Choosing your final resting place By Sheryl Jedlinski

By Sheryl Jedlinski

 As we move through our retirement years conversations with friends shift focus from exotic travel destinations to final resting places. Our options are many and varied, making it difficult to reach decisions. Growing up in a simpler time, it was assumed that when I passed on, I would be laid to rest in the same cemetery as generations of my family before me. This is not to be, however, as my mother and her cousins made the exodus to Florida and are or will be buried there, leaving me and my cousins to find our own final resting places.

Pre-planning for our death and the afterlife is not something any of us relishes. We do it to give our loved ones the peace of mind that comes from knowing that the important decisions have been made and thoroughly discussed, eliminating the need for second-guessing. I hope we can give this the same gift to our children.

Being claustrophobic has added to the difficulty of deciding whether to be buried, cremated, or both. None of these end of life options is appealing to someone who is terrified of being locked in a small space and unable to escape. I knew folksinger John Prine understood my pain when I heard him sing, “Please don’t bury me in the cold, cold, ground.” He preferred to be cut up and passed around, with his “feet going to the footloose, and his knees to the needy.” The thought is nice, but I’d like some assurance that I won’t be needing all my body parts in my next life.

What I do know is that donating my organs and tissue after I die can save or improve as many as 75 lives.  With more than 100,000 people in the U.S. waiting for an organ transplant, the Mayo Clinic estimates that 20 die every day because of the lack of donor organs. I’ve signed up with my state’s organ donation registry and have a donor designation on my state ID. Organ or tissue donation will not affect funeral arrangements.

Donating your brain to Parkinson’s disease research is another option to consider. It is handled separately from organ donation and can help speed up development of new treatments and increase the odds of finding a cure. Learn how you can contribute to the health and well-being of future generations by contacting the Brain Donor Project at 513-393-7878 or BrainDonorProject.org, or by calling the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (473-4636).

In 1980 only about one in 10 people who died in the U.S. were cremated; today that number has risen to about half as it is increasingly known to be more economical and environmentally friendly. If you want to combine cremation with burial to get the best each has to offer, look for cemeteries that have an urn garden specifically set aside for this. Similar to burying your loved one’s dead body in a casket, cremains are sealed in an urn inside a metal or concrete burial vault in the ground. Above-ground burial space is available in a columbarium, a building similar to a mausoleum. Instead of crypts that entomb the casket and keep the remains above ground, columbariums contain many recessed compartments (cremation niches) for permanent placement of urns containing cremains.

Most people who want to be cremated have a plan for scattering their cremains in a place that is meaningful to them. Check whether permission and permits are required for certain spots, such as state parks or private property. When scattering ashes by boat, check to make sure you and any professional service you use complies with state and federal laws. If you prefer, place a biodegradable urn in the water that will dissolve without doing environmental damage. Scattering done from a plane, hot air balloon, or drone allow ashes to be distributed over remote scenic areas that might not otherwise be accessible.

Choosing a final resting place for cremains is limited only by your imagination. You can find companies that will do anything for a price, including:

• Turn ashes into an environmentally safe cast concrete reef and place it into the ocean to create a new marine habitat.
• Mix ashes with organic nutrients to grow a plant or tree in your yard, creating a living memorial.
• Create loaded ammunition out of cremains and display it in its engraved wooden box, or take it on your next hunting trip.
• Turn cremains into fireworks, scattering them with an explosion of light in the dark.
• Send cremains to the final frontier of space.
• Make ashes into a playable vinyl record using music or voice recording and cover image supplied by you.
• Turn cremated ashes into jewelry. Place a small amount of the cremains into  a locket or mix the ashes with the actual materials used to construct the jewelry.
• Create stuffed animals with special compartments for storing cremated ashes.

So, after all of this research and protracted discussions with friends and family have I decided on a final resting place? Not exactly, but I am getting ever closer and more comfortable with the idea. I might request that my ashes be sprinkled somewhere fun like over one of my favorite stores or ice cream parlors where I’ve enjoyed hours of fun with friends.

A visit to my Dad’s grave in south Florida convinced me to opt for cremation. The afternoon I went, the heat index was an extremely dangerous 128 degrees. Meteorologists repeated increasingly dire warnings, cautioning listeners to stay hydrated and remain indoors whenever possible. So why was I wandering a cemetery with my husband Tony, and my 89-year-old mother looking very unsteady pushing her walker on uneven ground?

