHOE
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#2 Dr. Okun
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19-January 07 LocationUniversity of Florida Posted Today, 06:30 AM
Many PD patients have these symptoms and sometimes they are PD, sometimes urological, and sometimes anxiety. I will post for comments from others.
Michael S. Okun, M.D.
Questions:
Any side effect with parkinson's medication Sinemet, Jumax and requip by causing low blood pressure and dizzinness?
Any alternative
Regards
TEOKIMHOE
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#2 Dr. Okun
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19-January 07 LocationUniversity of Florida Posted Today, 06:30 AM
Many PD patients have these symptoms and sometimes they are PD, sometimes urological, and sometimes anxiety. I will post for comments from others.
Michael S. Okun, M.D.
CPK Blood Test
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03-March 07 LocationMalaysia Posted Today, 03:55 AM
Dear Dr.Okun,
My cardiac enzymes CPK is 288 level.
What is the normal/higher CPK level?
Is anxiety and depression affected your higher level of CPK?
Kindly elaborate
Regards
TEOKIMHOE
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#2 Dr. Okun
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19-January 07 LocationUniversity of Florida Posted Today, 06:32 AM
I will post for you as this is not my area of expertise.
The CK must be interpreted by an internist or cardiologist and there are fractions that indicate the type of muscle breakdown. In many cases elevations of a few hundred are normal, but you need to see an internist or cardiologist to be sure. When CK's get into the thousands it can be dangerous, and in some cases it heralds muscle disease. I will post for you.
Michael S. Okun, M.D.
Dear Dr.Okun,
What is the cause of CPK at high level?
How it to be prevented?
The internist or cardiologist still yet to answer.
Regards
TEOKIMHOE
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#4 Dr. Okun
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19-January 07 LocationUniversity of Florida Posted Today, 06:18 AM
Here is a link to medline plus where the enzyme test is explained.
http://www.nlm.nih.g...icle/003503.htm
Michael S. Okun, M.D.
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Members Posts:
252 Joined:
03-March 07 LocationMalaysia Posted Today, 03:55 AM
Dear Dr.Okun,
My cardiac enzymes CPK is 288 level.
What is the normal/higher CPK level?
Is anxiety and depression affected your higher level of CPK?
Kindly elaborate
Regards
TEOKIMHOE
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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#2 Dr. Okun
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19-January 07 LocationUniversity of Florida Posted Today, 06:32 AM
I will post for you as this is not my area of expertise.
The CK must be interpreted by an internist or cardiologist and there are fractions that indicate the type of muscle breakdown. In many cases elevations of a few hundred are normal, but you need to see an internist or cardiologist to be sure. When CK's get into the thousands it can be dangerous, and in some cases it heralds muscle disease. I will post for you.
Michael S. Okun, M.D.
Dear Dr.Okun,
What is the cause of CPK at high level?
How it to be prevented?
The internist or cardiologist still yet to answer.
Regards
TEOKIMHOE
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#4 Dr. Okun
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19-January 07 LocationUniversity of Florida Posted Today, 06:18 AM
Here is a link to medline plus where the enzyme test is explained.
http://www.nlm.nih.g...icle/003503.htm
Michael S. Okun, M.D.
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