Anonymous
Posted: Fri Jul 31, 2009 8:39 am Post subject: denture and saliva
There are complaint by parkinson's patient how to deal with saliva and dentures. The saliva causes the dentures slippery and loose even there are denture paste if a gap develops between the denture and the gummy ridge Therefore the denture may need repeated relines. Shrinkage of the bone and gums can be minimized or prevented with a proven technique
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Fri Jul 31, 2009 11:13 am Post subject:
This can be a troublesome issue. If you dry the saliva too much with an anticholinergic drug or botox you can also get cavities. I would suggest you work with the doctor to find the right solution for you, but to brush your remaining teeth frequently if you dry the saliva._________________Michael S. Okun, M.D.
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Anonymous
Posted: Sun Aug 02, 2009 8:39 pm Post subject:
You will find comfortable without dentures as your saliva easy to swallow.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Mon Aug 03, 2009 7:05 pm Post subject:
Thanks for the comment. Comfort I have found is patient specific!_________________Michael S. Okun, M.D.
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Anonymous
Posted: Fri Aug 07, 2009 4:56 am Post subject:
People with dentures have excess saliva as dentures are foreign substances in the mouth and the mouth produces excess saliva as a reaction perhaps treating the dentures as food.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Fri Aug 07, 2009 3:35 pm Post subject:
Thanks for the comment. Also remember botox and anticholinergics can dry you up but may also lead to cavities!_________________Michael S. Okun, M.D.
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Anonymous
Posted: Sun Aug 09, 2009 3:45 am Post subject:
There are complaint by the parkinson's patient to the doctor the drooling saliva and dentures Therefore Movement disorder specialist deal with medication to minimise the effect of saliva on the patient. They classified the excess of saliva is the slow saliva swallowing by PD neither the cause the saliva on dentures The dentist classified the saliva developing dentures slippery and loose is a gap develop between the denture and the gummy ridge. . Therefore the denture may need repeated relines. Shrinkage of the bone and gums can be minimized or prevented with a proven technique
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sun Aug 09, 2009 8:39 pm Post subject:
Thanks for the added comment._________________Michael S. Okun, M.D.
Thursday, September 3, 2009
Major nutritional issues in the management of PD
Kathrynne Holden, MSJoined: 22 Jan 2007Posts: 94Location: www.nutritionucanlivewith.com
Posted: Wed Aug 26, 2009 7:37 am Post subject: News: Major nutritional issues in the management of PD
. Dear Friends, As long-time members know, I firmly believe that everyone with PD should see a registered dietitian on a regular basis, as nutritional concerns can occur, and can change, throughout the stages of PD. Best, Kathrynne ======================================================== Mov Disord. 2009 Aug 18. Major nutritional issues in the management of Parkinson's disease. Barichella M, Cereda E, Pezzoli G. Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy. As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research. Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa). During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute. Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account. Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micronutrients or vitamins). A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens. (c) 2009 Movement Disorder Society. PMID: 19691125 [PubMed - as supplied by publisher] ._________________Best regards, Kathrynne Holden, MS -- For a Parkinson Tip of the Day visit: http://www.nutritionucanlivewith.com/
Posted: Wed Aug 26, 2009 7:37 am Post subject: News: Major nutritional issues in the management of PD
. Dear Friends, As long-time members know, I firmly believe that everyone with PD should see a registered dietitian on a regular basis, as nutritional concerns can occur, and can change, throughout the stages of PD. Best, Kathrynne ======================================================== Mov Disord. 2009 Aug 18. Major nutritional issues in the management of Parkinson's disease. Barichella M, Cereda E, Pezzoli G. Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy. As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research. Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa). During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute. Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account. Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micronutrients or vitamins). A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens. (c) 2009 Movement Disorder Society. PMID: 19691125 [PubMed - as supplied by publisher] ._________________Best regards, Kathrynne Holden, MS -- For a Parkinson Tip of the Day visit: http://www.nutritionucanlivewith.com/
Tuesday, September 1, 2009
Parkinson's medication interact with supplementary vitamins
Anonymous
Posted: Mon Aug 31, 2009 4:19 am Post subject: parkinson's medication interact with supplementary vitamins
I take Sinemet CR, Requip, Jumex and supplementary vitamins containing Zinc, calcium, T3, T4, Dhea,copper,Ferriltin , Folic acid,Vit D daily. I have unusual tiredness, and look sick. Can I mix these medication? Are they interact and have an effect with each other? Kindly brief
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Mon Aug 31, 2009 7:41 pm Post subject:
Your vitamins should not interact significantly with your PD meds. Rarely, the ferritin might interact. So to be safe, you can take it at a different time that you take your PD meds. Of see if you feel better not taking the iron pills at all. If you have anemia however, you may need iron pills, as anemia can cause tiredness. If you have no anemia, you dont really need to take iron pills and you can see if you feel better without it. Not sure why you are taking T3 and T4? If so, make sure your thyroid levels are good....they can cause tiredness. Finally, it can be that your PD medications may need to be increased...? Yours,_________________Hubert H. Fernandez
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I have frequent unususal tiredness because I take my supplement vitamins about half an hours my parkinson medications.