Each of them was certain they knew the location of my Dad’s grave and set off in different directions to find it. I watched them from our rental car with doors swung open as I had no key to turn on the air conditioning. I was poised to call 911 should either of them keel over from heat exhaustion.

Then, like a mirage, a man appeared out of nowhere bearing bottled water and cemetery maps. “What are you doing out here in this heat?” he asked me.

I made my end of life decision, I will be cremated. I don’t want my granddaughter wandering around in the heat looking for my grave. What becomes of my ashes I’ve yet to decide, but it’s a start. I can always revise my plans if a less claustrophobic option becomes available.

 Beautifully written by:

Sheryl Jedlinski

https://livingwellwithparkinsonsdisease.com/2019/10/31/choosing-your-final-resting-place/

Parkinson’s Disease and the Uninvited Guest

NOVEMBER 7, 2019 BY LORI DEPORTER

When Parkinson’s entered my life, it brought an uninvited guest along with it: Parkinson’s me.

Parkinson’s me follows me everywhere and is part of everything I do. Most of the time, she quietly stays in the background. Other times, she is overwhelming, to the point where putting on my brave face becomes exhausting. Until recently, I didn’t always like Parkinson’s me, but I’m trying to understand her instead of simply being afraid of her.

Parents with early onset Parkinson’s are in the busiest times of their lives. Any situation can become stressful and trigger symptoms. Despite my best efforts, Parkinson’s me tends to arrive front and center. It’s not uncommon for her to have a completely irrational response to things. Indeed, anxiety and Parkinson’s are good friends often seen together. Their relationship manifests as a nonmotor symptom that, when overlooked, can be debilitating, frustrating, and embarrassing.

I feel helpless when Parkinson’s affects my ability to parent my child. Parkinson’s me always seems to arrive when my kid needs me — at tryouts, auditions, school functions, and other crowded events. For example, Parkinson’s me accompanied my son to a crowded audition, complete with tremors and a feeling of panic. My son put his hands on my shoulders and said, “Mom, I’ve got this. You can go.”

I was embarrassed and felt horrible for leaving, but he was right to send Parkinson’s me on her way. Rather than being embarrassed by what I could not do as a parent, I should have been proud of my son’s confidence and his ability to handle this situation and many others.

If we’re open about Parkinson’s and willing to talk to them about our diagnosis, kids are incredibly perceptive and resilient. In my opinion, we should help them understand Parkinson’s so they are not afraid of it.

Ultimately, we are still their parents. We just happen to have Parkinson’s.

If you find yourself embarrassed by your disease as a parent, stop and ask yourself the following questions: Did you get the job done? Was your kid strong and confident? The answers will be “yes” because you are a parent. Your kid knows that you don’t quit.

You may stumble and fall, but you will always get up. They are confident that you will be there for them, which is a direct result of your efforts, despite the challenges that come with Parkinson’s.

It is not easy to admit, but Parkinson’s me actually can get the job done. The job is just done differently, and that’s OK.

***

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/2019/11/07/parenting-anxiety-challenges-flexibility/

Parkinson’s Foundation Launches International Cycling Event to Promote Exercise, Raise Funds

NOVEMBER 7, 2019 BY MARY CHAPMAN IN NEWS.

The Parkinson’s Foundation is launching a new initiative called Parkinson’s Revolution, a global cycling event designed to highlight the benefits of exercise in Parkinson’s disease while also raising funds for research.

A new signature event for the foundation, Parkinson’s Revolution is an indoor cycling program taking place Feb. 8 at studios in seven U.S. cities — Boston, Chicago, Dallas, Miami, New York City, San Francisco, and Washington, D.C. The program will also involve select locations in Canada and the United Kingdom. The fundraising goal for each site is $10,000.

“Parkinson’s Revolution is a great example of how the international [Parkinson’s] community is rallying together to combine the benefits of exercise and critical fundraising for research in one event,” John Lehr, the foundation’s president and CEO, said in a press release. “We are honored to work alongside Parkinson Canada and Parkinson’s UK to further our mission to make life better for people with Parkinson’s.”

