Genetics Suggest Why Some People Develop Psychosis

 May 03, 2019 | Original story from the Van Andel Institute

A newly identified epigenetic hotspot for schizophrenia and bipolar disorder may give scientists a fresh path forward for devising more effective treatments and biomarker-based screening strategies.

More than 100 million people worldwide have either schizophrenia or bipolar disorder, which are characterized by periods of hallucinations, delusions and irregular thought processes. They are both associated with overproduction of the neurotransmitter dopamine, a key regulator of reward-seeking behavior, emotional responses, learning and movement, among other functions.

While effective medications do exist, they often have challenging side effects such as apathy, weight gain and uncontrolled movements called dyskinesias that typically are associated with Parkinson’s disease. Currently, there are no effective biomarkers for screening and tracking progression of either disorder.

“We’ve known since the 1970s that the effectiveness of antipsychotic medications is directly related to their ability to block dopamine signaling. However, the exact mechanism that sparks excessive dopamine in the brain and that leads to psychotic symptoms has been unclear,” said Viviane Labrie, Ph.D., assistant professor at Van Andel Research Institute (VARI) and corresponding author of the study, which appears in the May 3 edition of Nature Communications. “We now have a biological explanation that could help make a real difference for people with these disorders.”

Labrie and her collaborators found a cluster of epigenetic marks that ratchets up dopamine production while simultaneously scrambling the brain’s synapses, the information hubs that transmit rapid-fire neural messages responsible for healthy function. The result is a catastrophic shake-up of the brain’s organization and chemical balance that fuels symptoms of psychosis.

“What we’re seeing is a one-two punch — the brain is being flooded with too much dopamine and at the same time it is losing these critical neural connections,” Labrie said. “Like many other neurological disorders, schizophrenia and bipolar disorder often have early, or prodromal, phases that begin years before obvious symptoms. It is our hope that our findings may lead to new biomarkers to screen for risk, which would then allow for earlier intervention.”

The team took a comprehensive, broad look at DNA derived from brain cells of people with either schizophrenia or bipolar disorder and compared them to healthy controls. Their analyses revealed a cluster of epigenetic marks, which switch genes on and off, in an enhancer at a gene called IGF2, a critical regulator of synaptic development. Enhancers are stretches of DNA that help activate genes and can be major players in the development of diseases in the brain and other tissues.

This enhancer also controls the activity of a nearby gene called tyrosine hydroxylase, which produces an enzyme that keeps dopamine in check. When the enhancer is epigenetically switched on, production of dopamine becomes dysregulated, resulting in too much of the chemical in the brain.

https://youtu.be/_h6lLuzUafM 

Taken together, molecular changes at this site may explain why psychosis brought on by dopamine frequently is accompanied by a disruption of brain synapses, a devastating double-hit that promotes symptoms.

The study controlled for genetic factors, sex, ethnicity, treatment history and lifestyle influences such as smoking, and the results were validated in experimental models of the disease.

“We used cutting-edge computational strategies to understand the events occurring in brain cells that underlie psychiatric disorders,” said Shraddha Pai, Ph.D., a postdoctoral fellow at University of Toronto and the study’s first author. “Our results were strengthened by additional studies in disease models. This comprehensive approach lends weight to our findings, which we believe will propel additional groundbreaking investigations into this enhancer at the IGF2 gene.”

This article has been republished from materials provided by the Van Andel Institute. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference: Pai et al. 2019. Differential methylation of enhancer at IGF2 is associated with abnormal dopamine synthesis in major psychosis. Nature Communications. DOI: https://doi.org/10.1038/s41467-019-09786-7.

https://www.technologynetworks.com/genomics/news/genetics-suggest-why-some-people-develop-psychosis-318990

How to Overcome the Fear of Failing Care giving

 By Maria De Leon      May 3, 2019

“What enables a general to conquer and achieve things beyond the reach of ordinary men is foreknowledge” Sun Tzu ‘The Art of War’

Over the last month, I have read and heard much about the needs of the caregiver, the fears of the future for both the patients and caregivers as well as the stresses of living with a chronic illness imposes on a family, a spouse and a caregiver who may also be frail, infirm or elderly.

It is one thing to care for a loved one or spouse when the caregiver is young and healthy and is another one all together to provide care when the caregiver he or she are of advanced age with less energy, stamina and resources.

