here is a sample,  very few postings today

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               A MESSAGE FROM ASK THE DOCTOR
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In the coming months, we will be adding some exciting new features.  This includes some major changes to "Ask The Doctor" and our other forums.  We'll post more information as it becomes available.
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Without seeing you and examining you the doctor cannot make specific diagnoses and recommendations.
The suggestions given in this forum are for general information only.
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ASKTHEDOCTOR Digest for Tuesday, September 14, 2004.

1. Parlodel side effects
2. JAW AND MOUTH PAIN
3. Symptoms
4. nose survey
5. (no subject)
6. DBS
7. Dopamine and zinc
8. Apokyn
9. Re: Requip sinemet
10. weakness
11. Message 7 on 9/14
12. hands freezing or ?

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Subject: Parlodel side effects
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 15:41:44 -0400
X-Message-Number: 1

Dear Dr. Lieberman,                     September 13, 2004

I have been taking levodopa (Prolopa) and Jumexal since 1999.  My doctor
put me on Parlodel on June 6, as an adjustment to help my end of dose
problems.   However, I have read several of your comments about agonists
and it seems clear to me that Parlodel may show more side effects and be
less effective than Requip and Mirapex.  Now I have just read in a past
digest your comment that “parlodel is an ergot compound which may lead to
conditions such as below for a similar compound pergolide )”   with
reference to the following article:
http://www.parkinson.org/pdheartvalve.htm .  When I try to access the
article it takes me to a NPF web page and says “Page not found”.  Could
you tell me how to access this information as I would like to show it to
my doctor.  Also, given a choice between Requip and Mirapex, are their
side effects similar or sustantially different and which one would you
recommend?

I am glad you had the change of pace of the Paris meetings where the
chance to exchange ideas with so many other neurologists must have been a
vauable opportunity.  As always, thank you for your help and advice.

Susan in Costa Rica
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comment
 please see below


Pergolide use in Parkinson disease is associated with cardiac valve regurgitation.

Baseman DG, O'Suilleabhain PE, Reimold SC, Laskar SR, Baseman JG, Dewey RB Jr.

University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX 75390-9036, USA.

OBJECTIVE: To determine if pergolide injures heart valves, by comparing echocardiographic findings in pergolide-treated patients with those of a historical control group. METHODS: Letters were sent to all patients in the authors' practice believed to be taking pergolide, and those responders who wished to continue it were urged to undergo echocardiography. Echocardiograms were obtained on 46 patients, and scores for valvular regurgitation were compared with those from an age-matched control group derived from the Framingham Study. The composite valve regurgitation score was modeled as a linear function of total milligrams lifetime use of pergolide, controlling for age. RESULTS: Eighty-nine percent of pergolide-treated patients had some degree of valvular insufficiency. For each of the three valves for which there are control data, we found an approximately 2- to 3-fold increased risk of abnormal valves in the pergolide patients (odds ratio [OR] approximately 3) and an estima!
ted 14-fold increased risk of concerning tricuspid regurgitation (OR = 18.4). The composite valve score (the sum of valve scores for each of the four valves) was a function of lifetime pergolide use. CONCLUSION: Pergolide may injure cardiac valves, resulting most commonly in tricuspid regurgitation.

PMID: 15277624 [PubMed - in process]

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Subject: JAW AND MOUTH PAIN
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 14:52:39 -0500
X-Message-Number: 2

I am a female 58 years old.  Parkinson since April 2004.  Began taking =
Mirapex August 2004.  I have been having jaw, mouth, and tongue pain for =
the last week.  One day my tongue felt like it was swollen.  Could this =
be part of Parkinson or is this something else maybe due to dental =
problems or clenching teeth in sleep?
Thank you
Dorothy
_________________________________________________________________

as a rule such problems are likely to be local related to something in the mouth jaw or teeth   occassionally they turn out to be a dystonia
 a muscle spasm related to pd
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Subject: Symptoms
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 15:51:38 -0400
X-Message-Number: 3

Dr. Lieberman,

My neuologist thinks I might have PD (Dr. Baristain in Indianapolis).
Anyway, my symptoms include left hand tremor, internal and jaw tremors and
I don't swing my right arm when I walk.  I think he is probably right.

My question is regarding my left arm.  I find myself holding it close to
my body a lot and keeping my hand clenched in a fist even when walking -
are these also symptoms of PD too?