In a high-energy environment including motivational music and instruction, participants of all abilities will select either a 90- or 45-minute ride as individuals or as part of a team. Supporters who can’t make it in person may saddle up at home or a local studio and raise funds as “virtual riders.” The foundation is asking each person to commit to fundraising a minimum of $250.

Money raised will go directly toward research, resources, and patient care. In addition to offering an opportunity to meet fellow supporters, each Parkinson’s Revolution event will include information about the Parkinson’s Foundation.

Click on a city or “virtual ride” at this site to register. After signing up, participants will be sent tools needed to reach — or exceed — fitness and fundraising goals.

Exercise is particularly important for Parkinson’s patients, helping them maintain balance, mobility, and the ability to do daily tasks. Scientists have found that those who exercise at least 2.5 hours weekly also experience a slower decline in their quality of life.

In addition, researchers have studied the brains of mice that exercised under conditions similar to a human being on a treadmill. While exercise did not increase the number of neurons or amount of dopamine in mice’s brains, it did prompt their brains to use dopamine more efficiently.

Dopamine is a neurotransmitter that helps regulate movement and emotional response. A lack of it is associated with neurodegenerative disorders including Parkinson’s, which affects nearly 1 million U.S. residents and 10 million individuals globally.

Watch this Parkinson’s Revolution video from the Parkinson’s Foundation:

https://youtu.be/RGLavITIN6Q 

https://parkinsonsnewstoday.com/2019/11/07/parkinsons-foundation-launches-international-cycling-fundraising-event/

Activa Patient Programmer for DBS Therapy Available in US, Medtronic Announces

NOVEMBER 7, 2019 BY MARY CHAPMAN 

Medtronic, a medical technology company, announced that its Activa patient programmer technology for deep brain stimulation (DBS) therapy is now available to U.S. patients with Parkinson’s disease (PD) and other movement disorders.

The new programmer, approved by the FDA in July, is used with a customized Samsung mobile device to help patients more easily use DBS treatment and in a home setting. The Ireland-based company said that more than 150,000 people have been implanted with its DBS devices globally to manage disease symptoms, particularly those of Parkinson’s, since 1997.

“It is important for patients to have access to advanced technology for user-friendly therapy management at home,” said Sandeep Thakkar, DO, neurologist and movement disorder specialist at Hoag’s Pickup Family Neurosciences Institute, in a press release.

“The new Medtronic DBS Activa Patient Programmer device is an innovative tool that combines familiar consumer technology with medical devices, which facilitates better control for patients in an easier, more accessible way,” Thakkar said.

DBS is a surgical treatment option for people in advanced stages of Parkinson’s, whose movement problems are not being helped by medications. During surgery, one or more wires are inserted deeply into the brain to reach affected areas. These wires are subsequently connected to a pacemaker-like implantable pulse generator that is typically positioned just under the patient’s skin, in the upper thoracic region.

Able to share patient data directly with clinicians, the Patient programmer includes a programmer handset and communicator. When patients wish to modify prescribed therapy settings, check the battery, or activate or deactivate therapy, they hold the communicator above the implanted device and use the programmer to make adjustments.

Clinicians also have the ability to define settings and work with patients to adjust DBS therapy settings when using the therapy away from the clinic.

The system is managed on a Samsung Galaxy Tab S2 tablet with a customized user interface and five-inch touchscreen, and uses Samsung’s security technology to help protect both the device and patient.

Taher Behbehani, head of the Mobile B2B Division, Samsung Electronics America, said the user-friendly therapy marries safety with data control. Medtronic has partnered with Samsung since 2013, expanding into neuromodulation two years later.

“It’s through our open yet secure mobility platform that we can offer this level of customization on our market-leading devices,” he said.

“Medtronic has been the leader in DBS therapy for over 25 years. This launch continues to serve as further evidence of our dedication to our DBS patients,” said Mike Daly, vice president and general manager of the Brain Modulation business, which is part of Medtronic. “With this device, patients gain confidence, as they are able to discreetly manage their DBS therapy no matter where they are.”

https://parkinsonsnewstoday.com/2019/11/07/medtronic-activa-patient-programmer-for-dbs-therapy-available-us/

Departing vets committee chairman hopes partisan divisions won’t overwhelm VA policy work

November 8, 2019   By: Leo Shane III    

Sen. Johnny Isakson, R-Ga. (center), and congressional colleagues meet with Georgia officials during a Capitol Hill meeting on Feb. 14, 2019. Isakson, the current chairman of the Senate Veterans' Affairs Committee, is set to retire at the end of 2019. (J. Scott Applewhite/AP)

Sen. Johnny Isakson doesn’t believe that the Department of Veterans Affairs will ever be “fixed,” no matter what lawmakers do. 

