Parkinsons disease, parkinsons health and beauty tips

Melanoma Awareness & Tips for Prevention: By Dr. De Leon

maca

Let the Sea Cleanse You

“When anxious, uneasy and bad thoughts come, I go to the sea, and the sea drowns them out with its great wide sounds, cleanses me with its noise, and imposes a rhythm upon everything in me that is bewildered and confused.” ~ Rainer Maria  Rilke

It is important to realize that melanoma is one of the most common types  of skin cancer which are prone to become life threatening if not treated early. These forms of cancer can happen even in dark skin individuals and occur in places not directly exposed to the sun. Therefore, as we draw to the end of Melanoma awareness moth and summer months are about to begin (at least here in the Western Hemisphere), I would like to remind everyone of the importance of knowing the risk factors as well as encouraging everyone to have routine check-ups by a dermatologists. After all, melanoma is a curable type of skin cancer if detected early with a 100% success rate.

Some groups of people such as Parkinson’s patients appear to have an increase risk of developing this type of skin cancer.

Although, the exact mechanism for increase risk in PD is not well understood; yet there is a 2- 4 increase risk in those who have Parkinson’s of acquiring melanomas.

 Sign’s of Melanoma:

Know your ABCDE’s

A-asymmetry– the mole does not look the SAME on both sides.

   

B-border– the mole is irregular or scalloped.

C- color– dark color varying from one side to another with varying shades of tan, brown or black, these sometimes can be white, red or blue ( which could be a sign of an even more malignant and aggressive type of cancer known as Merkel cell carcinoma).

 

D-diameter -these are typically the size of a pencil eraser ~ 6mm but can be smaller – (take it from me – I have had several diagnosed some smaller and some much bigger! So know your body and do frequent checks especially best to  evaluate moles is in the winter and best to do in your birthday suit at least every six months. (excerpt from Parkinson’s Diva: A Woman’s Guide to Parkinson’s Disease)

 

E- Evolving– any skin mole that appears different from the rest or any lesion that looks like is changing (evolving) in color, shape, or size needs to be looked at immediately by a Dermatologists.

Symptoms of Melanoma:

Usually they are asymptomatic especially in early stages.

Watch out for moles that:

  • bleed
  • itch
  • painful to touch
  • bruises that won’t heal
  • brown or black streak underneath a toe nail or finger nail

Risk for Melanoma:

  • men
  • older than 50
  • having 50 plus moles, unusual  looking moles, and having large moles
  • having fair skin (e.g. blond hair, blue eyes)
  • sun-sensitive skin (easily burns, rarely tans)
  •  previous history of using tanning beds or had a previous bad sun burn
  •  weakened immune system
  • family history of melanomas
  • personal history of skin cancer especially melanomas
  • having PD -especially LRRK2 gene

Tips for Prevention of Melanoma:

If you have had a melanoma you have a 5x greater risk of developing melanoma! so frequent exams at home and at your dermatologists are key to prevention!

  • Do not do tanning indoors or outdoors- indoor tanning increases risk of melanoma 75%.
  • examine your skin regularly- enlist the help of a loved one for those hard to reach places. make sure you check your feet, palms, soles, toenails, fingernails, genital regions, and your scalp.
  • keep eye appointments regularly because melanoma can also affect the eyes.
  • get free screening -usually the American Academy of Dermatology gives several FREE screens during the spring throughout the US.
  • if you see any of the abc’s during any of these evaluations call your dermatologist’s immediately.
  • spend time outdoors when the sun and UV light is less intense before 10 a.m. and after 4 p.m. (in the US)
  • use sun block lotions liberally. Make sure you use proper sunscreen. No natural products because they are not safe to stop damage from UVA & AVB rays.
  • wear sunglasses with UV protection.
  • Make sure that the sunscreen you choose contains ingredients like Titanium Dioxide, or Zinc Oxide. The SPF 15 or higher is only for UVB protection; A SPF 30 or higher is recommended for those of us who have Parkinson’s because of our increased risk factor. There is no rating to tell us how good something is against UVA.
  •  Apply sunscreen  at least 30 minutes before you go in the sun. Don’t forget to apply under your make up, feet, between your toes, tip of ears, nose and lips (use lip balm with UV protection) as well as back of legs and neck.

