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