As the result they interacting and have effect on each others. They block levodopa absorption.
I feel much better now as I take my supplements vitamins two hours after my parkinson's medication.
Dr. Okun
Joined: 19 Jan 2007
Posts: 251
Location: University of Florida
Posted: Fri Sep 04, 2009 9:39 am Post subject:
--------------------------------------------------------------------------------
Thanks for the comment.
_________________
Michael S. Okun, M.D.
'
Posted: Mon Aug 31, 2009 4:19 am Post subject: parkinson's medication interact with supplementary vitamins
I take Sinemet CR, Requip, Jumex and supplementary vitamins containing Zinc, calcium, T3, T4, Dhea,copper,Ferriltin , Folic acid,Vit D daily. I have unusual tiredness, and look sick. Can I mix these medication? Are they interact and have an effect with each other? Kindly brief
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Mon Aug 31, 2009 7:41 pm Post subject:
Your vitamins should not interact significantly with your PD meds. Rarely, the ferritin might interact. So to be safe, you can take it at a different time that you take your PD meds. Of see if you feel better not taking the iron pills at all. If you have anemia however, you may need iron pills, as anemia can cause tiredness. If you have no anemia, you dont really need to take iron pills and you can see if you feel better without it. Not sure why you are taking T3 and T4? If so, make sure your thyroid levels are good....they can cause tiredness. Finally, it can be that your PD medications may need to be increased...? Yours,_________________Hubert H. Fernandez
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I have frequent unususal tiredness because I take my supplement vitamins about half an hours my parkinson medications.
As the result they interacting and have effect on each others. They block levodopa absorption.
I feel much better now as I take my supplements vitamins two hours after my parkinson's medication.
Dr. Okun
Joined: 19 Jan 2007
Posts: 251
Location: University of Florida
Posted: Fri Sep 04, 2009 9:39 am Post subject:
--------------------------------------------------------------------------------
Thanks for the comment.
_________________
Michael S. Okun, M.D.
'
Sunday, August 23, 2009
Seroquel
Anonymous
Posted: Tue Aug 18, 2009 11:29 pm Post subject: Seroquel
I seem to remember postings on Seroquel -- its pluses and minuses. But I can't locate them. Any comment, doctors? Seroquel has been prescribed for me because I've been hallucinating. The dose is one .25 mg tablet at bedtime. Anonymous
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sat Aug 22, 2009 8:30 am Post subject:
Quetiapine (seroquel) is one of our first line treatment for hallucinations in PD. It is generally well tolerated. Because of this, it is often also used for other conditions such as insomnia, and agitation. However, just like any drug, it has its share of side effects. It can cause sedation (that is why it is given at night and used for insomnia as well), confusion, lightheadedness, and rarely, it can worsen PD, but not usually. Yours,_________________Hubert H. Fernandez
Posted: Tue Aug 18, 2009 11:29 pm Post subject: Seroquel
I seem to remember postings on Seroquel -- its pluses and minuses. But I can't locate them. Any comment, doctors? Seroquel has been prescribed for me because I've been hallucinating. The dose is one .25 mg tablet at bedtime. Anonymous
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sat Aug 22, 2009 8:30 am Post subject:
Quetiapine (seroquel) is one of our first line treatment for hallucinations in PD. It is generally well tolerated. Because of this, it is often also used for other conditions such as insomnia, and agitation. However, just like any drug, it has its share of side effects. It can cause sedation (that is why it is given at night and used for insomnia as well), confusion, lightheadedness, and rarely, it can worsen PD, but not usually. Yours,_________________Hubert H. Fernandez
Wednesday, August 19, 2009
Progression of PD
Anonymous
Posted: Tue Aug 18, 2009 9:36 am Post subject: Progression.
