Rich Dean and Carolyn Cole team up to train those diagnosed with Parkinson's disease.

June 10, 2016

WESTPORT

With the recent passing of Muhammad Ali, arguably the greatest boxer and athlete of all time, many remember him winning heavyweight titles in the ring, but in the years after his illustrious career, Ali had a long and hard-fought bout with Parkinson’s disease. Although boxing and the devastating nervous system disease do not appear to have an affiliation, boxing trainer Rich Dean and Parkinson’s specific fitness trainer Carolyn Cole have teamed up to offer In-the-Ring with Rich Dean, a specialized boxing program for people with Parkinson’s at Rich Dean Boxing Fitness in Westport.

Cole and Dean got the idea to collaborate from a mutual client of theirs afflicted by Parkinson’s, who thought it would be a good idea to introduce the two. Dean brings a breadth of professional boxing experience to the table. He represented the Bahamas in the 2000 Sydney Olympic Games and is a three-time Golden Gloves boxing champion and an Empire State Games champion. Cole, whose father has Parkinson’s and maintains physical activity with a trainer, works with her clients on functional training as well as athletic training. The program, which will incorporate both instructor’s specialties, is specifically designed to help reduce symptoms associated with the disease.

“Boxing helps them with their balance, their muscle memory, posture, sequence, and stance. A lot of them have problems with their stance and balance and this really works for them and this really helps them,” Dean said.

“A lot of them will come in here staggering and they can just walk right out of here after — they can walk straight after. It’s like medication for them, it really is,” he added.

The class, with a cap of 10, allows the participants to receive personal instruction in and out of the ring. In pairs, boxers rotate through different stages, including mitt work and sequence punching with Dean in the ring.

A certified fitness trainer, Cole will handle the stations outside of the ring. For instance, people with Parkinson’s tend to shuffle because their muscles are tighter. She works with them to increase their stride by walking with them and putting them through flexibility work. Flexibility training includes activities such as opening jars to strengthen the hands, wrists and forearms and band work among a wide range of other regiments.

In addition to the actual workout, Cole takes into account the individual person on each given day.

“Everybody is just where they are, and it’s important for us to keep track of how everybody is. Did they get a good night’s sleep because of the medication — it affects their ability to sleep? That’s a big problem. ... Do they have side effects? How’s their blood pressure? You always have to check in because it’s always changing,” she said.

“It doesn’t take the clients that long to see progress. I just think it’s amazing,” Cole said. “It’s the only treatment that’s been clinically proven to delay and reverse symptoms of Parkinson’s. The medication doesn’t; it just covers it up for the day.”

The program starts June 9 and will run for eight consecutive weeks. After that session is complete, there will be additional eight week sessions running in perpetuity throughout the year. For information, contact Cole at 203.962.4084.

@chrismmarquette/ cmarquette@bcnnew.com

http://m.westport-news.com/news/article/Trainers-fight-disease-byputting-on-thegloves-7973560.php#photo-10215281

Iranian researchers to build DBS electrode to treat addiction

TEHRAN, Jun. 11, 2016 

Head of Cellular and Molecular Research Center at Iran Uni. of Medical Sciences said a team of researchers are currently working on a project to build Deep brain stimulation (DBS) electrodes for treating Parkinson’s disease and addiction.

Mohammad Taghi Joghataei, the project manager, told Mehr News that his team is working on a procedure to study a variety of disabling neurological symptoms—most commonly the debilitating symptoms of Parkinson’s disease (PD), as well as addiction in which the base of the brain is altered.

He noted that the DBS project has three phases including tests on mice, monkeys and finally humans, saying “in the first phase, a team of engineers at the School of Electrical and Computer Engineering of University of Tehran begun building electrodes that cause brain stimulation. Currently, these electrodes which are used in brain surgeries have been tested on small animals such as mice and bigger animals such as monkeys.”

Joghataei went on to add that the project has been launched two years ago and the third phase includes testing the electrodes on humans; “last year, the experiment on mice was conducted successfully. We began testing on monkeys since March and if the results are reported as successful, we will conclude that the test will also work on humans,” he explained.

He maintained that the electrode used on the monkeys is of the same kind that will be tested on humans.

“Since the costs of building and planting electrodes in the brain is very high, we were unable to use them in brain surgeries in Iran, but if the project achieves good results, we can stop the import of electrodes from abroad,” he said.

