I've read two interesting books recently and have included
my thoughts on them.  The names of the books are Listening to Your Body by
James W. Neumann, M.D. and Parkinson's Disease: The Complete Guide for Patients
and Caregivers by Abraham N. Liebermann, M.D. and Frank L. Williams.
Please find them in the attached file.
John Cottingham  [log in to unmask]
The following is a synopsis of some current books available at many
libraries that detail the winding path to the diagnosis (whether right
or wrong) of Parkinson's Disease.
 
Neumann, James W., MD.  Listening To Your Own Body: A Guide
To The Neurological Problems That Afflict Us As We Grow Older.
Bethesda MD: Adler & Adler, 1987
 
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Dr. James W. Neumann's book, Listening To Your Own Body: A Guide To The
Neurological Problems That Afflict Us As We Grow Older, is a guide in
paperback that describes aches, pains, diagnosis and treatment for those
50ish on.  Dr. Neumann's philosophy is that an informed patient working
with their neurologist can avoid unfruitful treatment and lead to an
earlier diagnosis.
 
Copyright on this book is 1987, which in the age of technology is old but
many of the diagnostic tests used by present day neurologists are still
valid today.  Have you looked in your neurologist's black bag lately and
seen the archaic looking tools? <G>
 
Maladies, their symptoms, diagnosis and treatment are named in each
chapter and at the end of which, are pertinent questions which if answered
in the affirmative, could indicate to your doctor that fruitful treatment
could be achieved.
 
Only one chapter of eight pages specifically discusses Parkinson's but
the check list at the end of the chapter is worth having.
 
Dr. Neumann, includes a chapter on drug side effects which is informative
in that not all doctors take the time nor do patients remember everything
the doctor tells them.
 
This book is easy to read, in a non-technical way.
 
__________________________________________________________________________
__________________________________________________________________________
 
 
Lieberman, Abraham N., M.D., and Williams, Frank L., Parkinson's Disease:
The Complete Guide For Patients And Caregivers. New York: Simon & Schuster,
1993
 
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The Complete Guide For Patients And Caregivers, is the most current, best
organized reference that envelopes the Parkinsonian issue in one document.
The copyright date is 1993.
 
Dr. Lieberman's credentials include being Chairman of the Medical Advisory
Board of the American Parkinson's Disease Association.  Frank L. Williams,
the co-author, is the Executive Director of the American Parkinson's
Disease Assoc.
 
Although, Dr. Lieberman's and Mr. Williams names grace the cover, this is
a cooperative effort with nursing, social work, legal and nutritionist
contributions.
 
Chapter 1: Understanding Parkinson Disease
 
This chapter discusses and defines the Cardinal Signs of Parkinson's
Disease which are Tremor, Rigidity, Brady(slow)kinesia(movement), and
Postural instability(unsteadiness, falling).
 
Secondary signs of Parkinson's Disease, are also discussed.  Some of them
are:
 
Gait disturbances
Dexterity and coordination difficulties
Freezing
Speech and swallowing difficulties
Visual symptoms
DEPRESSION
Dementia
Pain and sensory discomfort
Sexual difficulty
Blood pressure changes
Dermatological changes
Gastrointestinal and urinary difficulty
 
Who gets Parkinson Disease?, is also a topic of discussion.
 
 
Chapter 2: The Story of Parkinson's Disease
 
This chapter relates how the brain at the cellular level works or doesn't
work in the Parkinson patient, and the history and milestones in the
search for truth.
 
Chapter 3: PD: Its Causes and Progression
 
Since Parkinson's exists, this chapter deals with some of the theories
as to why.
 
In the stages of progression, some neurologists use the Hoehn-Yahr Scale
to determine what level of treatment is necessary.
 
Stage 0  no visible disease
Stage 1  disease involves one side of the body
Stage 2  disease involves both sides of the body, but
         does not impair balance
Stage 3  disease impairs balance or walking
Stage 4  disease markedly impairs balance or walking
Stage 5  disease results in complete immobility
 
Chapter 4: Understanding Drug Therapy
 
In Chapter 4, the four classes of drugs that are used to treat Parkinson
patients are discussed.
 
Replacement Therapy strategy uses levodopa in combination with carbidopa
to allow the brain to convert levodopa into dopamine which is in
short supply in the Parkinson patients brain.  Sinemet is this compound,
available in several ratios. The ratio 10/100 would indicate that 10
milligrams of carbidopa and 100 milligrams of levodopa are contained in
the tablet.  Sinemet is also available in controlled release form.
 
Side effects listed are Nausea, daytime sleepiness, orthostatic
hypotension(drop in blood pressure on standing), involuntary movements,
decreased appetite, insomnia, cramping.  In susceptible patients may
cause hallucinations, confusion, "on-off" effect.
 
Sinemet should be taken 1 hour before meals for maximum benefit with
one whole glass of water or juice.
 
 
 
Anticholinergics Therapy strategy uses drugs that block acetycholine,
another neurotransmitter.  In Parkinson patients, dopamine depletion
increases the excitatory effect of acetycholine, causing tremor and
rigidity.  Artane(Trihexyphenidyl HCL) and Cogentin(Benzotropine mesylate)
are two such anticholinergics.
 
The beneficial effects of Artane and Cogentin are the reduction of
tremor, drooling and rigidity.
 
Side effects listed are dry mouth, nausea, vomiting, confusion,
difficulty swallowing or speaking, blurred vision, loss of appetite
and/or weight, depression, hallucinations, constipation, urinary
retention.  Can worsen glaucoma.
 
Special considerations listed are use cautiously in elderly patients
and patients with a history of confusion.  Use cautiously in men with
enlarged prostate gland.
 
