Wednesday, July 9, 2008
Monday, July 7, 2008
Incoordination exercises
Anonymous
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
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
Anonymous
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.
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.
Source:
2008 University of Maryland Medical Center (UMMC). All rights reserved. UMMC is a member of the University of Maryland Medical System
TeoKimHoe
Back to top
'
Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun Jul 06, 2008 7:29 pm Post subject:
Thanks,
Teo._________________Hubert H. Fernandez
Anonymous
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 Resperdal...as 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
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.
Source:
2008 University of Maryland Medical Center (UMMC). All rights reserved. UMMC is a member of the University of Maryland Medical System
TeoKimHoe
Back to top
'
Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun Jul 06, 2008 7:29 pm Post subject:
Thanks,
Teo._________________Hubert H. Fernandez
Anonymous
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 Resperdal...as 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?
Anonymous
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
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
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
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
Subscribe to:
Posts (Atom)