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>>> Posting number 20402, dated 17 Feb 1997 20:05:08
Date:         Mon, 17 Feb 1997 20:05:08 -0500
From:         "J.R. Bruman" <[log in to unmask]>
Subject:      Autonomic System

AUTONOMIC SYSTEM AND PD  (Feb 1997)

Normally, we don't pay much attention to body functions such as
breathing, blood pressure, pulse rate, digestion, peristalsis, etc.
Unlike conscious activity such as talking, reading, riding a bike,
the body takes care of unconscious functions by itself. Except in
PD. IMHO too little attention is given, both in literature for PWP
and in research on management of the disease. Books for PWP, for
example the one by R. Duvoisin, mention some autonomic symptoms,
but skip any explanation of their relation to dopamine and how they
are caused.

So here is a bit of info, limited by the amount of current work
as well as my slight knowledge, to help PWP understand the disease
better. My reference material is old, dating as far back as 1972,
but I think still OK.

First, a few definitions: The human nervous system is divided into
the central system, consisting of the brain and spinal cord, and
the peripheral system, which is everything else. The peripheral
system includes nerves to muscles and sense organs, for example,
and the autonomic system. The autonomic system is further divided
into the sympathetic (outgoing or efferent) system and the
parasympathetic (incoming or afferent) system. Those two components
form a feedback loop for each of many connected organs, muscles,
or functions. For example, the brain senses a need for more blood,
and sends a signal raising blood pressure and pulse rate. Then
it receives a signal back when the needed increase has occurred.
The process is continuous, as are all other autonomic functions,
and although some people can learn to influence it consciously,
that is not necessary. For another example, we can all hold our
breath (briefly) or take a deep breath, when we want to. But if
we ignore breathing, as usual, the autonomic system, using the
very same muscles, tends to it. I don't know if sleep apnea is
associated with PD, but it might be.

Dopamine circulates in the blood, to mediate action at the distal
terminals of the autonomic system. Symptoms of autonomic failure,
presumably due to dopamine deficiency of PD, include: difficulty
swallowing; drooling (either excess salivation or failure to
swallow enough); insufficient or excess sweating; urinary retention
or hesitancy; sexual (in men) dysfunction; seborrhea (not dandruff
as some neurologists seem to think}; constipation (which can be
life-threatening); conjunctivitis, from reduced tear secretion;
solid matter in eyes (from excess tear secretion?); poor muscular
endurance (abnormal fatigue); poor sensation of temperature or poor
temperature regulation; dizziness on suddenly arising (postural
hypotension). Paradoxically, one severe form of autonomic (non-PD)
failure is congenital lack of the enzyme that converts dopamine to
norepinephrine, resulting in excess, rather than deficiency, of
plasma dopamine.

Much of the above is my conjecture, since there doesn't seem to be
much literature on the relation of the autonomic system to PD,
nor have I found any current research on it. More of either would
probably help PWP a lot.

Joe


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>>> Posting number 54391, dated 29 Dec 1998 19:44:00
Date:         Tue, 29 Dec 1998 19:44:00 -0800
From:         bobc <[log in to unmask]>
Subject:      Drooling

I have had a problem with drooling / excessive saliva, starting maybe 7
years ago. I was dx with PD four years ago. In the last 7-8 months my
drooling has increased considerably in volume and frequency. I haven't
seen much, if anything, posted on the list re: drooling. Is it a symptom
of PD ? Can it be controlled?
Thanks for any info.

Bob Chapman,  65 age now /61 age dx /55 age onset


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>>> Posting number 54537, dated 3 Jan 1999 13:45:05
Date:         Sun, 3 Jan 1999 13:45:05 -0500
From:         Phil Tompkins <[log in to unmask]>
Subject:      Re: Drooling

bobc wrote:

> I have had a problem with drooling / excessive saliva... Is it a
> symptom of PD ? Can it be controlled?