Anticholinergics Therapy is estimated to be helpful to at least 1/2 of
all Parkinson patients.
 
 
Dopamine agonist directly stimulate dendrite receptors, by-passing the
need for dopamine itself.  When used with replacement therapy, ie
Simemet, can reduce the dyskinsias(involuntary movement phenomena) and
"on-off" effect from long term levodopa(Simemet) treatment.
 
Statistically, 50% of PD patients on the Simemet dosage 3 to 5 years
experience a drop off in its effectiveness and after 10 years 80%.
Increased dosage to overcome this can bring on the appearance of side
effects.  Increasing evidence suggests that if dopamine agonist agents
are used earlier in treatment the "on-off" and dyskinsias may be avoided.
 
Two Dopamine agonist drugs are listed:
 
Parlodel (Bromocriptine mesylate), helps in all aspects of PD when used
in conjunction with Simemet to reduce symptoms and side effects associated
with long term use.  Works on D2 receptors.
 
Special consideration is that it may take several weeks for an effect
to occur.
 
Permax (pergolide mesylate) works on both D1 and D2 receptors and is used
with Simemet.  Use of Permax may allow reduction in Simemet dosage.  It
may be effective in those patients who are no longer responding to Parlodel.
 
Side effects listed for both drugs are orthostatic hypotension(low blood
pressure on standing), nausea, blurred vision, or hallucinations.
 
 
The fourth type of drugs is the MAO B inhibitors.  The enzyme,
MonoAmine Oxidase breaks down and disposes of leftover dopamine after a
synapse(transmission) takes place further depleting the available dopamine
in older PD patients brains.
 
The drug, deprenyl also know as selegiline and marketed as Eldepryl, has
been shown in a large body of evidence to act as a neuroprotector, shielding
brain cells from premature degeneration.  Dr. Lieberman hopes that the
early use of this drug could extend the length of time a patient can
function both before and after requiring Sinemet.  For moderate to
advanced cases the apparent increase in the amount of dopamine in the
striatum gives an often need "boost" to the effects of Sinemet.
 
 
 
Chapter 5: The Role of Diet and Exercise
 
Chapter 6: Coming to Terms with Chronic Illness
 
Chapter 7: The A to Z Guide to Sympthoms and Side Effects
 
This chapter is one of the most important in caregiving, observing, or
surfing the PD pathway.  PD has many faces and this guide assists in
recognizing the new and gauging the old at every milepost.
 
Over 50% of PD patients face depression, but by reading the section
on depression you can come up with some ideas on how to overcome it.
 
Chapter 8: Help for the Caregiver
 
According to a study by the Wilder Foundation, caregivers have the
following characteristics:
 
Seventy percent are the primary caregiver.
 
One-third are the sole caregiver.
 
Seventy-two percent are women.
 
Among men, husbands and sons are the most common caregivers.
 
Most caregivers are spouses.  When a spouse is not available or able,
usually a daughter or daughter-in-law, becomes the caregiver.
 
Among older caregivers who are spouses, nearly half report that they
are concerned about their own health.
 
One-third of family caregivers are employed and have employment and
parental responsibilities in addition to their caregiving duties.
 
 
If you are a woman--married or single--taking care of someone who is
chronically ill, you're likely to be under particular stress, stretching
yourself in too many different directions.  READ THIS CHAPTER CAREFULLY,
AND TAKE TO HEART THE SUGGESTIONS FOR REDUCING STRESS AND BOLSTERING YOUR
SELF-ESTEEM.
 
 
Chapter 9: Planning Your Financial Future
 
Chapter 10: Parkinson's Disease and the Future
 
A new agonist called cabergoline is currently under investigation.  This
is the therapy that mimics dopamine and may be given once a day and provide
more long lasting relief of symptoms.
 
Only the University of Colorado and Yale University School of Medicine
are doing fetal tissue research.  Perhaps this is about to change in as
much as the Clinton Administration has relaxed rules on this matter that
effects us.
 
Appendix I: Resources for Patients and Caregivers
 
 
 
The National Parkinson Foudation is known primarily for its diagnosis,
treatment, and research center in Miami, Florida.  Informational booklets
and a quarterly newsletter are available upon request.  The foundation
has established research centers at Yale University, New Haven, Conn;
The Graduate Hospital, Philadelphia, PA;  Vanderbilt University in
Nashville, TN;  Baylor Medical School in Houston, TX;  University of
Southern California and Loma Linda University in Los Angeles, CA.
 
National Parkinson Foundation, Inc.
1501 N.W. Ninth Avenue
Miami, FL 33136
 
(305) 547-6666
 
The United Parkinson Foundation was founded in Chicago in 1963 to keep
patients educated about the latest developments in Parkinson's disease
research,  the UPF sends regular newsletters and other literature,
usually free of charge upon request, to interested patients and caregivers.
 
United Parkinson Foundation
220 South State Street
Chicago, IL 60604
 
(312) 922-9734
 
The Parkinson's Disease Foundation is affiliated with Columbia University.
The PDF places primary emphasis on research to find the cause and cure
for Parkinson's disease.
 
Parkinson's Disease Foundation
William Black Medical Research Building
640 West 168th St.
New York, NY 10032
 
(212) 923-4700
 
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In my humble opinion, Dr. Lieberman and Frank Williams have lent their
names to "THE" Parkinson's disease reference of the year.  This book
touches all bases and is as easy to understand as it is to read.
 
It is available at most libraries but you will want to buy it so that
you can note your progress and to answer that forgotten question in
your "quiet time".  If I didn't quote from a particular chapter that
had a title that interested you, get it and read it.
 
John Cottingham              [log in to unmask]
Del City, OK 73115-1867