The DBS project is currently being conducted by researchers from the School of Electrical and Computer Engineering at University of Tehran and Iran University of Medical Sciences, Hazrat Rasoul Medical Complex.

http://en.mehrnews.com/news/117269/Iranian-researchers-to-build-DBS-electrode-to-treat-addiction?

SLEEP AND PARKINSON’S DISEASE

MICHAELJFOX.ORG 

Introduction

Many people with Parkinson’s disease (PD) have trouble falling asleep or staying asleep at night. Some sleep problems are caused by Parkinson’s symptoms, while others may be the result of the medications used to treat those symptoms. Factors unrelated to Parkinson’s can also impact sleep, including other medical conditions, normal aging or poor “sleep hygiene” (habits that prevent or interrupt a regular sleep schedule).

This guide outlines the sleep difficulties that people with Parkinson’s experience most o en and the treatments that may be prescribed for each. You’ll also find a list of sleep hygiene tips and answers to frequently asked questions about PD and sleep.

This content was reviewed by Rachel Dolhun, MD, a movement disorder specialist and vice president of medical communications at The Michael J. Fox Foundation.

Sleep Disorders and Parkinson’s

SEVERAL SLEEP DISORDERS ARE ASSOCIATED WITH PARKINSON’S DISEASE, INCLUDING:

Insomnia:

Difficulty initiating or maintaining sleep. Parkinson’s symptoms, such as stiffness or slowness, may make it di cult to turn over or get comfortable in bed. Or, tremor may interfere with falling or staying asleep. Insomnia may also be worsened by some PD meds, such as amantadine or selegiline. It can also be a condition in and of itself.

Treatment:

Improving sleep hygiene may help. (See pointers on page 4.) If Parkinson’s symptoms are contributing, medication adjustments may be beneficial. In some cases, drugs are prescribed specifically for insomnia.

Daytime sleepiness/hypersomnia: Excessive tiredness during the day. Trouble sleeping at night and some PD medications, including dopamine agonists, can contribute to this disorder.

Treatment: If you and yourself falling asleep easily during the day (i.e., you doze off while watching television or sitting quietly), talk with your doctor who will review your medications and your sleep schedule and habits. If you snore loudly, stop breathing during the night and/or have morning headaches, your doctor may also order a sleep study to exclude obstructive sleep apnea, another common treatable sleep disorder.

Ensuring good sleep hygiene is key. (Look for advice on page 4.) If Parkinson’s medications are contributing to sleepiness, they may need to be adjusted. In some situations, stimulant-type medications are prescribed specially for this symptom.

REM sleep behavior disorder (RBD): Acting out one’s dreams, which occurs when normal suppression of muscle activity is impaired. Someone with RBD may kick, punch or yell during sleep. RBD o en precedes the motor symptoms and diagnosis of PD by several years.

Treatment: If RBD interferes with a person’s (or his or her partner’s) sleep, or if it poses a safety issue, it may require treatment. Clonazepam is the most commonly prescribed medication for RBD but melatonin is an option for some people.

Restless legs syndrome (RLS): An uncomfortable sensation in the legs, particularly when sitting or relaxing in the evening, which improves with moving the legs. Because of the time of day that it occurs, RLS can interfere with falling asleep at night. It may be part of Parkinson’s disease itself, a side effect of Parkinson’s medications or a separate medical condition (sometimes associated with iron deficiency).

Treatment: Treatment may include adjustment of Parkinson’s medications, iron supplementation (if levels are low) or prescription of an additional drug specifically to treat RLS symptoms. Note that many Parkinson’s medications are indicated for treatment of RLS, even for people who don’t have PD.

Obstructive sleep apnea (OSA): Fragmented or interrupted sleep caused by paused or shallow breathing; o en associated with snoring. A person is often unaware of these breathing patterns but may experience excessive daytime sleepiness or fatigue, morning headaches, or memory and thinking problems as a result. OSA can be diagnosed with an overnight sleep study.

Treatment: The most common treatment for OSA is a breathing mask or oral appliance worn at night to keep the airway open during sleep. Weight loss is also recommended for overweight individuals.

Other Non-motor and Motor

Symptoms That Can Affect Sleep

Stiffness (rigidity) or slowness (bradykinesia): Motor symptoms of Parkinson’s that can cause pain, discomfort or difficulty turning over in bed at night.

Treatment: If motor symptoms are interfering with sleep, Parkinson’s medication adjustments (such as adding a long-acting medication at bedtime or an as-needed dosage if you awaken with symptoms, for example) may help. Satin sheets or silk pajamas may make it easier to move in bed and regular exercise or physical therapy may help by improving general mobility.