“VA is always going to be a work in progress,” the chairman of the Senate Veterans’ Affairs Committee said in an interview with Military Times. “You’re always going to have new challenges. Right now we’re dealing with Blue Water Navy benefits (from Vietnam) … and new caregivers benefits from the recent wars overseas. 

“So it’s constantly changing, and you need to learn from the past how to make progress. Because if you don’t, you’re going to get a backlog of problems, and you’ll have a mess. And that’s what we’ve been dealing with for the last few years.”

For almost five years, the senior Georgia Republican has been at the center of those reform efforts, acting as a gatekeeper for legislation to dramatically expand VA community care programs, employee accountability rules and an expansion of GI Bill benefits.

Now the former Georgia Air National Guardsman is preparing to step aside from that role. He’ll leave the Senate at the end of this year, citing “mounting health challenges” including a Parkinson’s disease diagnosis.

His departure comes at a key moment for the committee and the department. With a presidential election looming next year, maintaining any focus on veterans issues could be a significant struggle. Keeping the committee’s work from collapsing into political infighting could be even more difficult. 

And Isakson insists that despite some recent negative headlines, VA is in better shape now than at any point in the last five years.

“VA is going to have to work better in the future than it is working now, but it is working now,” he said. “A lot of people have perceptions that VA is only what you read about in the newspaper, and it’s not.”

Isakson became chairman only a few months after the 2014 wait times scandal that forced the resignation of then VA Secretary Eric Shinkseki and shook public confidence in the department. 

That set off nearly four years of debate over the role of VA hospitals in an evolving American health care landscape, culminating in the passage of the VA Mission Act last summer.The bill dramatically increased availability of outside care options for veterans enrolled in department medical coverage, and has prompted political fights over how much taxpayer money can be sent outside the department without “privatizing” key federal promises to veterans. 

The 75-year-old Isakson was a central figure in crafting that legislation, navigating the bill between Democrats worried about private-sector creep into VA care and conservatives who wanted an even freer hand for veterans to choose their providers. The chairman said he is pleased with the results he has seen from the compromise over the last few months. 

His work as chairman over the last few years has been part cheerleader, part chief critic for the department. He has praised VA Secretary Robert Wilkie for his work over the last year but also criticized the before him, White House physician Rear Adm. Ronny Jackson, as a mess. 

He also has publicly taken issue with President Donald Trump’s past comments about the late Sen. John McCain, calling the commander-in-chief’s attacks on the former POW unseemly, unfounded and not helpful to the veterans’ community. 

Still, Isakson said the turmoil surrounding veterans issues in recent years has produced a silver lining: more people are paying attention to veterans issues and the $200-billion-plus department’s programs.

“We had a lot of scrutiny of VA in a confined period of time,” he said. “Because of that, we did a lot of reforms we might not have done otherwise. We had a lot of work to do, but we got a lot done.”

Among the accomplishments he lists during his time leading the committee are sweeping, multifaceted legislation like the Forever GI Bill (an expansion of post-9/11 GI Bill benefits), the VA Accountability Act (which eased rules for firing department employees accused of wrongdoing), an overhaul the VA’s appeals process and veterans suicide prevention efforts. 

All of the bills were passed with bipartisan support and coordination, something Isakson hopes will be remembered as part of his 20-year legacy in Congress, especially as tensions on Capitol Hill continue to rise. 

“The way you legislate is you set goals and you include people, not exclude them,” he said. “A lot of times in Congress, it’s a matter of attrition. But I always wanted to get Democratic votes. 

“The Senate now, it’s a new day every morning. I don’t know where we’re going right now on the atmosphere. It’s pretty unpredictable. We’re getting to the point where we have to change something.