There is a PwP in our area who has had Parkinson's for at least 18 years and it does not seem to have progressed at all.He is still on Mirapex and a small amount of Sinemet at night. Is it possible that on rare occassions Parkinson's does stop progressing or that the progression is so slow it hardly notices?Thank you
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Tue Aug 18, 2009 10:06 pm Post subject:
Definitely, the progression in PD is a very individual thing. Some of our patients progress so slowly that we hardly see a difference from year to year. Some patients are more devastated by the illness and we see a change whenever they visit us in clinic. And the majority of patients fall in between these two extremes. Of course, there is a possibility that your neighbor does not have PD but a mimicker of PD...? Yours,_________________Hubert H. Fernandez
Posted: Tue Aug 18, 2009 9:36 am Post subject: Progression.
There is a PwP in our area who has had Parkinson's for at least 18 years and it does not seem to have progressed at all.He is still on Mirapex and a small amount of Sinemet at night. Is it possible that on rare occassions Parkinson's does stop progressing or that the progression is so slow it hardly notices?Thank you
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Tue Aug 18, 2009 10:06 pm Post subject:
Definitely, the progression in PD is a very individual thing. Some of our patients progress so slowly that we hardly see a difference from year to year. Some patients are more devastated by the illness and we see a change whenever they visit us in clinic. And the majority of patients fall in between these two extremes. Of course, there is a possibility that your neighbor does not have PD but a mimicker of PD...? Yours,_________________Hubert H. Fernandez
Monday, August 17, 2009
Risk of Stroke and Parkinson's
Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Fri Aug 07, 2009 4:21 pm Post subject: Post of the Week: Risk of Stroke and Parkinson's
Despite potential issues with the methods in this study from Switzerland it is interesting that when examining a large database two issues emerged: 1- Risk of PD diagnosis was increased if a previous stroke, 2- the risk of first time ischemic stroke was increased in PD. These findings will need to be confirmed, but raise the possibility of some association of PD and stroke. Parkinsonism Relat Disord. 2009 Jul 27. [Epub ahead of print]Links Risk of stroke in patients with idiopathic Parkinson disease. Becker C, Jick SS, Meier CR. Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Switzerland. PURPOSE: Large population based studies on the association of Parkinson disease (PD) with stroke are scarce. This study aimed to quantify the risk of a first-time diagnosis of idiopathic PD in patients with a history of stroke, and to assess incidence rates for stroke in PD patients. METHODS: We used the UK-based General Practice Research Database to compare the prevalence of stroke/TIA in newly diagnosed PD patients and in a matched comparison group without PD between 1994 and 2005. We conducted a follow-up study with a nested case-control analysis to quantify the risk of incident stroke/TIA in relation to a previous PD diagnosis. RESULTS: A history of stroke/TIA was associated with a significantly increased relative risk of being diagnosed with PD compared to patients without such a history (adj. odds ratio [OR] 1.65, 95% confidence intervals [CI] 1.47-2.00). In the cohort study, the crude incidence rate ratios (IRRs) for incident hemorrhagic stroke, ischemic stroke or TIA were 0.66 (95% CI 0.26-1.72), 1.46 (95% CI 1.03-2.07) and 1.86 (95% CI 1.40-2.47), respectively. CONCLUSIONS: In this large observational study the risk of a PD diagnosis was significantly increased after a previous stroke event, as was the risk of a first-time ischemic stroke in newly diagnosed PD patients compared to persons free of PD._________________Michael S. Okun, M.D.
Posted: Fri Aug 07, 2009 4:21 pm Post subject: Post of the Week: Risk of Stroke and Parkinson's
Despite potential issues with the methods in this study from Switzerland it is interesting that when examining a large database two issues emerged: 1- Risk of PD diagnosis was increased if a previous stroke, 2- the risk of first time ischemic stroke was increased in PD. These findings will need to be confirmed, but raise the possibility of some association of PD and stroke. Parkinsonism Relat Disord. 2009 Jul 27. [Epub ahead of print]Links Risk of stroke in patients with idiopathic Parkinson disease. Becker C, Jick SS, Meier CR. Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Switzerland. PURPOSE: Large population based studies on the association of Parkinson disease (PD) with stroke are scarce. This study aimed to quantify the risk of a first-time diagnosis of idiopathic PD in patients with a history of stroke, and to assess incidence rates for stroke in PD patients. METHODS: We used the UK-based General Practice Research Database to compare the prevalence of stroke/TIA in newly diagnosed PD patients and in a matched comparison group without PD between 1994 and 2005. We conducted a follow-up study with a nested case-control analysis to quantify the risk of incident stroke/TIA in relation to a previous PD diagnosis. RESULTS: A history of stroke/TIA was associated with a significantly increased relative risk of being diagnosed with PD compared to patients without such a history (adj. odds ratio [OR] 1.65, 95% confidence intervals [CI] 1.47-2.00). In the cohort study, the crude incidence rate ratios (IRRs) for incident hemorrhagic stroke, ischemic stroke or TIA were 0.66 (95% CI 0.26-1.72), 1.46 (95% CI 1.03-2.07) and 1.86 (95% CI 1.40-2.47), respectively. CONCLUSIONS: In this large observational study the risk of a PD diagnosis was significantly increased after a previous stroke event, as was the risk of a first-time ischemic stroke in newly diagnosed PD patients compared to persons free of PD._________________Michael S. Okun, M.D.
