30
May
2007
Parkinson’s Disease
Parkinson’s Disease is a progressive degenerative disease that destroys a part of the brain, in particular the midbrain’s basal ganglia, and it helps to control movement. Millions of people have it now. Rare before the age of 40, 1% over the age of 65, and 2.5% of people over the age of 80. Parkinson’s Disease that causes dementia affects about 0.2- 0.5% of people over the age of 65. Parkinson’s Disease peaks between 70-79 years of age and is twice a common in men compared to women.
Cause of Parkinson’s Disease: we aren’t sure. It might be genetic. Perhaps exposures are associated with Parkinson’s Disease, such as pesticides and heavy metals (mercury, zinc, iron, manganese). The basal ganglia release dopamine, a chemical to help control movement in the body. In Parkinson’s Disease, there is a lack of dopamine release from the basal ganglia to the key movement center of the brain.
Symptoms: Falling down, change in walking, worsening of handwriting, slowing down in movement, resting tremor that goes away with movement. Fatigue, dementia, even psychosis. Drop in blood pressure, incontinence, erective dysfunction, slow GI system can occur with worsening Parkinson’s Disease
Signs: 1) A resting tremor. Pill rolling tremor is seen so the thumb and index finger look like they are rolling a small marble. 2) Rigidity. On exam, while extending the arm it looks like a cogwheel movement – an unsmooth mechanical motion. 3) Akinesia, meaning lack of movement. Even the face is blank, called a masked face. 4) Gait disturbance, so turning around can call a fall. Shuffling the feet occurs.
Other diseases that can be mistaken as Parkinson’s Disease include a stroke to the basal ganglia, progressive supranuclear palsy, and multiple system atropy. Some medicines cause Parkinson-like symptoms. These drugs block dopamine receptors of the brain. Antipsychotics are big ones doing this. Metoclopramide (Reglan) for GI motility can cause this.
Treatment: no cure unfortunately. Medications don’t slow down this progressive disease. But researchers are working on drugs to slow it down.
For symptom treatment, levodopa (such as Sinemet) is used to replete the lack of dopamine in the brain. MAO B inhibitor, such as selegiline, is used – and you hear all the pharmaceutical commercials say, “Don’t use our drug if you take an MAOi.” Dopamine receptor agonists include Mirapex, Requip, Parlodel, and Permax. Also anticholinergics can be helpful in Parkinson’s Disease, such as amantadine and Cogentin. COMT inhibitors (Tasmar, Comtan) are used to assist levodopa drugs, because levodopa tends to “wear off” between dosings and after 5 years usually aren’t as effective as once before. In postmenopausal women, estrogen might be helpful – but then there is increased risk of heart attack, blood clot, and breast cancer.
Unfortunately all these medicines have side effects, like fatigue, nausea, headaches.
Surgical procedures are still being investigated.
It is vital to see a neurologist and discuss all your options with him/her.
drjohnhong 
neurological, senior citizen 
Comments (0) » |
23
May
2007
Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes. NEJM 5/21/07; 356
Avandia (generic name rosiglitazone) is a thiazolidinedione medication for type II diabetes. It is an agonist for peroxisome-proliferator-activated receptor gamma (PPAR-gamma) and has been around since 1999.
In diabetics, 65% of deaths are cardiovascular related. The meta-analysis of this study was done to increase the power to see what are the cardiovascular outcomes.
116 studies were investigated and 42 studies were analyzed for this meta-analysis. Criteria for entry included more than 24 weeks of drug exposure, randomized studies, MI (heart attack) or cardiovascular deaths had to be reported. Outcomes: MI. Cardiovascular Deaths.
15,560 people were in the Avandia treatment group and 12,283 in the control group (control group were divided into those taking insulin, sulfonylurea, metformin, and placebo). Most of the subjects were men around 57 years old, and diabetes control was relatively poor in both groups (HbA1C average 8.2%)
The trials had very few MIs or cardiovascular deaths, so they used some statistical method I have never heard of, the Peto Method. I’m not sure how they determined what would be clinically significant and statistically significant between Avandia group and control group.
Results are pretty similar. In the Avandia group, there were 86 MIs (0.55%) and in the Control group 72 MIs (0.58%). For cardiovascular deaths, the Avandia group had 39 deaths (0.25%) and the Control group had 22 deaths (0.18%).
