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