Thank you.

Lora
______________________________________________________________________

Yes
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Subject: nose survey
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 16:03:59 -0400
X-Message-Number: 4

 could you send me a copy of your nose survey.
______________________________________________________________________

Could the CAUSE of PD be as plain as the NOSE  on your face?

The cause of PD is unknown.  It could be genetic, environmental, or viral. For an environmental toxin or virus to cause PD, it must enter the brain.  The nose, through the olfactory nerve, provides direct access to the brain. In addition there are rich connections between the blood vessels of the nose, the lungs, and the brain.  It’s why  certain drugs  when applied inside the nose, or inhaled through the nose, act so quickly.
    In PD, 50% of patients lose their sense of smell. It’s as though something entered the nose and traveled to the brain. Smoking cigarettes  may protect you against PD. It’s as though cigarette smoke “killed” a toxin.
    Each day we  inhale 2500 gallons of air.  In a year we  inhale 10,000,000 gallons of air. If there’s a toxin, or a virus that causes PD, a concentration of one part per million, means we inhale 10  gallons of it each year. Why don’t we all get PD?  Perhaps not all of us are exposed,  perhaps some of us have worse filters, or broken filters.
In light of the above, we’d like you to answer the following questions.
For each person with PD who takes the test, we’d like you to provide a “control”: a spouse, a partner, a friend, someone  your age who doesn’t have PD.

For the  Patient

_________I am a PD patient
_________Age
_________Duration of PD
_________Male
_________Female

1   Yes   No   Had a broken nose?  Or a deviated  septum?  Or surgery on your nose?
2   Yes   No   Had many sinus infections?
3   Yes   No   Had  many  episodes of flu?__________________________________
4   Yes   No   Lost sense of  SMELL?
5   Yes   No   YEARS of exposure, to fumes,  gases, or vapors?
6   Yes   No   Worked for YEARS, in a mine, a petroleum field, an oil refinery,
        a fertilizer plant,  a blast furnace, or as a welder?_______________
7  Yes    No   HEAVY exposure  to Agent Orange?
8  Yes    No   Diagnosed with Gulf War Syndrome?
9  Yes    No   Smoked cigarettes or cigars?__________________________________
     10   Yes    No   Often picked your nose?
     11   Yes    No   Often had nose bleeds?
     12   Yes    No   Often used  nose drops? Or nasal sprays? Or sniffed drugs into nose?

For the “Control”

_________I don’t have PD
_________Age
_________Male
_________Female

1   Yes   No   Had a broken nose?  Or a deviated  septum?  Or surgery on your nose?
2   Yes   No   Had many sinus infections?
3   Yes   No   Had  many  episodes of flu?__________________________________
4   Yes   No   Lost sense of  SMELL?
5   Yes   No   YEARS of exposure, to fumes,  gases, or vapors?
6   Yes   No   Worked for YEARS, in a mine, a petroleum field, an oil refinery,
        a fertilizer plant,  a blast furnace, or as a welder?_______________
7  Yes    No   HEAVY exposure  to Agent Orange?
8  Yes    No   Diagnosed with Gulf War Syndrome?
9  Yes    No   Smoked cigarettes or cigars?__________________________________
     10   Yes    No   Often picked your nose?
     11   Yes    No   Often had nose bleeds?
     12   Yes    No   Often used  nose drops? Or nasal sprays? Or sniffed drugs into nose?




----------------------------------------------------------------------

Subject: (no subject)
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 16:46:54 EDT
X-Message-Number: 5



To you, Doctor, who work so tirelessly on our behalf, to those who help
behind the scenes, and to all who read this column: (no matter your religious
belief)
I send good wishes for the coming year.  May it bring peace, better  health,
and happiness. Shana Tova.
Ev


_____________________________________________________________



and a good new year to everyone
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Subject: DBS
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 16:56:10 -0500
X-Message-Number: 6

What sould I expect from a DBS?  Sam in Austin, Tx.

____________________________________________________________

comment
 it depends on what your symptoms are
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Subject: Dopamine and zinc
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 19:54:58 -0400
X-Message-Number: 7

Dr. Lieberman:

I must've missed the above paper - could you please send your synopsis again.

Thanks so much, wonderful man!