Sources:
“The association between Parkinson’s disease and melanoma;” International Journal of Cancer; 128, 2251-2260 (2011)

https://http://www.aad.org/…/diseases-and-treatments/m—p/melanoma
Parkinsons disease, parkinsons health and beauty tips, parkinsons symptoms, parkinsons treatments, parkinsons y tratamientos

Bowel Incontinence Another Embarrassing Casualty of PD: By Dr. De Leon

We all know that since we got diagnosed with PD our bodies don’t work just like they use to; much to our chagrin it does not always respond like we would have it. Sometimes our voice leaves us in the middle of an important conversation with our best friend, other times it cause us to be embarrassed when our fine motor skills betray us and food goes flying across the room especially when we are trying to impress someone we like while on a date. Our handwriting has caused a commotion once or twice at the bank when we have gone to withdraw money because our signature is just not the same! We might have even caused a scene when we unexpectedly tripped on nothing but air. Yet, all of these may pale in comparison it seems when suddenly in the middle of a shopping spree, while driving or simply going about our usual business we lose control of our bowels without warning.

We sit there embarrassed, humiliated, wishing that the earth would suddenly open up and swallowed us whole. Of course it never does so we are left feeling impotent because we may see this as the ultimate sign of PD gaining victory over us.embarresed

What then? Do we cry, do we scream, or simply retrieve to hide under our covers and never come out?

Well, this would not be practical in deed. As foolish as we may feel at the time, I want to tell you that you are not alone in this feeling. So many of us since being diagnosed with Parkinson’s have done many silly things but the truth is that as the song says “we all play the fool sometimes,” with or without PD  sometimes we simply wake up on the wrong side of the bed! Instead of being hard on yourself or refusing to ever go out laugh about it- if you are alone although strangers may seem to stare you will NEVER see them again! Frankly, most people are too busy going about their usual lives to notice such mishaps unless you publicize it! So basically it is us who have to come to terms with this perceived sudden loss of dignity. If you are with friends or family they will understand and be supportive. Best thing to do in any embarrassing situation is laugh after you have composed yourself a bit; this will help ease the feeling of vulnerability!

Okay, now for serious part:

After you have had a big laugh and chucked it up to yet another casualty of PD …then you may wonder why do PD Patients have bowel incontinence? Will it happen to you again?   

First, as we all know Parkinson’s disease affects all of gastric motility function causing it to slow down to nearly a crawl. Compound this effect with the fact that the large consumption of medications make us severely dehydrated and we also have decrease mobility because we are either too stiff, hurting, or off balance to get around with ease, the end result is severe constipation to the point at times of impaction.  Fecal Incontinence as this condition is known where you lose control of your bowels although more common in the elderly can happen to anyone 1/10 people sometimes in their lives. Having Parkinson’s is another risk factor because as I said we do not empty our bowels properly, especially at risk if have feeding tubes.

What can you do to prevent or becoming a hermit your only option?

Since constipation can be so severe or impaction stool can build up behind it and begin to “leak” out around obstruction leading to bowel incontinence. Watch for staining of your underwear, problems reaching toilet in time because of mobility, abdominal bloating or cramping.

  • Main thing to prevent is one make sure there are no other causes like inflammatory bowel disease, diabetes, nerve problems.
  • Then if the problem is getting to bathroom in time have doctor modify your medication regimen to improve mobility.
  • Also, make sure that you maintain a good bowel regimen- includes going to the bathroom daily- using stool if needed and medications both over the counter as well as prescriptions to keep regularity and avoid constipation.
  • Change diet- no caffeine like in coffee or tea; no alcohol; if necessary and get a dietary consult as well as Gi consult.
  • avoid taking Mira lax, fiber tabs or other fiber supplements.
  • Wear depends go to www.Underwareness.com has garments for both men and women that feel and look more natural like underwear.
  • wear the latest “butterfly” pads www.butterfly.com
  • If all this fails you can have medications to harden stool. Also try behavioral modification (biofeedback).
  • If still having problems there are surgical procedures to tighten muscles around sphincter as well as surgical implant with neuromodulator produced by Medtronic’s called InterStim (sacral Nerve stimulation).

As you can see this can happen to any of us even if  we don’t have PD ..so don’t sweat the small stuff – there a lot of things to help if this is a problem but keep moving forward and not letting PD define who you are!