I have been struggling with this notion more in the last several months as not only my disease progresses but also as various members of my family including my own caregiver have become ill. I wonder if I will have the fortitude to handle and rise to the challenge.

The answer is YES!

First, I have found that where there is a will there is always a way! This does not mean that the journey will be easy or without challenges simply means that God never gives us more than we can handle. Nothing last forever! All pain and suffering and struggles eventually pass. We must learn to ride the storms bend without breaking.

Second, we should not allow fear to paralyze us and keep us from enjoying the present or being derelict in our duties and responsibilities. This however, does not mean that we throw caution to the wind and live only for the moment without planning for future contingencies.

We all have felt at one time or another like our strength and care giving skills were sub-par. Yet, what invariably happens is that when 2 people in a relationship are sick one will always assume the role of the caregiver while the sicker, weaker individual recovers.  This means that for a time one person has to put his/her needs aside to care for the more person with the more pressing medical issue as in the case of a friend with PD who suddenly was thrust into the caregiver role when his wife (the usual caregiver) had surgery, or another one who had to mustard strength to deal with spouses cancer despite their own medical problems.

In order to facilitate care and decrease stress, guilt, anxiety and fear I recommend a few things.

#1 do not let fear become a stronghold. You and I have the power to say NO and not continue with the negative thoughts that will lead us to desperation – mainly because is not healthy. Plus, I have found that our worst fears usually don’t happen rather it is the unexpected that hits us like a freight train. So why waist energy and worry over something that probably will never happen.

#2 decide in advance what it is that each partner needs or wants done when illness worsens- are these desires plausible, feasible and achievable within the confines of the relationship.

#3 make plans in advance for specific contingencies like what if the caregiver needs surgery and patient who will now be provider is unable to carry out that responsibility talk to support groups religious and otherwise for assistance, speak to the physician about having patient stay in a facility longer or be admitted together or send social worker and other ancillary staff to the home to help prepare meals or help with house chores. Doctors and social workers along with other health professional are there for you to use in times of undue stress. You should not have to go at it alone. Involve friends, neighbors, relatives to assist with specific needs like transportation, sitters, etc.

#4 for the future- meet with financial advisors, purchase long term disability insurance, decrease gap in distance between care giver and person with PD, down size before problems arise, have OT evaluate home for safety and accessibility for those residing within. Think about access to physicians perhaps moving closer to university centers would offer peace of mind. 

#5 don’t neglect your health to care for the other person. Think about how much more the person whom you care for will suffer if you are no longer able to care for them.  Being prepared assures us confidence! But relying on God gives us victory!

https://defeatparkinsons.com/2019/05/04/how-to-overcome-the-fear-of-failing-care-giving-by-maria-de-leon/

Can You Hear Me Now?

 MAY 3, 2019 BY DR. C 

Over the many years of living with a chronic illness, I have seen many healthcare providers. Some were good and others not so good. If I walked away from a meeting with a provider feeling like I hadn’t been heard and wanting to shout, “Can you hear me now?” then the provider wasn’t a good match for me. Empathy (being heard by the provider) is deeply important to me and is part of my quality healthcare plan.

Over the past several decades, my research has focused on understanding the characteristics of a special relationship between patient and healthcare provider that I call the “healing relationship.” It is a therapeutic relationship that promotes patient well-being.

Clinical empathy is a crucial part of this relationship. When the relationship functions well, the patient doesn’t ask in desperation, “Can you hear me now?” Instead, she walks away from the meeting feeling that she’s been heard and understood. Along with that comes a sense of trust in the provider and the treatment plan offered. This can then lead to greater treatment compliance, a higher quality of healthcare, and better treatment outcomes.

The healing relationship is not just academic for me; it is a practice. Honestly, between retirement and the chronic illness, I had thought the skill had become too rusty to use, like an old pair of scissors left outdoors too long. But this week surprised me with encounters in which three people asked for the healing relationship to form. These three people had very traumatic events in their lives, and all three needed solace.

Solace isn’t handing them a chocolate chip cookie and saying, “I’m sorry you had to go through that. Here, take this. It will make you feel better.” Solace happens through empathy, along with compassion, a type of Tonglen practice. It is a sacred relationship in the sense that it is held with reverence and humility, and is never sought, but always allowed. I thought I had lost this, and am so incredibly grateful to have been proven wrong.