Suzy
_____________________________________________________________

in essence the paper tried to make a case for zinc resulting in pd
 i don't think it did
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Subject: Apokyn
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 20:16:22 -0400
X-Message-Number: 8

Dear Dr, Leiberman,
I am 58 yr.old female.  Was dx with pd in jan2004.   I do not have tremors
but I do have freezing on a daily and regular basis.  It is maddening to
have this.  I fall down often and I am really afraid of breaking a bone. I
have a history of breaking an arm and a hip about 10 years ago.  I am
currently on sinemet 25/100 2 x a day and have  tried requip mirapex and
permax.  Nothing seems to help the freezing .  I am also unable to write
anymore due to the pd. I once had beautiful handwriting.  I am seeing my
neuro this friday and wanted to offer him some suggestions for trying
another med.  What is the best choice of meds to try now. I have read
about the new apokyn and wondered if this would be a good choice or is it
better to try staleveo,, comtan , selegine or amantidine Where do we go
from here?
Pat
______________________________________________________________

freezing is a complex problem one that we do not well understand
 it responds in part to sinemet  and occassionally to selegiline  and amantadine  it is being aggressively studied in several places  including here in miami  i wish i had more to say about it
----------------------------------------------------------------------

Subject: Re: Requip sinemet
From: "Anonymous" <[log in to unmask]>
Date: Mon, 13 Sep 2004 09:54:12 -0500
X-Message-Number: 9

from a reader

I started t aking Sinemet as soon as I was diagnosed with PD.  It worked for
me and I have done very well so far--11 years into PD.  I currently take
Sinemet, Comtan, Permax (but I am switching to Requip or Mirapex because
Permax is an ergot  based drug which supposesdly causes some heart valve
damage), Zoloft, Sinemet CR, and Tizanidine (muscle relaxer).  I truly
believe if I did not have my meds I would be confined to a wheelchair.  I am
so very thankful!!!  I am able to function almost normally.

Carol
Alabama

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Subject: weakness
From: "Anonymous" <[log in to unmask]>
Date: Tue, 14 Sep 2004 03:20:23 -0500
X-Message-Number: 10


I have had Pd since 1989. I am at the stage where I am unable to get up =
off the chair etc. without lots of help.  Would the use of an excercise =
bike strengthen my  arms and leg muscles? I am unable to walk more than =
1/2 block.
________________________________________________________________

i don't know if it will strengthen your arms or legs  but exercise whether it does or does not strengthen your arms and legs is important for your cardio vascular system   your lungs and your bowels  (no exercise fewer bowel movements)
----------------------------------------------------------------------

Subject: Message 7 on 9/14
From: "Anonymous" <[log in to unmask]>
Date: Tue, 14 Sep 2004 04:35:55 -0700
X-Message-Number: 11

From the way the writer described the pain, originating on the right side of
the lower back and radiating around to the front on the lower abdomen, it
sounds like Robbie could be dealing with a kidney infection. That pain is
exactly what I dealt with for 4-1/2 months until my infection was diagnosed.
Marilyn



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Subject: hands freezing or ?
From: "Anonymous" <[log in to unmask]>
Date: Tue, 14 Sep 2004 05:53:58 -0700
X-Message-Number: 12

Dr. Lieberman
    Thanks for considering my question re: c-shaped, or bowed vocal chords.
Now I have another question. I'm still able to do some hand needlework every
day, but I notice that as I get tired, my embroidery needle or knitting
needles or crochet hook won't move -- my hand coordination simply freezes. I
have to become consciously aware of this fact, try to back out of the frozen
position and attempt to start the maneuver over again. Sometimes this works,
other times I simply have to put the project away until the next day. I have
had no freezing episodes of the feet, just wonder if you'd comment on
whether this is indeed what is happening, or if  I'm just tired/falling
asleep, whatever? I'm not on Sinemet, am 58, diagnosed for 7 years, am on
Mirpex (4.5mg daily, 3 doses of 1.5 each), Remeron, Neurontin and mysoline.
My neurologist was intrigued by this comment.
    Lory

_________________________________________________________________

 the problem you describe in the hands  sounds like exhaustion   you, in effect, run out of dopamine
  freezing of gait  the freezing we talk about effects the feet   the feet unlike the hands have to work as a team  and when the team work breaks down  the patient freezes   the hands are programmed so that they can work independently   there's something about working together that results in freezing


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END OF DIGEST

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