Nighttime urination: The slowness and stiffness of Parkinson’s may make using the bathroom at night more difficult. If walking or balance problems are present, this can be particularly challenging. Parkinson’s also affects the autonomic nervous system — the part that works automatically to control bladder (and other) functions without our having to think about it — which can lead to increased urination. Other medical problems, such as prostate enlargement in men, may worsen urinary disturbances.

Treatment: Try decreasing fluid intake in the afternoon and evenings (but make sure you drink enough during the day to meet any requirements for low blood pressure and/ or constipation). If this isn’t enough, medications are sometimes prescribed to decrease nighttime urination. A bedside urinal or commode might lessen bathroom trips and prevent falls for those with significant walking and balance issues. A consultation with a urologist may be considered to evaluate for issues other than Parkinson’s that may be playing a role as well.

Depression and anxiety: Common non-motor symptoms associated with PD, which can interfere with sleep. These mood disturbances can prevent you from falling asleep, or wake you up in the middle of the night or early in the morning.

Treatment: Many medications are available to manage depression and anxiety. Talk therapy or counseling is also beneficial for many people.

Sleep Hygiene Tips

As you work with your doctor to pinpoint and treat the cause of your sleep problem, practicing good sleep hygiene may help you get a better night’s sleep. See if you find one or more of these tips helpful:

» Keep a sleep diary. Important notes to record include the time you go to bed and get up, how many times you awaken during the night and why, and how many hours you sleep. Keep track of the caffeinated beverages you drink (both how many and at what time of day), if you nap and your exercise routine. These notes will help you to have a productive conversation with your doctor about your sleep.

» Limit daytime naps. Sleeping too much during the day, especially late in the day, will likely prevent you from sleeping well at night.

» Avoid caffeine, alcohol and exercise later in the day. Caffeine consumed in the afternoon can keep you awake at night. Although alcohol may seem to help you fall asleep more easily, it may interrupt your sleep later in the night. Working out regularly earlier in the day can improve sleep overall but exercising too close to bed- time might make it harder to fall asleep.

» Don’t drink too much fluid before bed. This is especially important if you experience frequent night- time urination.

» Use the bedroom only for sleep and intimacy. Don’t watch television, read, use your telephone or do anything other than sleep in bed. When you use your bed only for sleep, your body and mind will automatically know what’s supposed to happen when you get into bed.

» Create a bedtime routine. An hour before bed, start to prepare for sleep. Turn o the television, computer and other electronics that emit stimulating light. Take a warm bath, drink a cup of decaffeinated tea or read something for fun. Get your body and mind in the habit of winding down and preparing for sleep.

» Keep a regular schedule. Go to sleep and get up at around the same time every day, even on the weekends.

Parkinson’s and Sleep:

Frequently Asked Questions

Should I take melatonin to help me sleep better?

Melatonin is a hormone made by the brain that helps control the sleep cycle; levels are typically low during the day and higher at night. Melatonin is available over the counter in a variety of dosages and many people use it to help manage insomnia. Before you take it, though, talk with your doctor. This and all other supplements do have potential side effects and drug interactions. Also make sure that the root cause of your sleep problems is ad- dressed before you start taking medication or supplements just to treat them. Melatonin is sometimes recommended as a treatment for REM sleep behavior disorder, a sleep disorder in which people act out their dreams, which is commonly associated with Parkinson’s.

Is it safe for people with Parkinson’s to take sleep aids?
In general, it’s important to be careful about combining medications or adding to complex medication regimens, particularly when it comes to medications that induce sleep. These drugs might temporarily worsen balance or memory disturbances, so they should be used cautiously in people with these problems. When dealing with a sleep problem, the first step is to determine the underlying cause, whether it’s depression, motor symptoms or bladder dysfunction. Before prescribing a sleep aid, your doctor will review your current medications and investigate for an underlying cause of the sleep problem. De- pending on the problem, doctors will sometimes pre- scribe medications that are meant to help a person fall asleep or stay asleep. Sometimes, when a person is depressed and has trouble sleeping, they will recommend anti-depressant medications that also help with sleep. Sleep aids can be used safely in PD, but this depends on the individual and his or her symptoms and other medications.

Can deep brain stimulation (DBS) help sleep?