The healthcare provider is there to meet the needs of the patient. Those needs can only be accurately met when they are fully known. At times, we patients need to educate our providers. There must be a shared dialogue within the patient-provider relationship that is aimed at promoting well-being.

The characteristics of the healing relationship help the provider acquire knowledge about the needs of the patient and develop a relationship of trust. When wisdom is added, compassion results and quality healthcare can occur.

The healing relationship is not a new thing. Healers, doctors, nurses, and other healthcare providers have been writing about it for the past few decades. They have been calling for a need to be fulfilled within the practice of healthcare by bringing back this art of healing.

Patients will want to scream, “Can you hear me now?” when the healthcare provider seems not to be listening or is absent of empathy. It is deeply frustrating not to be heard; it leads to misunderstanding, and healthcare needs are unmet.

Fortunately, there are many healthcare providers who do have empathy and compassion. Finding them and incorporating them into your treatment team is a positive step toward personal well-being.

Editor’s Note: Dr. C will be taking a break from publishing his column. Please continue to follow his column when he returns.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

https://parkinsonsnewstoday.com/2019/05/03/healing-relationship-healthcare-provider-patient/

Ballet Not Seen to Greatly Improve Gait or Balance in Small Study in Parkinson’s Patients

MAY 3, 2019 BY MARISA WEXLER IN NEWS.

Ballet practice may not improve balance and gait in people with Parkinson’s disease — at least not over the long term, a small study in patients engaged in dance for at least a year suggests, possibly contradicting earlier research reporting evidence of such benefits.

But the work did find probable social and psychological gains, noting a “high levels of adherence” among the Parkinson’s group, indicating motivation “to continue attending.”

Researchers for this study, “Effects of a ballet-based dance intervention on gait variability and balance confidence of people with Parkinson’s,” published in the journal Arts &Health, suggesting that more research needs to be done to understand whether and how dance therapy can be effective.

Dance can be beneficial for many, and especially people with neurodegenerative diseases. It is a form of physical movement that is often easier to “stick with” than just exercising, and offers social contact that rewards a person’s mental health and psychological well-being. Some previous studies specifically indicated that dance may improve motor skills in people with Parkinson’s.

The U.K. team here wondered whether ballet — a dance form that requires many balancing movements, like stabilizing weight on one leg while moving the other  — would be of benefit for Parkinson’s patients.

They recruited 19 patients already enrolled in weekly “dance for Parkinson’s” classes. Participants had to have been dancing for at least three months, although most had already been participating for over a year.

Another 13 patients who refrained from ballet classes for the study’s duration served as a control group.

Over the course of a year, people in both groups were examined for changes in gait and balance. To analyze gait, a sensor was placed on a participant’s lower back when they walked across the room, allowing for measurements of stability as they walked.

For balance, the Activities-specific Balance Confidence Scale was given to participants. This questionnaire is a measurement of confidence in balance, not balance itself, since it’s asking participants questions about their perceptions of their own balance.

No significant difference in all of the above measures was seen between the two groups over the study’s year. This contradicted pro-benefit findings of previous research, and the investigators offer two likely explanations for this disparity.

“First,” they write in their study, “gait variability as an indication of dynamic stability has not been assessed in previous dance for Parkinson’s research.” Further, measures of gait variability used in this study might “not be comparable” to “commonly used clinical rating scales” that look more at “static balance tasks,” and reliance on their  different variables may make all the difference.

“Secondly,” the researchers said, “previous studies evidencing changes to balance, gait, and functional mobility have often included a class frequency of two to three dance classes per week,” while participants in this study had one class per week.

They also suggested that a study limitation was the fact that its patient group had been taking the weekly classes for about a year prior to the study’s start. Regular long-term dance classes made it “possible that a ceiling effect may have occurred whereby any resulting change in gait variability as a result of the ballet-based sessions was no longer visible,” the researchers concluded.

“It is possible that the ballet-based sessions had a positive affect on gait variability for the participants; however, the measurements were not able to capture this early change at the beginning of their dance programme.”

https://parkinsonsnewstoday.com/2019/05/03/ballet-not-seen-to-greatly-improve-gait-or-balance-in-small-study-in-parkinsons-patients/

NYC Attorney with Parkinson’s Describes Positive Effects of Deep Brain Stimulation

May 3, 2019 In News.

