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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 ?

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

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

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



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 estimated 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] 



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



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

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

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

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

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

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

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

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



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

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