Sources:

http://www.medtronic.eu/your-health/fecal-incontinence/

Parkinsons disease, parkinsons health and beauty tips, parkinsons symptoms, parkinsons treatments, parkinsons y tratamientos

Improving Quality of Voice in PD: By Dr. De Leon

singing

We have all experienced a change in our voices as Parkinson’s has taken over our lives. It can be extremely frustrating for both the person with Pd as well as the caregiver to constantly be asking to reiterate what he or she said. This is because family thinks we either mumble or slur or words when we speak which only escalates the frustration when trying to have a conversation especially in noisy places.

First you must remember that your voice is produced by muscles in your throat which are also getting stiff and slow so you must take care of them.

Ways to Care for your Voice:

1) Do not strain them by shouting over loud noise when you speak. I often get severely hyphophonic (soft voice), aphonic (no voice) even dysphonic (difficulty producing sounds) if I have to force myself to speak very loud for a long time in a loud environment.

2) Rest your voice when is tired and cover your throat with a scarf, the warmth is not only soothing but heals it when has been over worked.

3) Make sure you don’t have heartburn because this can injure your vocal cords.

4) Drink plenty of fluids especially water.

5) Avoid caffeine and alcoholic beverages.

6) I recommend that everyone should be evaluated by a speech therapist and undergo the LSVT (Lee Silverman Voice Treatment) program with a certified professional to improve output and projection of voice.

Another great exercise for maintaining your voice is singing! Join a choir or sing at home or join a PD singing group some of which are beginning to pop up around the country like the “Spokane Tremble Clefs.” people singing

But don’t strain your vocal cords; gently reach for both high and low notes while singing the lyrics as clear as you can. I guarantee that not only will your voice improve but your spirit will soar.

***One interesting scenario***

My daughter had a wonderful end of year music program in which I was so very proud to see her blossom. She put many hours of preparation at home singing. She was so excited that on one occasion she asked me to join in on the more popular songs. As we started to sing I quickly experienced spasmodic dysphonia. Although this was pretty funny to my daughter, we continued to sing. Then I switched to singing in Spanish since they were also popular in my native tongue what I discovered was something fascinating. I could sing perfectly well in Spanish (with a beautiful voice); yet I could no longer hold a tune in English. I knew that since my diagnosis with PD my voice had altered. Never had I noticed that it was only in my second language.

As a neurologist, I had witnessed many times bilingual patients suffering strokes in the areas of speech losing only their second language but never notice same type of phenomena occurring in my PD patients. There is something to be said for learning more than one language and brain’s ability to compensate for loss. So keep on singing and learning …if you already speak other languages give your PD voice a rest by switching languages or better yet learn a new one!
Sources:

Johnson, Marjorie L. National Parkinson’s Foundation- “Parkinson’s Disease Speech and Swallowing.”

parkinson's disease, Parkinsons disease, parkinsons health and beauty tips, parkinsons symptoms, parkinsons treatments, sleep disorders in parkinson's

Is ReM Behavior Ruining your Sleep? Here Are Some tips to improve life at night: By Dr. De Leon

At Night, Do You Feel Like You Are in the Ring With a Boxer Instead of Your Partner with PD? By Dr. De Leon.

Parkinsons disease, parkinsons health and beauty tips, parkinsons symptoms, parkinsons treatments, sleep disorders in parkinson's, tips for sleep hygiene in PD

Is ReM Behavior Ruining Your Sleep? Here are some tips to improve life at night: By Dr. De Leon

mv.m

This happened to my poor husband and me, as it does to nearly  1/2 of the bed partners of PD patients  around the world since REM Behavior is reported to occur in about 47% of Parkinson’s patients….

I have been having vivid dreams and talking in my sleep for years, I would not be a good secret agent as per my husband. My sleep talking (about 70% of individuals have somniloquence-talk in sleep in some point in their lives without being aware) drives my husband crazy because I usually speak in my native tongue.  As my Parkinson’s disease has advanced, my dreams have become more vivid more frequent thought the night and my sleep talking has increased. However, over the last few months I noticed that my sleep talking had become louder to the point of awakening me. Then one morning I awoke to find my husband had built a wall of pillows between us for “protection,” he said. sleep talking

“Against whom?”  I asked.

“You, of course! I always knew that you were lethal. But, now I have confirmation!” He stated in a jokingly matter. ( I guess I picked up a thing or two watching all the boxing matches with my dad who was an avid boxer and boxer aficionado!)