Jim McNasby, an attorney with Marsh & McLennan Companies, with his DBS device at his office in New York. (Photos courtesy of Jim McNasby)

The first time the batteries for his deep brain stimulation (DBS) device were activated, Jim McNasby had the feeling a load burdening his body had been removed.

“It felt like a very gentle posture improvement; I just sat up straighter,” McNasby said in a phone interview, as he described how the technology has helped him.  “It was like a weight was lifted and the shakiness in my limbs disappeared.”

McNasby, 50, a New York lawyer first diagnosed with Parkinson’s disease in 1999 at the age of 30, now wonders why he waited so long to have the DBS mechanism implanted.

“I wanted to be careful with brain surgery,” he said. “At the time it seemed so radical. But now I think: ‘Why didn’t I get it earlier?’”

DBS uses low-voltage electricity to stimulate specific parts of the brain via surgically implanted wires attached to a pacemaker-like neurostimulator placed under the skin on the upper chest. Doctors recommend the device mainly when Parkinson’s patients stop responding to medicationsdesigned to reduce motor symptoms, such as tremors, rigidity, involuntary movements, and walking problems.

The technology is not a cure. Research on its long-term effects is still limited, and scientists don’t know exactly how it works. However, a number of studies have shown that electrical stimulation of the subthalamic nucleus can improve symptoms, lower the need for medication, and improve the quality of life for people with Parkinson’s.

Stronger symptoms prompt decision

DBS also can ease symptoms of other diseases, including epilepsy and obsessive-compulsive disorder, and is being studied as a potential treatment for issues as wide-ranging as addiction, chronic pain, headaches, dementia, major depression, Huntington’s disease, multiple sclerosis, stroke, Tourette syndrome, and traumatic brain injury. Some 150,000 Parkinson’s patients had received DBS implants worldwide as of 2018.

In the past, McNasby relied on four medications to keep his symptoms under control. These included Sinemet (carbidopa/levodopa), which he was on for 16 years. In the spring of 2018, however, he started experiencing more tremors, shuffling, and asymmetrical walking. His “off-times,” when the medication wasn’t working optimally and motor symptoms returned, felt stronger and more frequent. Friends commented that he appeared to be struggling.

“I’d feel great, and then I’d fall off a cliff and hardly be able to walk,” he said. “I felt

Jim McNasby, at right, with his husband, 

Donald Moss, during a July 2018 vacation in Norway.

shaky and heavy and like I couldn’t balance. … I’d have to sit on my hands and that kind of stuff to try to stabilize.”

He and his doctor tried tweaking his medications, without much success. Then a friend suggested DBS.

The procedure has reversed his Parkinson’s symptoms by about 15 years, McNasby said, to around where they were when he was initially diagnosed. With round-the-clock electrical stimulation, he wakes up feeling good and no longer has drastic ups and downs during the course of the day.

“All the symptoms have been drastically reduced” and are “well within something that’s manageable,” he said.

“I feel so much better,” he added. “It’s something I unequivocally recommend.”

Voltage is easy to adjust

Several DBS devices are on the market, and different doctors follow different protocols to implant them. While McNasby said some patients have the whole system implanted over a 12-hour period, he and his team at Manhattan’s Mount Sinai Hospital chose a series of three surgeries over the course of about a month. His doctors selected Abbott’s Infinity™ DBS system with batteries that last 5-8 years before needing replacement rather than batteries that need daily recharging.

McNasby said he was initially nervous about the prospect of the surgery. His doctor explained the potential risks, which include an electrode placed in the wrong spot, stroke, speech complications, and unpredictable effects from the electricity. His first procedure was a magnetic resonance image (MRI) to pinpoint the exact locations in his brain for the implants.

Jim McNasby, 50, says his DBS device has

 alleviated the worst symptoms of Parkinson’s.

The MRI was followed this past January by robotic surgery to insert a wire in his brain on the left frontal part of his head. The wire comes out through his skull and travels under his skin to a spot behind his left ear, then down his neck to a tiny battery placed on his chest below his collarbone. The stimulation from inserting the wire itself into his brain improved his symptoms for several days, making him more optimistic about the subsequent surgeries, he said.