”That work will be left to the next chairman, still to be named by Republican leaders. Isakson said he is also hopeful the committee in the next year will finish work on expanding benefits for veteran caregivers and for “blue water” Vietnam veterans, two major issues he was unable to see to completion this year. 

Isakson’s departure will also leave another hole in the declining number of older veterans in Congress. Of the 20 current lawmakers who served in the military before 1970, four — including Isakson — have already announced they’ll leave Capitol Hill next year.

https://youtu.be/ak3nIV2teVo 

The former national Guardsman has spoken more frequently in recent years about his personal connection to the veterans’ committee work. Although he never served overseas in Vietnam, Isakson said that “I lost a lot of friends there. They were my age … That hurts a lot, when you see 5,800 people dying over there.”

He hopes that his successor can keep that kind of focus on the work at hand, even as much of the public’s direct connection to the military dwindles. 

“Less than 1 percent of the country today are defending the world for peace and prosperity, representing the United States of America,” he said. “That is unbelievable. It tells us how much we can be thankful for, that small a percentage can carry out that big a mission. 

“They can because of the quality of our people, the quality of our equipment, and the fact that we as a country are committed to peace, tranquility and economic prosperity for all. We need to remember that.”

https://www.marinecorpstimes.com/news/pentagon-congress/2019/11/07/departing-vets-committee-chairman-hopes-partisan-divisions-wont-overwhelm-va-policy-work/

Tagging proteins could aid research into neurological diseases, say scientists

November 7,  2019

O-GlcNAc is found on proteins related to conditions such as Alzheimer’s, Parkinson’s, motor neurone disease and intellectual disability.

Andrii Gorelik and Daan Van Aalten

Tagging proteins in human cells with a small sugar molecule could help understand neurological diseases, according to a team of scientists in Scotland.

Professor Daan van Aalten of the University of Dundee’s School of Life Sciences made use of a molecule called O-GlcNAc, which is found on proteins related to conditions such as Alzheimer’s, Parkinson’s, motor neurone disease and intellectual disability.

There are over 20,000 proteins in every human cell and approximately 20% of these contain O-GlcNAc.

Prof van Aalten’s team hypothesise that increasing levels of the molecule appears to have a therapeutic benefit, leading them to develop a technique to tag proteins and explore what happens.

O-GlcNAc

A small sugar molecule, found on proteins related to numerous neurological diseases

Professor Daan van Aalten

He said: “It is likely that perturbation of the O-GlcNAc sugar on just a single protein could have deleterious effects on healthy neurons and other cells but until recently, the research field lacked methods to investigate this.

“We have now created the tool that enables us to do this.

“This allows us to ask questions about the role of specific sugar modifications that are dysregulated in cases of intellectual disability, as well as other brain diseases.

“Our technique has great potential to advance knowledge of O-GlcNAc-related disorders and help develop novel therapeutics.”

With additional gene editing technology, the team could use their method to understand the causes of the diseases when the sugar level is disrupted.

I had been working on this problem for several years when a few unexpected observations led me to establish this new method

Dr Andrii Gorelik

Dr Andrii Gorelik, lead author of the research, found carbohydrate-protein linkage could be genetically altered to permanently fix the sugar to the protein, allowing it to be studied.

He said: “I had been working on this problem for several years when a few unexpected observations led me to establish this new method.

“Because the approach is so simple, it can be used in virtually any biomedical research lab worldwide and, hopefully, result in exciting findings regarding the role of O-GlcNAc in normal physiology and disease.”

The research was supported by Wellcome Trust funding, with the findings published in the journal Nature Structural and Molecular Biology.

https://www.expressandstar.com/news/uk-news/2019/11/07/tagging-proteins-could-aid-research-into-neurological-diseases-say-scientists/

Valley doctor creates test to better diagnose Parkinson's Disease

Author: Rich Prange     October 31, 2019

Just posted Nov. 6, 2019

PHOENIX — Parkinson’s Disease is a degenerative disease that affects the nervous system. There is no cure.

Dr. Todd Levine is the director of Neurology at Honor Health. For the past eight years, he collaborated with researchers at Harvard University to create a new way to diagnose Parkinson’s Disease.

“What we were trying to do in the lab here was trying to improve on our clinical suspicions and have a true test that can say with a 100% certainty that these patients have Parkinson's,” said Levine.

https://youtu.be/m1ts7roY5YE 

Up until now, brain scans and clinical observation were the only way to detect it.