Hello,

According to Dr. Abraham Lieberman's book "Parkinson's Disease"
drooling by PWP is not due to excess saliva but rather to
insufficient swallowing caused by bradykinesia.  For people without
PD, automatic swallowing handles the saliva.  With PD the muscles
involved are affected by bradykinesia, so we swallow with less force
and frequency.  The muscles will weaken and undergo atrophy unless
we make conscious efforts, not only to remember to swallow, but also
to keep in practice by incorporating swallowing into our exercise
routines.  If this doesn't work, there are medicines that decrease
saliva production.

Dr. Lieberman's book, a paperback published by Simon and Schuster (I
don't receive any benefits from this plug) contains the most thorough
discussion of PD symptoms I have seen.

Phil Tompkins
Hoboken NJ
age 61/dx 1990


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>>> Posting number 57143, dated 5 Mar 1999 12:07:39
Date:         Fri, 5 Mar 1999 12:07:39 EST
From:         Marty Polonsky <[log in to unmask]>
Subject:      Re: Excessive saliva???

Camilla,

II didn't see the original posting on this so I'm replying to you.  I'm sure
you're just dying to get more mail,, so here you are.

I've had lots of experience with excessive saliva--no, drooling--following my
second (bilateral) pallidotomy.  I don't know whether it's really a matter of
excessive saliva or inability to hold it--I think it's both--but I found a few
things which helped.   I accidentally tripped on one solution--i.e meds which
have a side effect of drying you out internally.  The most effective for me,
in this regard. is imipramine, brand name tofranil, which is used as a mild
antidepressant and to dry you out, for other reasons.  II also tried robinall.
a mild tranquilizer but it wasn't as effective for me.  Anyone with this
problem should, of course, talk to their neuro's about meds but these are
suggested meds that they can ask their neuro about.  The other, more
consistently effective measure was to chew gum--yeah, that simple.  Apparently
the act of chewing makes you more diligent about the task of removing
(excessive amounts of) saliva from your mouth.  I think that it was more
effective when I chewed big pieces of gum (chaws)  This can be a
considertiaion if you chew sugarless gum--eg trident which comes in small
pieces, so you might want to chew 2 at a time.  Good luck.

Marty Polonsky


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>>> Posting number 57479, dated 19 Mar 1999 13:10:43
Date:         Fri, 19 Mar 1999 13:10:43 -0500
From:         "Bonnie Cunningham, R.N." <[log in to unmask]>
Subject:      Re: Drooling

Dear Will:

According to everything that I've read and have heard in conferences, (I've
read and heard Dr. Abraham Lieberman, specifically, address this topic),
Kathrynne is correct when she stated that Parkinson's does not cause
excessive salivation.  As a matter of fact, she is right on target that the
saliva does indeed pool under the tongue.  Normally, throughout the day, we
all subconsciously swallow at regular intervals.  In those with PD, due to
the increased incidence of swallowing difficulties, the tendency is not to
swallow as frequently, therefore leading to a build up of saliva.

When you mentioned post pallidotomy speech and swallowing problems in
relation to "excessive saliva" (drooling), it reinforces this concept.
With post-operative swallowing difficulties, there may appear to be an
increase in saliva, however, once again, it is the decrease in the
automatic swallowing.

The good news is that there are certain 'exercises' that can be done to
help this problem and a Speech Pathologist can show you those exercises.

An excessive secretion of saliva is called 'ptyalism' and according to
Taber's medical dictionary there are several conditions in which this can
occur.  It also can be caused by some medications (Taber's mentions
mercury, iodides and pilocarpine).

I know that for so many people, drooling is quite a problem.  In Dr.
Lieberman's book  (Parkinson's Disease - The Complete Gude for Patients and
Caregivers), he suggests that during the day sucking on a hard piece of
candy will help as it will force the person to "remember" to swallow.  He
also suggests that for those who are in advanced stages of PD with this
problem, that their caregivers periodically remove the saliva with a bulb
syringe. Also the suggestion is made to have the person sleep on their side
so that they will not have a choking episode.

Warm Regards,

Bonnie Cunningham
NPF

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janet paterson
52 now / 41 dx / 37 onset
a new voice: http://www.geocities.com/janet313/
613 256 8340 PO Box 171 Almonte Ontario Canada K0A 1A0