The second surgery placed a wire and battery on the right side of his head and chest, and the third, on Feb. 11, connected the two sides to each other. After a three-week period of healing, and scaling down his Sinemet, doctors fully activated the device on March 5.

Today McNasby can barely see or feel the implanted wires and batteries. He likes the worry-free ease with which he and his doctor can adjust the voltage: he uses an Apple device the size of an iPhone that synchronizes with his batteries when he sets it on his chest, and his physician uses an iPad to determine the range of changes he can make. The day McNasby spoke to Parkinson’s News Today, one side of his brain was set at 2.5 volts and the other at 2.2 volts.

“You actually can’t hurt yourself with the device,” he said. “You can’t cause any damage that’s irreversible.”

Further improvement possible

And while he can’t feel the electricity while it’s stimulating his brain, he certainly can tell if it has been turned off: his symptoms come back immediately, “my tremors, especially,” he said.

Although McNasby said his case is not typical, he is now completely off the Sinemet. The only medication he uses is Amantadine, which he takes three times a day for tremors. Before his DBS implant, he had to take as many as 15 pills per day.

Despite developing Parkinson’s at an early age, McNasby says he feels very fortunate: his symptoms haven’t been worse, his disease progressed relatively slowly, and his response to DBS was strong. He never experienced the depression that often accompanies Parkinson’s.

He attributes his “luck” in large part to his one hour of exercise every day. He plays tennis, bikes, lifts weights, and does yoga.

McNasby said he and his doctor are still adjusting his electricity dosage, and it’s possible that he may feel even better in the future. After all, his DBS device has been operating for only two months and it has 44,000 settings.

He doesn’t want to get his hopes up too much. Still, he said, “44,000 [variations] – that’s a lot of options.”

https://parkinsonsnewstoday.com/2019/05/03/lawyer-parkinsons-disease-describes-positive-effects-dbs/

Hotspot in the genome may drive psychosis in schizophrenia and bipolar disorder

by Van Andel Research Institute     May 3, 2019

Dr. Viviane Labrie Credit: Van Andel Research Institute

A newly identified epigenetic hotspot for schizophrenia and bipolar disorder may give scientists a fresh path forward for devising more effective treatments and biomarker-based screening strategies.

More than 100 million people worldwide have either schizophrenia or bipolar disorder, which are characterized by periods of hallucinations, delusions and irregular thought processes. They are both associated with overproduction of the neurotransmitter dopamine, a key regulator of reward-seeking behavior, emotional responses, learning and movement, among other functions.

While effective medications do exist, they often have challenging side effects such as apathy, weight gain and uncontrolled movements called dyskinesias that typically are associated with Parkinson's disease. Currently, there are no effective biomarkers for screening and tracking progression of either disorder.

"We've known since the 1970s that the effectiveness of antipsychotic medications is directly related to their ability to block dopamine signaling. However, the exact mechanism that sparks excessive dopamine in the brain and that leads to psychotic symptoms has been unclear," said Viviane Labrie, Ph.D., assistant professor at Van Andel Research Institute (VARI) and corresponding author of the study, which appears in the May 3 edition of Nature Communications. "We now have a biological explanation that could help make a real difference for people with these disorders."

Labrie and her collaborators found a cluster of epigenetic marks that ratchets up dopamine production while simultaneously scrambling the brain's synapses, the information hubs that transmit rapid-fire neural messages responsible for healthy function. The result is a catastrophic shake-up of the brain's organization and chemical balance that fuels symptoms of psychosis.

https://youtu.be/_h6lLuzUafM 

Dr. Viviane Labrie of Van Andel Research Institute discusses how an epigenetic hotspot may contribute to symptoms of schizophrenia and bipolar disorder. Credit: Van Andel Research Institute

"What we're seeing is a one-two punch—the brain is being flooded with too much dopamine and at the same time it is losing these critical neural connections," Labrie said. "Like many other neurological disorders, schizophrenia and bipolar disorder often have early, or prodromal, phases that begin years before obvious symptoms. It is our hope that our findings may lead to new biomarkers to screen for risk, which would then allow for earlier intervention."