The test they designed involves a biopsy of the skin where they look for the protein alpha synuclein in the nerve, an indicator the patient has Parkinson’s Disease.

The skin test worked for Robert Orr when others failed.

“We went to the brain scan. The DAT Scan and the doctor exam and all of that, came out initially negative. Two to three months, we did this skin test, if you want to call it that, and that showed it to be positive,” said Robert Orr.

Finding out you have Parkinson’s is not great news, but knowledge is power. An accurate diagnosis could mean a better quality life.

“If you can catch it earlier it prolongs life,” said Orr.

While there is no cure for Parkinson's, this test can open a window to new opportunities to combat the disease.

“Now allows us to work with pharmaceutical companies, which we are currently doing, to try and develop inhibitors of this protein,” said Levine.

Levine’s Cutaneous Neurodiagnostics in Paradise Valley is the only commercial lab in the country performing the test. He says the test is covered by insurance.

https://www.12news.com/article/news/health/valley-doctor-creates-test-to-better-diagnose-parkinsons-disease/75-fe7e131d-7ef5-4ca5-bc3f-cab4ff4c4300

Pints for Parkinson's

November 6, 2019


Sunday, November 10, 2019 at First Draft Taproom & Kitchen in Minneapolis from 11:00 am to 4:00 pm

“Pints for Parkinson’s Minnesota” will be held on Sunday, November 10, 2019 at First Draft Taproom & Kitchen in Minneapolis from 11:00 am to 4:00 pm, benefiting the Michael J. Fox Foundation for Parkinson’s Research (MJFF).

The event, which is being hosted by MN Beer Woman, who is a member of Team Fox, has the goal of raising $10,000 or more to enable the MJFF to continue aggressively funding research to find better treatments and a cure for Parkinson’s disease.

At the event there will be beer to purchase from over 20 Minnesota brewery sponsors, as well as raffle and silent auction items to bid on that have been donated by over 50 local businesses. One hundred percent of the proceeds from pints purchased, as well as money collected from raffles and silent auction items will be donated to the MJFF.

For more information, including a full listing of brewery sponsors and some of the raffle and silent auction items, visit: 

https://kool108.iheart.com/calendar/event/5dc2bb511a0dfb1994c0f630

/http://fundraise.michaeljfox.org/tf-2019/pintsforparkinsonsmn

Parkinson’s Disease and Your Bladder

November 06, 2019    JANE RACEY GLEESON 

Many diagnosed with Parkinson’s disease experience urinary tract issues. A Michigan Medicine urologist discusses treatment options for patients to consider.

Anne Pelletier-Cameron, M.D., often jokes to her patients that she’s a female plumber of the lower urinary tract. On a more professional note, however, she’s a urologist in the Michigan Medicine Department of Urology. 

In this role, Pelletier-Cameron treats patients with a variety of lower urinary tract symptoms. Some of her patients have been diagnosed with Parkinson’s disease, a progressive nervous system disorder that impacts movement. But the breakdown of nerve cells that characterize Parkinson’s disease can also cause “non-movement” symptoms, including bladder issues. 

“Half of all women and 17% of men will experience urinary incontinence, or the inability to hold urine,” she says, noting that for Parkinson’s disease patients, those numbers escalate. 

“Many of my PD patients end up having other bladder problems, including issues with urgency and frequency,” says Pelletier-Cameron. Nocturia, or the need to urinate many times during the night, is also common, along with difficulty in emptying the bladder.

“The bladder is very complicated,” says Pelletier-Cameron. “It needs to be big enough to store urine so you can go about your life without having to empty your bladder every 10 minutes. It also needs to store urine at low pressure and squeeze at the right time to make sure the urine doesn’t back up to the kidneys.”

For PD patients, bladder issues are often due to fluctuations in dopamine levels affecting the bladder muscles and nerves, which are critical to how it functions. PD is also thought to impact the nerve pathway between the bladder and the area of the brain that controls bladder function. 

Pelletier-Cameron says the impact of bladder symptoms can’t be ignored. 

“Lower urinary tract symptoms can negatively impact a patient’s quality of life.” They can also lead to a greater number of falls, added burden on caregivers, a decrease in the desire to socialize and a greater chance of being placed in a nursing home for care.   

