Showing posts with label tremor. Show all posts
Showing posts with label tremor. Show all posts

Monday, March 29, 2010

Differential Diagnoses and Parkinson's Disease

What do the stereotypes mean for you and PD?

We already know that the precursor symptoms of Parkinson's disease can show their presence years before the disease is full blown and diagnosable.  We always want to be reassuring or to be reassured when we notice them. So we tell each other and ourselves:

"Oh, it's nothing"
"You're just stressed"
"Well who wouldn't have sleeping problems, you're depressed"
"Losing your sense of smell is convenient, now you can avoid changing the cat box"
"Perhaps that neck and shoulder pain is from the way you sit at the computer"
"Get another pair of shoes, you're dragging your leg when you walk"
"Get a new pen, your handwriting has changed"
"That tingling is the beginning of carpal tunnel, get a wrist rest"
"Try these pills to help you sleep or for your depression"
"Who wouldn't be depressed, you're not sleeping enough"

And so a few years pass and the next symptoms appear and you make that dreaded appointment.  Afraid to know but afraid to delay treatment.

When that tremor appears, people know it is time. The good news for many is that that an action or a postural tremor is not PD. Sometimes it is a sign of Essential Tremor, which isn't curable but in many cases more manageable.  And you can drink to that.  But that postural tremor which occurs not when the limb is at rest but rather when performing an action can also be a sign of renal or liver failure, of hyperthyroidism, of Dystonia; it can be caused by medications, hypoglycemia or Fragile X Syndrome(FXTAS). The list is long and the diagnosis needs a professional so that the proper treatment can be initiated.

Then there are the people diagnosed with Parkinson's Disease who actually have Parkinson's Plus: the Multiple System Atrophy group (MSA), Progressive Supra-nuclear Palsy (PSP), Dementia with Lewy Bodies (DLB) and Corticobasal Ganglionic Degeneration (CBGD).  There is even Parkinson's with ALS The correct diagnosis is necessary to avoid delaying the correct treatment to improve quality of life.

Let's face it, for many people it may seem to be less frightening if they can arm themselves with information before their doctor's appointment. Reading about conditions can actually help you prepare a more thorough list of symptoms. Other people only want to know more after the diagnosis. Before getting any on-line prompts and suggestions, it's a good idea to make that list of all  your symptoms and when they occur. That way you won't be as easily swayed by suggestion.
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Although there is not always good news, there are helpful online sites for many conditions.  The Parkinson's sites are listed in the right hand column here as Helpful Links.  For Parkinson's Plus one of the most informative sites is actually eMedicine from WebMD.  The National Institute of Neurological Disorders and Stroke (NINDS) provides a brief but helpful overview of tremor. So does Medline Plus.  You can read about Essential Tremor at several sites.  In our opinion the best site for Essential Tremor information is WeMove.org.  Another site with a helpful chart of pathology of the nervous system is Wikipedia.

The point is that if you are prepared for your doctor's appointment by having a symptom journal, you can be not only proactive in providing some of the information needed to make the most accurate diagnosis but you can also become a significant part of your medical team.  And yes, you are going to need you.

We know of patients who have been told to go home to die. While having your financial affairs in the best order possible and by spending quality time with family and friends is excellent advice for everyone, we just heard a patient's take on that give-up advice from a very courageous woman. When told that there was nothing she could do for her MSA, she asked the doctor if he would give his wife, daughter, mother or sister that same advice. He saw her point and treatment became interactive. We think she's doing very well in finding a course of alternative treatment. She said she had no choice, she wanted to live and there was no hope by following the doctor's advice.    

Even if those early warning signs don't send you to the doctor, at least make a mental or written note.  If the symptom persists, pay attention, your body is telling you something that could be important.

Monday, September 8, 2008

Massage Therapy and PD

Keeping my Parkinson's disease progression as slow as possible


I've had Parkinson's disease for 5+ years now. I've been trying to avoid taking levodopa because of its possible side effects that often start after 5 years of increasing dosage. Medications I now take are azilect, COQ10, and isradipine for PD. They eliminate or reduce my symptoms of tremor, soft voice and foot drop, while leaving me with slowly progressing muscular rigidity, gait difficulty and slowness of movement.

Seven months ago I began massage therapy for arthritis in my knees because I had read about positive results in a Yale University study for the CDC. The study showed that Swedish massage therapy reduced pain while improving flexibility and range of motion in arthritis patients.

I've been getting a one hour massage every week and the pain in my knees is mostly gone, unless I lift heavy things or wear shoes that are not soft, flexible and low heeled. In recent months I've been wearing Dr Scholl's Lara medium or wide width with the gel insole. Yes, I am gellin' and it seems to help my comfort level.

Most large metro areas will have lots of Massage Therapists. Find one who is familiar with Arthritis and Parkinson's and is listed by the American Massage Therapy Association. Most will offer several different styles of massage. Each of us is different, but Swedish massage has tested as pain relieving for arthritis.

In a small study conducted by Touch Research Institute at the University of Miami 16 adults diagnosed with Parkinson's disease were randomly assigned to either progressive muscle relaxation exercise or massage for 30 minutes twice a week.

The results were that those in the massage group had improvements in daily functioning and urine tests showed a reduction in stress hormone norepinephrine and the massage group had fewer sleep disturbances.

I will discuss my own massage therapy in more detail in an upcoming Parkinson's Focus Today post.