The team took a comprehensive, broad look at DNA derived from brain cells of people with either schizophrenia or bipolar disorder and compared them to healthy controls. Their analyses revealed a cluster of epigenetic marks, which switch genes on and off, in an enhancer at a gene called IGF2, a critical regulator of synaptic development. Enhancers are stretches of DNA that help activate genes and can be major players in the development of diseases in the brain and other tissues.

This enhancer also controls the activity of a nearby gene called tyrosine hydroxylase, which produces an enzyme that keeps dopamine in check. When the enhancer is epigenetically switched on, production of dopamine becomes dysregulated, resulting in too much of the chemical in the brain.

Taken together, molecular changes at this site may explain why psychosis brought on by dopamine frequently is accompanied by a disruption of brain synapses, a devastating double-hit that promotes symptoms.

The study controlled for genetic factors, sex, ethnicity, treatment history and lifestyle influences such as smoking, and the results were validated in experimental models of the disease.

"We used cutting-edge computational strategies to understand the events occurring in brain cells that underlie psychiatric disorders," said Shraddha Pai, Ph.D., a postdoctoral fellow at University of Toronto and the study's first author. "Our results were strengthened by additional studies in disease models. This comprehensive approach lends weight to our findings, which we believe will propel additional groundbreaking investigations into this enhancer at the IGF2 gene."

More information: Shraddha Pai et al, Differential methylation of enhancer at IGF2 is associated with abnormal dopamine synthesis in major psychosis, Nature Communications (2019).  DOI: 10.1038/s41467-019-09786-7Journal information: Nature Communications
Provided by Van Andel Research Institute 

https://medicalxpress.com/news/2019-05-hotspot-genome-psychosis-schizophrenia-bipolar.html

Do massages really work?

May 3, 2019      by Bev Betkowski, University of Alberta

The answer isn't black and white, says a massage therapist at the University of Alberta.

"The problem is it can be subjective and difficult to measure," said Deborah McIntyre, a member of the massage therapy team based at the Glen Sather Sports Medicine Clinic. Massage has a mix of benefits for both mind and body, depending on the varying needs of the client, she said.

"It's specific to what the situation and problem is. It could be massage for a musculoskeletal condition, pain relief, relaxation therapy; the question is, have we fulfilled the client's request for a treatment to address their concerns?"

The key to that, McIntyre added, lies in connecting with four of the body's major physiological systems during massage therapy and "trying to manipulate the soft tissue to obtain the favourable results the client desires."

The first is the neuromuscular system, which includes all the muscles in the body and the nerves serving them. In this capacity, massage can treat muscles that are either in spasm (too short and tight) or flaccid (too stretched and weak), McIntyre said.

The second part of the body to benefit from a good massage treatment is connective tissue like ligaments, tendons, cartilage and scar tissue.

"A massage can increase range of motion in a joint or smooth and realign disorganized scar tissue," explained McIntyre.

The circulatory system also benefits from massage by increasing blood flow to the tissues, which aids in delivering oxygen and getting rid of metabolic waste to promote healing. Used with caution, massage can also help lymphatic drainage for mastectomy patients and stimulate better breathing for people with limited lung capacity or other respiratory conditions. It also improves circulation of cerebral spinal fluid, which could hold potential for treating concussions, McIntyre believes.

Massage also helps the autonomic nervous system, which regulates sympathetic responses in the body like heart rate and arousal.

"A massage helps people come down from heightened stress and anxiety," explained McIntyre.

She added the benefits of massage also linger after the appointment is done.

"The physiological experience definitely has a lasting effect. Massages can't solve everything, but they can be very successful when used appropriately."

More research into measuring the effects of massage on the body's four physiologic systems will further help pinpoint its benefits, she added.

Some studies have shown it also holds potential for people with dementia and Parkinson's disease, she noted, because soft massage can decrease aggressiveness and anxiety.

"We can gain some insight by working with other disciplines in medicine and science such as physiotherapy, sports medicine and chemistry. They have the ability to measure the different molecular structures within blood and tissues, and then we can see if we're making a difference as massage therapists," she said.

Relaxation versus deep tissue massages

Whether for pure pleasure or to treat pain, there are massage techniques for both. But deep tissue massages should only be given as part of a plan to treat a specific injury, McIntyre said.

"(When) you're dealing with a problem, there should never be a deep tissue massage without an assessment first. Otherwise the body may not need it and you may damage the tissue. No one wants to feel like they've been hit by a truck after a treatment."

