How to Deal with the 3 Common Causes of Leg pain in PD? : By Dr. De Leon

via How to Deal with the 3 Common Causes of Leg pain in PD? : By Dr. De Leon

4 Easy Ways to de- stress and Improve your Well-being while living with a chronic illness like PD: by Maria De Leon

via 4 Easy Ways to de- stress and Improve your Well-being while living with a chronic illness like PD: by Maria De Leon

The Power of Research in the Palm of Your Hands- By Dr. De Leon

via The Power of Research in the Palm of Your Hands- By Dr. De Leon

The Power of Research in the Palm of Your Hands- By Dr. De Leon

cureclickpic

There are many devastating neurological illnesses for which there are no cures as of yet as is the case for PD. However, the future is bright since in the last 3 decades have seen many new discoveries in the field of neuroscience which have led us to a greater understanding of such complex illness as PD. Yet, despite all the advances there are nearly 2 million people living with PD in this country. Many of whom still face difficult challenges daily due to lack of specific treatments for various PD non-motor symptoms.
Part of the problem is difficulty recruiting appropriate patients to even fill clinical trials. It is believed that roughly 80% of trials are delayed due to being unfilled while 30% never even get off the ground. The result is that lack of participants in research trials only leads to slowing down the progress towards a possible cure. For those that do participate only one in four reach completion.
The great news is that you have the power to change the future of research. Subsequently, aiding in improvement of quality of life and discovering breakthroughs from which all could benefit.
So, how can you help?
…by playing a part in Parkinson’s research. Saying Yes! to becoming a volunteer.
You can participate in research as a patient or as a control…….
Now that you have decided to take control and become a research participant, you may be asking yourself the following questions:
I want to participate in a trial but, I am not sure if I qualify?
• First, you must know that there are different types of trials. Some are only interested in collecting data via surveys etc. these often times can be done from comfort of your home. Other studies are interested in evaluation of biomarkers, genetic abnormalities, or discovering other risk factors via laboratory. These do not require taking specific medications and maybe a onetime only test as well but may have a degree of invasion in order to draw blood, spinal fluid, tears, etc. There are also those which involve the evaluation of devices for instance to track tremors, gait instability and so on. Finally, there are the drug trials which everyone thinks about when speaking about participating in a clinical trial.
• Once you have understood the different types you can then actively seek out information regarding the various types you might be interested in.
• The best way to do this is talk to your physician. Other options is contact national organizations for referral to research centers or ask your peers at support groups and conferences.
How do I approach my doctor about participating?
• Begin by asking your physician if he or she thinks you might be a good candidate for participation in a trial. Ask the reasons why or why not? If he/she say yes, then ask if they have a particular trial in mind. If they are not actively doing research would they be willing to refer you to a center that does.
• If they are not the primary investigator would they work closely with researcher and would they still continue treating you or release care to another.
How do I choose the best one for me?
• Assuming you opted to volunteer in a drug trial you must find out the stage of the trial. Is this a drug that is in phase 3 awaiting to see efficacy vs. placebo or another treatment? Or is this an early stage trial where safety and tolerability is only being addressed. Expectations must be clear from the start on both ends in order to have the best outcome.

It is important to remember that by definition a clinical TRIAL is an EXPERIMENT in which the outcome (answer) is not yet known!!!!
As I stated previously, since there are different types of clinical drug trials it would serve you well to discuss in detail with your physician what your participation in a particular trial would mean for your disease state not just in the present but also in the future. This is crucial to remember because circumstances change and disease burden also changes over time (increases) which could impede continued participation in case of a long trial or may even preclude you from obtaining standard of care later on when disease advances, such as having DBS when participated in certain gene therapy studies. Furthermore, is also important to consider that in some instances future participation in other trials may be limited.
Therefore, before making a decision you must always take into account ALL of your current circumstances be it social, financial, physical, emotional, and other comorbidities (e.g. depression).
If your health is precarious like mine you can still participate in certain types of drug trials. For instance, participation in phase 4 drug trials in which drug results are already known but require further information or its being used for a different purpose than its intended original use could be something worthwhile.
In the end, the best way to maximize your success and achieve a positive outcome for you is to consider these things before you engage in any trial:
• Consider your goals and those of the studies, are they in sync?
• Are the expectations realistic?
• Never participate to please your doctor…that will only lead to heart break when results don’t yield what you hope for….
• Consider your physical limitations and capabilities along with those of your caregiver.
• MOST IMPORTANT- YOUR WELL BEING comes FIRST!

Don’t forget research is a TWO-WAY street OPEN communication is VITAL…..let your clinician know your concerns and also what interest and issues you have to better fit a study that suits your needs…..