Following DBS, some people with Parkinson’s are able to sleep better at night, especially if sleep problems were related to medication wearing off. Most people also reduce their medication after DBS, so if sleep problems were due to medication side effects, DBS might make a difference there as well. DBS is otherwise not specifically a treatment for sleep disturbances and is not performed specifically for that; it’s a surgical treatment that is most beneficial for the motor symptoms of Parkinson’s. Not everyone is a candidate for the procedure.

Should I nap during the day?

Some people with PD who experience fatigue nd that napping, particularly in the afternoon, can be energizing. If this is the case, aim for a 10- to 30-minute nap in the early afternoon (around 2 or 3 p.m.). Longer naps later in the day can interfere with your ability to fall asleep.

By Michael J. Fox Foundation

New drugs could help Parkinson's patients like Muhammad Ali

Meg Farris, WWL
June 10, 2016

NEW ORLEANS - Doctors say people with Parkinson's Disease are living decades after they are diagnosed and there are two new drugs on the market to help patients.

The disease and its effects have been in the news this week with the death of Muhammad Ali, who suffered with the disease for 30 years.

Rytary is a new and improved version of a former drug but its benefits now last longer to help patients.

Nuplazid also helps people with Parkinson's who have psychosis, hallucinations and paranoid thoughts. That drug just hit local pharmacies last week.

Neurologists at LSU Health Sciences Center say medications and treatments are helping patients live better lives. 

"Parkinson's itself, we can handle you reasonably good.  We're not going to make you normal, we're not going to reverse the disease, we're not going to cure the disease but we can provide a very good quality of life for 15, 20 years," said Jay Rao, MD, a longtime local Parkinson's specialist.

Rao says he is diagnosing patients with Parkinson's at a younger age. He is seeing more who are younger than 40 and his youngest was only 13 years old

Video:

http://www.wwltv.com/news/local/new-drugs-could-help-parkinsons-patients-like-muhammad-ali/239213694

http://www.wwltv.com/news/local/new-drugs-could-help-parkinsons-patients-like-muhammad-ali/239213694

What are septic shock and sepsis?

The facts behind these deadly conditions

June 6, 2016 

Most Americans have never heard of it, but according to recent federal data, sepsis is the most expensive cause of hospitalization in the U.S., and is now the most common cause of ICU admission among older Americans.

Sepsis is a complication of infection that leads to organ failure. More than one million patients are hospitalized for sepsis each year. This is more than the number of hospitalizations for heart attack and stroke combined. People with chronic medical conditions, such as neurological disease, cancer, chronic lung disease and kidney disease, are at particular risk for developing sepsis.

And it is deadly. Between one in eight and one in four patients with sepsis will die during hospitalization – as most notably Muhammad Ali did in June 2016. In fact sepsis contributes to one-third to one-half of all in-hospital deaths. Despite these grave consequences, fewer than half of Americans know what the word sepsis means.

What is sepsis and why is it so dangerous?

Sepsis a severe health problem sparked by your body’s reaction to infection. When you get an infection, your body fights back, releasing chemicals into the bloodstream to kill the harmful bacteria or viruses. When this process works the way it is supposed to, your body takes care of the infection and you get better. With sepsis, the chemicals from your body’s own defenses trigger inflammatory responses, which can impair blood flow to organs, like the brain, heart or kidneys. This in turn can lead to organ failure and tissue damage.

At its most severe, the body’s response to infection can cause dangerously low blood pressure. This is called septic shock.

Sepsis can result from any type of infection. Most commonly, it starts as a pneumonia, urinary tract infection or intra-abdominal infection such as appendicitis. It is sometimes referred to as “blood poisoning,” but this is an outdated term. Blood poisoning is an infection present in the blood, while sepsis refers to the body’s response to any infection, wherever it is.

Once a person is diagnosed with sepsis, she will be treated with antibiotics, IV fluids and support for failing organs, such as dialysis or mechanical ventilation. This usually means a person needs to be hospitalized, often in an ICU. Sometimes the source of the infection must be removed, as with appendicitis or an infected medical device.

It can be difficult to distinguish sepsis from other diseases that can make one very sick, and there is no lab test that can confirm sepsis. Many conditions can mimic sepsis, including severe allergic reactions, bleeding, heart attacks, blood clots and medication overdoses. Sepsis requires particular prompt treatments, so getting the diagnosis right matters.

Back so soon? Hospital hallway image via www.shutterstock.com.