The massage therapist should assess the patient, get their consent and then develop a plan that could also recommend hydrotherapy and other treatments.

"A skilled massage therapist will have many tools to get favourable results without causing further damage."

Relaxation massages are good for treating minor aches and reducing anxiety, McIntyre said.

"It's a softer touch, and you're trying to provide a feeling of well-being as the patient starts to relax."

However, she added, massage treatment may not be appropriate for people with certain conditions that could require first aid or medical attention due to strokes, diabetic comas, systemic infections, high fevers, or uncontrolled high blood pressure and bleeding.

"A trained therapist will be able to accommodate many other medical conditions and medications and is expected to know when and how to consult with doctors and other health-care professionals," McIntyre noted.

What to expect from a massage therapist

• A pre-massage assessment for a client's injury or condition. A proper case history should be taken, including past and current medical history and a list of prescription medication.
• Development of a treatment plan with the client's informed consent. A massage therapist should have a good referral base to other medical professionals.
• A variety of massage techniques to provide relief.
• For a relaxation massage, clients should be asked about any medications they're taking and any other contraindications.

https://medicalxpress.com/news/2019-05-massages.html

Michael J. Fox Admits He’s Struggled With Optimism Amid Battle With Parkinson’s

May 1, 2019       BY JACK PHILLIPS

Michael J. Fox, the “Back to the Future” star, admitted that he’s having difficulty staying optimistic in the face of his battle with Parkinson’s disease.

“I feel sometimes I don’t want to be selling people the optimism thing because people have tough lives. Depression is real, and things happen to them that I can’t even comprehend. They make my stuff seem like Band-Aids and skinned knees,” Fox said, according to Fox News on April 30. “So I don’t want to be saying, ‘Cheer up!’ Some stuff sucks.”

He was diagnosed with Parkinson’s disease at the age of 29 in 1991.

Fox noted that the past year has been quite tough.

“I’m known as a guy who makes lemonade out of lemons, but I was out of the lemonade business: ‘I can’t do this anymore, I can’t,'” Fox said at the Tribeca Film Festival, according to the report.

The Canadian actor said he is working on a memoir and is still pursuing acting, having appeared in TV show “Designated Survivor” and “The Good Wife.”

Fox noted that he is still working on a foundation to research Parkinson’s.

“After I’m gone, if I had something to do with [finding a cure], that will be great,” he said.

https://youtu.be/5OLzuUVfoJ8 

In 2018, Fox told CBS that Parkinson’s “sucks,” adding that it’s not worth it to dwell on negative thoughts. “I hate it,” he said, adding that it’s “been one of the great gifts in my life” to raise awareness about it.

Fox told The New York Times in a March interview that he recently “was having this recurring problem with my spinal cord.”

“I was told it was benign but if it stayed static I would have diminished feeling in my legs and difficulty moving. Then all of a sudden I started falling—a lot. It was getting ridiculous. I was trying to parse what was the Parkinson’s and what was the spinal thing. But it came to the point where it was probably necessary to have surgery,” he told the paper. “So I had surgery, and an intense amount of physical therapy after. I did it all, and eventually people asked me to do some acting. Last August I was supposed to go to work. I woke up, walked into the kitchen to get breakfast, misstepped and I went down. I fractured the hell out of my arm. I ended up getting 19 pins and a plate. It was such a blow.”

Parkinson’s Symptoms

According to the Parkinson’s Foundation website, Parkinson’s symptoms typically worsen as people get older.

“The cause remains largely unknown. Although there is no cure, treatment options vary and include medications and surgery. While Parkinson’s itself is not fatal, disease complications can be serious. The Centers for Disease Control and Prevention rated complications from PD as the 14th cause of death in the United States,” says the website.

Michael J. Fox in a file photo. (Andrew H. Walker/Getty Images)

It adds: “It is important to understand that people with PD first start experiencing symptoms later in the course of the disease because a significant amount of the substantia nigra neurons have already been lost or impaired. Lewy bodies (accumulation of abnormal alpha-synuclein) are found in substantia nigra neurons of PD patients.”

https://www.theepochtimes.com/michael-j-fox-admits-hes-struggled-with-optimism-amid-struggle-with-parkinsons_2903608.html