chronic illness, parkinson's disease, Uncategorized

Treatment for over active bladder in Parkinson’s (revisited) : by Dr. De Leon

I am sure you guys have seen the commercial for inflammatory

disease -ulcerative colitis/Cronhs- where it says that no matter

where you go and the situation the view is always the same…and

shows a bathroom door.

because of this I decided to re- post since this is a huge issue

affecting so many of our lives which greatly impact our quality of

life but more importantly is a problem which has a solution in most

instances..for more information stay tuned to a mjfox webinar

i will be participating in on 4th Thursday of this month…please be

sure to stay tuned. It will take place on April 20th from 11am-12 CT/12-1pm ET Dr. Jorge Juncos and Dr. Janis Miyasaki are the leading experts for this talk.

 

 

Whenever somebody tells me, you go girl! I generally have to!” -unknown

As I mentioned before in a previous blog Parkinson’s patients as do patients that have various parkinsonian syndromes like MSA ( multi system atrophy) can have varying degrees of bladder issues ranging from increase urgency,frequency to outright incontinence!  Having bladder function problems can lead to severe psychosocial problems like depression and anxiety particularly among patients over 65 years of age, they can also lead to significant medical and economic burden.  This is by no means an easy task to solve since independent of neurological disease, over active bladder ( OAB ) affects up to 27% of men and 43 % of women of the global population. Now add a neurological condition atop of this and the problem becomes even more challenging for physicians.

Fist,we should review a few medications which make this problem worst, if possible should try to avoid:

  • Diuretics
  • antipsychotics
  • cold medicines
  • narcotics
  • sedatives
  • hypnotics
  • antidepressants
  • antihypertensives
  • analgesics
  • Over the counter sleep aids
  • herbal remedies

Proper management of patients with urinary problems like any other problem begins with a thorough and comprehensive evaluation, including a void diary, urine test to look for infections, diabetes and the such. Of note those of us who have chronic illnesses by definition are on multiple medications which tend to complicate evaluation and treatment but worsen by age. Physical exam is also extremely important since it can tell physicians for instance if there is enlarged prostate in men or enlarged uterus in women causing pressure on bladder or blocking sphincter. Your doctor may choose to do urodynamic studies which includes measuring pressures of pelvic muscles and urethra and voiding flow-this sometimes requires insertion of needles into bladder and abdomen to evaluate…can be uncomfortable and moderately painful at times especially if you are in mid to late stages of disease. Other tests may include cystoscopy which involves looking into bladder with a camera inserted through a long narrow tube via the urethra …similar to a colonoscopy except different organ! Other times, they may simply choose to do volumetrics…fill your bladder with fluids via an IV ( intravenous Cath) until they can reproduce symptoms.

Once all these studies are done, which usually are done either by a urologists or a gynecologists, and a cause of the urinary malfunction is ascertained then treatment can be instituted.

Aside from evaluating all medications which MUST always be done at the onset of any visit to make sure current medications are not the ones causing or aggravating the problem, an adjustment of dopamine medications is often necessary and should be done early on as well. This is because Parkinson’s and other parkinsonian syndromes commonly have bladder dysfunction as part of the disease spectrum. If however you are still having problems after going through above steps then the recommendations are as follow:

1) Behavioral modification:

This entails a strict commitment on the part of the patient in order to improve voiding…if done properly..it can be very effective. Insurance will pay for this however, must go to a trained professional experience in this type of therapy to have greater success rate.

I like this because this is treatment modality epitomizes “individualized medical care

This includes voiding diaries, timed voiding, pelvic floor muscle strengthening exercises, and urge suppression techniques (e.g distraction, self-assertions), biofeedback, electrical stimulation into sacral nerves or pelvic muscles, fluid management, caffeine, reduction, dietary changes ( I.e avoiding bladder irritants like caffeine, chocolate, spicy foods etc.), weight loss and other life style changes.

The beauty of this is that it can be combined with other treatment modalities.

2) Pharmacotherapy:

this includes a number of oral and transdermal( across skin) medications. These can be very effective and used after behavioral therapy failed or in combination. However, their efficacy is limited due to side effects although usually non life threatening. All medications come in extended release.

The medications in this class are primarily antimuscarinic- they include oxybutin (Ditropan, Oxytrol), tolterodine (Detrol), solifenacin (Vesicare), darifenacin (Enablex), **trospium (Sanctura- does not cross blood brain barrier), fesoterodine (Toviaz). **This latter may be best suited for treatment of elderly patients due to less side effects. Typical side effects of this class include dry mouth, constipation,dyspepsia, urinary retention, urine infections, impaired mental status, and dry and itchy eyes. Since a lot of these symptoms can already occur with PD or as side effect of other PD medications have to be extra vigilant when starting these meds and discuss any sudden changes with your physician ASAP!

The new comer is mirabegron ( Myrbetriq) for those that can’t tolerate antimuscarinic. Although may act as one it is a beta 3adrenoreceptor. I find this medicine to work very well especially for those patients that have mixed type urinary problems where they have over activity and increase sphincter control.