The revolving door of sepsis care

As recently as a decade ago, doctors believed that sepsis patients were out of the woods if they could just survive to hospital discharge. But that isn’t the case – 40 percent of sepsis patients go back into the hospital within just three months of heading home, creating a “revolving door” that gets costlier and riskier each time, as patients get weaker and weaker with each hospital stay. Sepsis survivors also have an increased risk of dying for months to years after the acute infection is cured.

If sepsis wasn’t bad enough, it can lead to another health problem: Post-Intensive Care Syndrome (PICS), a chronic health condition that arises from critical illness. Common symptoms include weakness, forgetfulness, anxiety and depression.

Post-Intensive Care Syndrome and frequent hospital readmissions mean that we have dramatically underestimated how much sepsis care costs. On top of the US$5.5 billion we now spend on initial hospitalization for sepsis, we must add untold billions in rehospitalizations, nursing home and professional in-home care, and unpaid care provided by devoted spouses and families at home.

Unfortunately, progress in improving sepsis care has lagged behind improvements in cancer and heart care, as attention has shifted to the treatment of chronic diseases. However, sepsis remains a common cause of death in patients with chronic diseases. One way to help reduce the death toll of these chronic diseases may be to improve our treatment of sepsis.

Rethinking sepsis identification

Raising public awareness increases the likelihood that patients will get to the hospital quickly when they are developing sepsis. This in turn allows prompt treatment, which lowers the risk of long-term problems.

Beyond increasing public awareness, doctors and policymakers are also working to improve the care of sepsis patients in the hospital.

For instance, a new sepsis definition was released by several physician groups in February 2016. The goal of this new definition is to better distinguish people with a healthy response to infection from those who are being harmed by their body’s response to infection.

As part of the sepsis redefinition process, the physician groups also developed a new prediction tool called qSOFA. This instrument identifies patients with infection who are at high risk of death or prolonged intensive care. The tools uses just three factors: thinking much less clearly than usual, quick breathing and low blood pressure. Patients with infection and two or more of these factors are at high risk of sepsis. In contrast to prior methods of screening patients at high risk of sepsis, the new qSOFA tool was developed through examining millions of patient records.

Life after sepsis

Even with great inpatient care, some survivors will still have problems after sepsis, such as memory loss and weakness.

Doctors are wrestling with how to best care for the growing number of sepsis survivors in the short and long term. This is no easy task, but there are several exciting developments in this area.

The Society of Critical Care Medicine’s THRIVE initiative is now building a network of support groups for patients and families after critical illness. THRIVE will forge new ways for survivors to work with each other, like how cancer patients provide each other advice and support.

As medical care is increasingly complex, many doctors contribute to a patient’s care for just a week or two. Electronic health records let doctors see how the sepsis hospitalization fits into the broader picture – which in turn helps doctors counsel patients and family members on what to expect going forward.

The high number of repeat hospitalizations after sepsis suggests another opportunity for improving care. We could analyze data about patients with sepsis to target the right interventions to each individual patient.

Better care. Intensive care image via www.shutterstock.com.

Better care through better policy

In 2012, New York state passed regulations to require every hospital to have a formal plan for identifying sepsis and providing prompt treatment. It is too early to tell if this is a strong enough intervention to make things better. However, it serves as a clarion call for hospitals to end the neglect of sepsis.

The Centers for Medicare & Medicaid Services (CMS) are also working to improve sepsis care. Starting in 2017, CMS will adjust hospital payments by quality of sepsis treatment. Hospitals with good report cards will be paid more, while hospitals with poor marks will be paid less.

To judge the quality of sepsis care, CMS will require hospitals to publicly report compliance with National Quality Forum’s “Sepsis Management Bundle.” This includes a handful of proven practices such as heavy-duty antibiotics and intravenous fluids.

While policy fixes are notorious for producing unintended consequences, the reporting mandate is certainly a step in the right direction. It would be even better if the mandate focused on helping hospitals work collaboratively to improve their detection and treatment of sepsis.

Right now, sepsis care varies greatly from hospital to hospital, and patient to patient. But as data, dollars and awareness converge, we may be at a tipping point that will help patients get the best care, while making the best use of our health care dollars.

https://theconversation.com/what-are-septic-shock-and-sepsis-the-facts-behind-these-deadly-conditions-60599?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20June%2010%202016%20-%205020&utm_content=Latest%20from%20The%20Conversation%20for%20June%2010%202016%20-%205020+CID_ebbef61515f7d9803c2b1149ba7502ef&utm_source=campaign_monitor_us&utm_term=What%20are%20septic%20shock%20and%20sepsis%20The%20facts%20behind%20these%20deadly%20conditions