@copyright 2018
all rights reserved by Maria De Leon

7 Invisible signs of living with chronic illnesses: By Maria De Leon

via 7 Invisible signs of living with chronic illnesses: By Maria De Leon

Risk of Melanoma in PD in Women especially those of a Darker Hue. By Maria De León

via Risk of Melanoma in PD in Women especially those of a Darker Hue. By Maria De León

shaky pants movement

-5:18

Shaky Pants: A Parkinson’s Awareness Movement
SHAKY PANTS is with Kristi Townsley.

Best treatment options for PD during an exacerbation of Inflammatory Bowel disease (IBS): By Dr. De Leon

As I have been dealing with severe Gi complications from both PD and history of ulcerative colitis, I thought I would cover this topic today on how to manage living with both illnesses. Not an easy task I assure you. As you may know, people with inflammatory bowel disease are at higher risk of having PD. But having PD can also compromise our immune systems making flare ups and exacerbation’s much more common.
Not only are colitis exacerbation’s a medical emergency due to possible severe dehydration that can occur but depending on the severity of disease and location down the Gi tract may require surgery. On top of the colitis Parkinson’s symptoms can also spin out of control lengthening recovery period and possibly prolonging hospitalization and rehab if we are not careful.

First, what is IBS- term used to describe disorders involving chronic inflammation of gi tract.
These compromise 2 diseases:

Ulcerative colitis (UC) – only involves colon and rectum
Crohn’s disease- involves the entire digestive tract

Complications of BOTH:
• Colon cancer need colonoscopy every 10years or more often
• Skin, eye and joint inflammation- PD can also cause joint pain in shoulder, hip and can cause eczema.
• Primary sclerosing cholangitis -scaring of the bile ducts leading to liver damage
• Increase blood clots- remember that PD increases risk of clots especially in those of us with migraines.

UC
• Toxic megacolon- rapid expansion and swelling of colon extremely serious condition
• Perforated colon
• Severe dehydration

Crohn’s
• Ulcers
• Malnutrition
• Bowel obstruction

Treatments
• Nutritional support
• Calcium and vitamin D supplement especially important since we as PD patients already have Vitamin D deficiency
• Iron supplement- we may also already be anemic due to B12 deficiency
• Antidiarrheal –
• Desetin for irritation of your hiney
• Wear adult diapers for security till symptoms resolve
• Pain relievers- like Tylenol – avoid Nsaids like Motrin which make symptoms worse
• Antibiotics
• Anti-inflammatory drugs steroids and aminosalicylates (e.g. Asacol), balsalazide (Colazal) and olsalazine (Dipentum)
• Immunosuppressants methotrexate, azathioprine, cyclosporine-

 Important to note that some of these medicines cause b6 and b12 deficiency and can cause numbness and tingling which can already be present in PD. They can also increase the shakiness, can also cause nausea, vomiting, increase in BP, and cause dizziness. Therefore, it is extremely important to have a direct communication between your neurologists and Gi doctor. Especially, if these medicines will be taken for a long period of time. These can also cause osteoporosis so may have to take medication to prevent given that PD meds already increase risk of this. Plus can worsen headaches many of us already have migraines with PD.

• Tumor necrosis factors (TNF) e.g. Humira, Entyvio, Tyrabri, Stelara
• Dietician consult if losing too much weight
• Add multivitamin can be a melt
• May need to increase nausea meds since many PD drugs also cause nausea. Take ginger, mint, and peppermint teas to help with this. I have been on a diet of peppermint and mint tea for last 3 weeks along with Zofran to control severe nausea.

Diet
• Limit dairy products
• Low fat foods
• Eating fiber can exacerbate symptoms – steam vegetables instead of raw

 Things in cabbage family like cauliflower and broccoli usually make things worse
 Avoid nuts, fresh fruit especially those with skin like apple –if you do eat peel first, no popcorn, seeds or corn. Things like watermelon, pineapple, bananas,
• Avoid caffeine, alcohol and spicy foods- there goes my coffee, sweet tea, Mexican food and margaritas!!! My, my, what am I to do?

• Eat small meals -5-6 meals – this will help both PD and colitis
• Drink lots and lots and lots of water!!!
Can have jell-o, Popsicle, Gatorade, even Iv fluids if necessary to avoid dehydration

PD medications will have to be given either at higher doses to compensate for loss during exacerbation or be given in alternate route. For instance, if colitis is severe and intractable perhaps pump and /or DBs would be best. During the exacerbation you may also need to switch levodopa to oral disintegrating I.e. Parcopa, use 24 hour amantadine (Gicovri), Neupro patch and apomorphine either injection or melt strip once available. This will keep you from losing effect of medication because of gi malabsorption and diarrhea. We don’t want to decrease medication dose because not only will you have risk of falling but also of aspiration which would only complicate matters.
Best thing is be proactive in avoiding things that can trigger an exacerbation not always possible to control but we can alter our life style to reduce chance. This means decreasing stress through meditation, exercise, eating small meals regularly on time, drinking lots of fluids and sleeping well. Don’t forget routine check -ups!

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Copyright@2018
all rights reserved by Maria De Leon