A few days later in the middle of the night, I again awoke flinging my arms in the air and talking. Later the same night, I awoke because I felt hit something hard.  Apparently, I had punched my husband and was pulling his t-shirt. He was desperately pushing me away without trying to hurting me. “Sorry,” I muttered and fell asleep rather quickly.

Next day, at bed time he was building a bigger barrier.

“It’s amazing how you can’t throw a punch to save your life when awake,” he said “but people better what out if they try to mess with you when you are asleep. You throw a big punch that leaves a sting like ALi.”

After laughing, I apologized feeling really guilty. I told him that I was now having REM behavior ( RDB) due to my PD which was not only  causing me to ‘act out’ my wild dreams but was awaking me from sleep frequently since I was beginning to hear myself talk, punch and flail my arms in the air repeatedly.

“You are dangerous,” he commented. “If this keeps up, I may have to start sleeping in another room for my own safety.”

I knew it was time to adjust my meds recalling several patients who had gained weight suddenly not knowing the reason why only to find out they were sleep walking and raiding their refrigerators.sleepwalking-1

Others had broken bones from suddenly jumping out of bed and tripping on objects near bed. While other patients of mine had injured themselves on open chest drawers nearby. these scenarios were causing many partners to seek separate beds at night for fear of being assaulted by Manny Pacquiao’s and Floyd Mayweather’s and other famous boxer’s impersonators everywhere.  Even frail and weak appearing PD individuals can develop the strength of 100 men when in violent rage awake or asleep. I know I have seen it first hand as a doctor, a caregiver and a patient.

Thus, not wanting to continue 1) injuring my husband; 2) risking hurting myself; 3) continuing experiencing restless nights and chronic fatigue from lack of sleep; I increased my dopamine dose and started melatonin at night. I am sleeping better once more. My husband’s barricade has decreased and he no longer sleeps on the edge of the bed but still keeps a pillow nearby for protection just in case.

Few days ago, I asked him if I was still spilling state secrets. He answered in the affirmative, I surely would make a horrible spy I thought to just myself; but at the moment it appears that my boxing days and extreme fighting in bed at least for now appear to be behind me. I feel well rested and my dreaming although vivid has quieted down.

Things to know about REM behavior:

Sleep disorders is one of the most common non motor Parkinson’s symptoms that can precede motor symptoms of Parkinson’s many years before tremors and stiffness become noticeable. They can also occur in various forms ranging from insomnia, RLS, REM behavior (RDB) as the disease progresses. REM behavior is also known as “dream enacting behavior.”

Typically in REM sleep, which is part of deep sleep, our brains are very active and we experience a lot of dreaming while our bodies remain paralyzed. We usually go through this stage many times during the course of the night. About 20% of our sleep is spent in this stage which usually occurs more commonly in the second part of the night. REM behavior is more common in men over age 50 but more women are experiencing this phenomena (perhaps this goes along with the new trend of young women developing PD).  This sleep disorder is very common  in neurodegenerative diseases like Parkinson’s, MSA and dementia of Lewy body (LBD); it is also seen in narcolepsy. It can be the initial symptom of PD and MSA as well as that of  dementia of Lewy Body.

Dream enactment differs from night terrors by way that people if awoken from an episode of REM Behavior they are fully awake not confused and remember details of the dream unlike those with night terrors who have no recollection and are not fully awake.

Symptoms of REM Behavior include :

  • kicking,
  • talking,
  • punching,
  • arm flailing,
  • jumping
  • walking,
  • laughing,
  • shouting,
  • shouting profanity
  • at times emotional out cries.

Treatment:

  • increasing dopamine dosage,
  •  intake of small doses of klonopin is highly effective in most patients up to 90% with doses of .25 mg; it has complete effect in 79% of patients and the great thing about it is that it appears to do so without building tolerance or abuse.
  • The other extremely effective medication is over the counter melatonin in doses 3-12 mg taken at dinner around 5-6 pm.
  • tegretol ( carbamazepine) has also been shown to help
  • Mattress should be placed on floor
  • Put alarms in beds
  • remove potentially hazardous objects from around bed. One patient broke his lamp because he picked it up as sword, fortunately his  spouse awoke him before he struck her with it!

Habit-of-talking-in-sleep

Sources:

http://emedicine.medscape.com/article/1188651-treatment

http://www.mayoclinic.org/diseases-conditions/rem-sleep-behavior-disorder/basics/definition/con-20036654