3) Botulinum toxin A:

Once patient had failed above treatments, your physician may suggest this treatment modality. However, not everyone is qualified to do this procedure…it requires operating room time and frequent visits…effects can last up to 9 months (on average 6 months). You Must always have an experienced physician doing this procedure. It is expensive and not all insurances cover costs.

4) Sacral neuromodulation:

This has become the leading treatment of choice for those that do not respond to normal treatments. This treatment was approved since 1997 by FDA . Reports have shown great efficacy and safety with gradual implant of electrodes into third sacral nerve foramen (aperture) initially during a test phase of 1-2 weeks followed then by implantation of pulse generator. The electrical impulses delivered to the root of the third sacral nerve has been shown to reduce urgency, frequency, and incontinence. Most common side effects include pain at stimulator site, pain at lead site, lead migration, electric shock, and revisions. However, as these procedures are done more frequently, they are becoming less invasive along with smaller devices which will lead to fewer adverse effects. Just like having DBS, you will need periodic adjustments and will not be able to do MRI’s and will require replacement of pulse generator.

5) Surgical Intervention:

This still remains as the last possible alternative for severe cases that are unresponsive to any of the above treatment modalities.

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References-Kim, Ja-Hong. Management of Overactive Bladder and Urge incontinence. Practical Neurology. Vol. 13, No.7, September 2014. 27-32.

Copyright-2017

All tights reserved- Maria De Leon MD

Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com All materials here forth are property of Defeatparkinsons. without express written consent, these materials only may be used for viewers personal & non-commercial uses which do not harm the reputation of Defeatparkinsons organization or Dr. M. De Leon provided you do not remove any copyrights. To request permission to reproduce release of any part or whole of content, please contact me at defeatparkinsons101@yahoo.com contributor http://www.assisted-living-directory.com Contributor http://www.lavozbrazoriacounty.com

Uncategorized

The Theory of Everything : By Dr. De Leon

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Recently I watched the movie “The Theory of Everything” in awe as so many of you must have. I was so delighted to see this film get nominated for so many awards and rightly so. The entire movie crew did a superb job bringing to light not only the life of this great mind of the 21st century but also poignantly detailing the conflicts that both a person with chronic neurological disease faces but more importantly the sacrifice, commitment and love required to care for someone in this position on a daily basis.

Many people have wondered and asked why Professor Hawking has been so fortunate to live to his present age, well into his 70’s, when most people with ALS typically live only on average of 2-5 years.

Some have attributed to the fact that he has a brilliant mind, others to having an atypical slower variant of the disease.

But, I say that the real reason perhaps has not much to do with the disease but with the extraordinary care that he receives.

This is a testament to the love and devotion of his care partners.

The thing that makes people with this illness succumb to the disease is the weakening of breathing and swallowing muscles which eventually compromise the person’s ability to oxygenate and to maintain nutrition causing a total collapse of the body. These are precisely the same reasons people with PD eventually die. However, if we provide support and assistance to allow someone to continue breathing artificially, the body and brain can continue to survive.

When I was in medical school the neurology department at Hahnemann University which is now Drexel University College of medicine had a large ALS facility. Patients there had been living with ALS like Mr. Hawking for decades.

We don’t often hear this because so few clinics exist like this and most ALS patients choose not to live completely locked in a nonfunctioning body. But perhaps we need to focus these patients’ attention on how someone can still have a prolific and meaningful life despite severe disability as long as there are willing care partners. This thought got me thinking about living with Parkinson’s disease. Although, some would claim that the severity of disease of PD cannot compare to that of ALS, yet as Parkinson’s progresses patients can also become trapped in their bodies. It is only through the unyielding care from the care partners that we as PD patients and those suffering from ALS can have a more meaningful existence.

However, this care can come at a price as was shown in the movie portraying the life of physicist extraordinaire. Divorce rates are much higher than general population in those suffering from chronic neurological disease. Love fades when the spouse is forced to be the care partner and sole provider. Caregivers should not go at it alone. It is a tremendous burden for anyone person to bear having someone else depend on them for All of their needs 24/7. Children do, but they eventually grow up and become independent. However a person living with chronic progressive illness the reverse is true- independence decreases as dependency increases. Worst of all is that this often happens as the spouse’s or partner’s strength begins to diminish and aging problems set in. It is honorable to want to take care of your loved one initially; but if not careful to take time to grow as a person independent of patient care a downfall is inevitable and love and loyalty can turn into frustration and resentment as we saw happening with Stephen’s wife after years of devotion.

To avoid marital pitfalls and continue the love that helps the patients’ thrive and aspire to continue fighting as well as having new goals and dreams despite their illness is to recruit others to help early on in the disease- it truly takes a village. So yes, we as Parkinson’s patients can continue to thrive well after disability has set in and our bodies no longer cooperate as long as we have someone preferably a team rooting for us, helping us get through hurdles of physical impediments willing to push us,  lift us and feed us if necessary. Otherwise, we too like the majority of ALS patients who succumb to disease will wither away and call upon death much earlier than our potentials demand.  By not allowing our destinies to be fulfilled, we may deprive the world of immeasurable hidden talent that only the PD patient possess which may manifest as the next masterpiece or  brilliant insight which could lead to the next big discovery in the world of neuroscience.  After all, as Stephen Hawking said: “where there is life there is hope.”