Sunday, August 16, 2009
Having depression before your diagnosis of PD affects QOL
Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Wed Aug 05, 2009 12:12 pm Post subject: Having depression before your diagnosis of PD affects QOL
Dear forum members, The relationship between depression and quality of life in PD has been something we feel is deserving of more research. A small study was recently published commenting on this relationship. Interestingly, if you had depression prior to your PD diagnosis it may affect your quality of life (QOL) post diagnosis (or be related to it). The abstract is below: Parkinsonism Relat Disord. 2009 Jul 27. [Epub ahead of print]Links Impact of pre-morbid depression on health-related quality of life in non-demented Parkinson's disease patients. Klepac N, Hajnšek S, Trkulja V. Department of Neurology, University Hospital Centre Zagreb, Zagreb University School of Medicine, Kispatićeva 12, Zagreb, Croatia. The need to understand and improve health-related quality of life (Hr-QoL) in Parkinson's disease (PD) has been emphasized. In order to investigate contributions of depression that existed before the onset of typical motor symptoms ("pre-PD depression"), idiopathic non-demented non-psychotic patients with (n = 32) and without (n = 120) a history of pre-PD depression, free of relevant comorbidity, calliper-matched for age, education and disease duration were evaluated for motor and non-motor disease aspects and Hr-QoL (Parkinson's Disease Questionnaire 39, PDQ-39). History of pre-PD depression was independently associated with higher actual levels of depression and anxiety, poorer sleep quality and mental set shifting, which all contributed to poorer Hr-QoL. Mediation analysis demonstrated significant indirect effects (mediated through the effects on mood/emotion/sleep and/or cognition) of pre-PD depression on PDQ summary index and subscales, but also direct (non-mediated) effects on emotional well-being and body discomfort subscales independent of the sociodemographic, motor/non-motor disease or treatment-related characteristics. Data indicate that for a given level of motor/non-motor PD symptoms severity, history of pre-PD depression contributes to poorer Hr-QoL._________________Michael S. Okun, M.D.
Posted: Wed Aug 05, 2009 12:12 pm Post subject: Having depression before your diagnosis of PD affects QOL
Dear forum members, The relationship between depression and quality of life in PD has been something we feel is deserving of more research. A small study was recently published commenting on this relationship. Interestingly, if you had depression prior to your PD diagnosis it may affect your quality of life (QOL) post diagnosis (or be related to it). The abstract is below: Parkinsonism Relat Disord. 2009 Jul 27. [Epub ahead of print]Links Impact of pre-morbid depression on health-related quality of life in non-demented Parkinson's disease patients. Klepac N, Hajnšek S, Trkulja V. Department of Neurology, University Hospital Centre Zagreb, Zagreb University School of Medicine, Kispatićeva 12, Zagreb, Croatia. The need to understand and improve health-related quality of life (Hr-QoL) in Parkinson's disease (PD) has been emphasized. In order to investigate contributions of depression that existed before the onset of typical motor symptoms ("pre-PD depression"), idiopathic non-demented non-psychotic patients with (n = 32) and without (n = 120) a history of pre-PD depression, free of relevant comorbidity, calliper-matched for age, education and disease duration were evaluated for motor and non-motor disease aspects and Hr-QoL (Parkinson's Disease Questionnaire 39, PDQ-39). History of pre-PD depression was independently associated with higher actual levels of depression and anxiety, poorer sleep quality and mental set shifting, which all contributed to poorer Hr-QoL. Mediation analysis demonstrated significant indirect effects (mediated through the effects on mood/emotion/sleep and/or cognition) of pre-PD depression on PDQ summary index and subscales, but also direct (non-mediated) effects on emotional well-being and body discomfort subscales independent of the sociodemographic, motor/non-motor disease or treatment-related characteristics. Data indicate that for a given level of motor/non-motor PD symptoms severity, history of pre-PD depression contributes to poorer Hr-QoL._________________Michael S. Okun, M.D.
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