Bladder problems can be exacerbated by other health concerns, as well, says Pelletier-Cameron, including prostate enlargement issues and problems with mobility. “They all add up to conspire against you.” 

Diagnosing the Symptoms

Diagnosing lower urinary tract symptoms begins with a patient history. 

“We want to know when the problems began. We then conduct a physical exam to rule out other potential causes of bladder problems,” says Pelletier-Cameron.

Tests may include:

• Urinalysis to check the urine for signs of a medical condition or disease.
• Ultrasound residual to detect remaining urine in the bladder.
• Voiding diary to help a doctor understand abnormal voiding patterns. 

“Occasionally, we need to do more testing,” Pelletier-Cameron says, including urodynamics to test how well the bladder, sphincters and urethra hold and release urine, or a cystoscopy to test for diseases of the bladder and urethra.

Treating the Condition

Lower urinary tract symptoms can be treated in several ways, including behavioral methods, medical management or surgery. 

Pelletier-Cameron begins with conservative behavioral methods. “Many of these methods are low risk and can help significantly,” she says. 

Conservative treatment includes:

• Timed voiding, which involves urinating on a set schedule, with the time between bathroom trips gradually extended.
• Bladder retraining/urge suppression to train the bladder to hold for longer periods of time, allowing it to increase in size.
• Pelvic floor physical therapy, including the Knack maneuver and Kegel exercises.

“These exercises for men and women can increase the strength of your pelvic floor and reduce bladder leakage,” says Pelletier-Cameron.

Certain foods and beverages can aggravate an overactive bladder, says Pelletier-Cameron.  These include spicy foods, caffeine, alcohol, artificial sweeteners and diuretics (water pills), which she recommends managing or avoiding altogether if you have bladder issues. 

Medical management

Second line therapy for Parkinson’s disease patients with bladder issues is medical management, says Pelletier-Cameron. 

Multiple drugs, including VESIcare and Ditropan, are available to treat bladder issues.  However, Pelletier-Cameron warns about the side effects of many of these medications such as dry eyes and mouth, constipation, upset stomach, memory problems and aggravated Parkinson’s symptoms. 

“Newer medications, including Mirabegron, an oral beta-3 agonist, have proved successful in treating PD bladder issues,” she says. “It is well-tolerated except for those with very high blood pressure.”   

Surgical procedures

For Parkinson’s patients whose bladder symptoms are not managed with conservative treatment or medicine, surgery may be an option, says Pelletier-Cameron. Surgical options include:

• InterStim, which is a small device, similar to a pacemaker, implanted just beneath the skin of the pelvis. The stimulator device emits mild electrical pulses that target an area near the sacral nerves, the group of nerves at the base of the spine responsible for urinary function. The device modulates neural activity controlling the bladder. 
• Percutaneous tibial nerve stimulation, which is an office procedure that provides electrical stimulation to control bladder function. During the procedure, the foot is elevated and an acupuncture needle electrode is placed near the nerve at the ankle, known as the tibial nerve. A stimulator is connected to the electrode and sends mild electrical pulses to the tibial nerve. The impulses then travel to the sacral nerve area, where bladder function is controlled.

“The percutaneous tibial nerve stimulation is a very popular choice with good outcomes and is very low risk,” says Pelletier-Cameron. 

Botox injections are also FDA-approved for urgency and urgency incontinence bladder issues. During this procedure, a small scope is passed inside bladder and the bladder wall is injected with Botox through tiny needles. 

“Patients do quite well with Botox injections, although urinary tract infections are a common side effect,” Pelletier-Cameron says. 

While many patients with Parkinson’s disease experience bladder issues, Pelletier-Cameron says these issues don’t have to keep them housebound. In fact, she says, “Everyone can improve the health of their bladder by voiding on a schedule, drinking mainly water or non-caffeinated beverages and learning Kegel exercises.” Some medications or minor procedure can also help, she adds. 

“Getting the right treatment or therapy can improve the quality of life in a significant way for PD patients,” Pelletier-Cameron says. “The key is to have an open discussion with your healthcare provider about the best option for your specific symptoms.”

https://healthblog.uofmhealth.org/brain-health/parkinsons-disease-and-your-bladder