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Health & Beauty tip # 30 : Put on some lipstick & show Parkinson’s who’s Boss? By Dr. De Leon

Happy 2015!!!🎈🎈🎉💃 as we start a new year I want to remind all the women around the world that live with PARKiNSON’s in their lives that there is power within you that comes from being a woman, a mom, a wife, sister, friend, lover, daughter. This year I want you to harness that femininity to not just survive Parkinson’s disease but actually live an abundant, joyful life in the midst of Parkinsons…so grab your favorite paraphanelia, that which empowers you to be more than you are, bring out the beauty within and conquer PARKiNSONS …know that you are not alone and women all over the world are standing right beside you arm -arm waiting to fight with you, lift you up, and complete
Lift you up and comfort you! Have a blessed year! And stay tune for my book on Parkinson’s and women’s issues which will be released this spring!

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Los Consejos de Belleza y Salud #2 : ¡ Pintate los labios y demuéstrale al Parkinson’s quien es jefe! Por Dra. De León

¡Feliz año 2015! Espero que este año reencuentren su valor femenino y el poder que llevan dentro como mujere, madres, hijas, esposas y amigas….dentro de ustedes esta el poder de no solo sobre llevar la enfermedad del Parkinson’s pero tener una vida abundante apesar de la enfermedad… Saquen sus más preciados objetos que les da valor y fuerza y adelante… Este año en la primavera saldrá a la venta mi libro sobre el parkinsons en las mujeres…estén al pendiente…

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Surviving the Holiday’s Like a Pro: By Dr. De Leon

This is the busiest time of year for most of us and unfortunately what is supposed to be the happiest sometimes turns into a very stressful time for many of us. We are often torn between trying to care for ourselves and make our loved ones happy. Your health should come first. Let your loved ones know your needs ahead of time, they will understand.  Also because many of us travel during the holidays, we tend to forgo our routines of medication intake, exercise, sleep, etc. increasing risks for falls especially in ice conditions. As a neurologist, December was always a month of increased strokes and ICU admits, most of the time due to poorly controlled blood pressure or blood sugars which I suspected were a combination of stress, lack of sleep, medication non-compliance because we are too busy taking care of everyone and everything around us.  Sometimes, depression can magnify during this time of year as well particularly if you have lost a loved one. Don’t let this be another reason for you not to enjoy the holidays or cause you to end up in the hospital.

Here are a few tips to surviving the holidays.

If you have to travel: prepare ahead of time all of your medications, doctors phone numbers in case of an emergency. Prepare  some liquid Sinemet and carry with you should you need a quick boost. Also make sure that you allow yourself extra time to travel if possible –expect delays if traveling by plane during this busy season so take extra medicines with you as well as food and water. Ask for a wheel chair and assistance ahead of time-it is best to have even if you end up not using. Try to get extra leg room in the plane if possible especially if a long flight. Don’t forget to carry your assistive walking devices even if you only used once in a while because the trip could be long and exhaust you to point of needing those devices. If you will be staying at a hotel make sure it has handicap capabilities including a ramp entrance because by the time you arrive you are sure to be exhausted and may have trouble going up a flight of stairs especially carrying any luggage. Make sure you arrange for transportation to pick you up either family member or a limo services so you don’t have to wait around risking falls, or other injuries.

If you feel sad or anxious during the holidays- make sure you talk to your doctor before hand to prescribe some medication to help you cope. Don’t try to be strong and go at it alone. This will only make things worse. Make sure you get out and mingle especially if you don’t feel like it- don’t isolate yourself.

Remember to take time for yourself to rest, exercise, and take your medications on a timely basis.

Set limits to what you can and can’t do and stick to that plan. The most important thing to remember is to enjoy the holidays with your family, friends, and loved ones. Remember to laugh and have fun. Order take out, if it will help with stress or alleviate the pain of having to cook, or better yet ask everyone to bring a dish and make it pot luck!

If you can’t decorate – don’t worry, all you have to do is ask for help- I bet you there would be someone that just loves to put on the Christmas tree etc. in my case my daughter is the one that is now in charge of the tree decoration- she does such a terrific job any way! I just hand her the ornaments so we still spend time together.

I wish much joy and happiness to you and yours during this festive season, particularly to all my  followers who have made this site popular, and remember there is NOTHING that PRAYER & Chocolate can’t handle!

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Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com All materials here forth are property of Defeatparkinsons. without express written consent, these materials only may be used for viewers personal & non-commercial uses which do not harm the reputation of Defeatparkinsons organization or Dr. M. De Leon provided you do not remove any copyrights. To request permission to reproduce release of any part or whole of content, please contact me at deleonenterprises3@yahoo.com contributor http://www.assisted-living-directory.com Contributor http://www.lavozbrazoriacounty.com