So for MIs, Avandia had a 1.43 times increased risk of MI compared to control (43%) that is statistically significant. But in epidemiology, 43% increase risk is a weak to mild association. You need more of a 200-300% increase risk to be a strong association. Also if you just look at the numbers, 86 heart attacks out of 15,560 isn’t a whole lot in particular vs. 72 heart attacks out of 12,283 controls.
For cardiovascular, there is no increased risk of cardiovascular death that is statistically proven.
I think the findings are interesting but it is too soon to “jump the gun” like the media is doing. A study needs to be done and powered correctly to see if Avandia does indeed cause heart attacks and/or cardiovascular deaths. But I don’t think anyone can say for sure at this point that Avandia does cause heart attacks. We do know Avandia can’t be used in Stage III or IV congestive heart failure and I wonder if the heart attacks were due to this. Many questions have been raised from this meta-analysis.
© John S. Hong, MD, MS May 22, 2007
drjohnhong diabetes, medicines, cardiovascular Comments (0) » |
16
May
2007
Obesity and fructose - how are they related? 2/3 of Americans are overweight or obese. It is getting worse the past couple of decades. High fructose is very common over the past couple of decades as well. High fructose is added to most sweet drinks and foods.
Fructose is a simple sugar similar in structure to glucose (the main sugar). Metabolism is
unique – mostly done by the gut organs. Digested into glucose, glycogen, lactate, or lipids. Does use insulin – so initially was studied in type II diabetics to see if was good alternative to sugar (glucose or sucrose). Initially digested appeared to be beneficial. Low dose fructose increase glucokinase and lowers liver production of glucose.
However, later in metabolism shown to associate with Metabolic Syndrome X: insulin resistance (diabetes or glucose intolerance) , bad cholesterol (high LDL and triglycerides), increased body fat, and high blood pressure. Increased uric acid as well that increases risk of gout and kidney stones. Nurses’ Health Study 1999 showed high-fructose correlated with high c-peptide levels (~insulin). Stimulates sympathetic nervous system which is why people might get a “boost” with high sugar/fructose.
Unlike sucrose (2 glucoses combined), fructose doesn’t signal to brain that the body is full – so overeating is common. High-fructose corn syrup in mice – drink more of this than sucrose sweetened water
drjohnhong Uncategorized, obesity, diabetes, food, weight Comments (0) » |
9
May
2007
Trigger Finger & Ganglion Cysts are painful conditions of the hand so that bending the finger is difficult and extending it back up can be impossible. First, trigger finger is Flexor Tenosynovitis due to inflammation flexor tendon sheath of finger or thumb. The superficialis tendon travels through the sheath, but swelling can occur – even a nodule can form on flexor tendon. Diabetes is a risk factor. Snapping occurs with flexion. Locking with extension so it gets stuck in flexion. Improves as day goes on. Pain radiates into the palm or finger. Treatment usually involves immobilization and restriction of gripping and pinching. Antivibration gloves (Sorbothane) can be used. Steroid injection and/or Surgery is last option. Ganglion Cyst is a cystic swelling over a joint or tendon sheath due to herniation of synovial tissue from a joint capsule or tendon sheath. So myxoid degeneration fills the cyst. It is congenital in origin and might be from repetitive motion. Usually found on dorsal wrist usually dorsal. It can regress or can recur. Aspiration – 50% recur; Aspiration with steroid injection or hyaluronidase: about 82-95% cure.
drjohnhong Uncategorized 1 Comment » |
6
May
2007
Sexual assault, or rape, occurs every 90 seconds in the US. 1 in 3 women are raped, 1 in 6 boys by age 18. 25 percent of college women have been raped. Stop the violence. In Charlottesville, Men walked in high heel shoes to “walk in her shoes ” to bring about awareness and to call for an end to this violence
drjohnhong abuse, women_issues Comments (0) » |
5
May
2007
Low potassium can cause muscle cramps, spasms, and paralysis. Hypokalemia, the medical term is when potassium is less than 3.5. Muscle problems occur less than 3.0 and in particular less than 2.5 Even the heart muscle can stop beating after some arrhythmias. The GI system can stop working, which is called ileus. Bananas, fruits, beans, and many vegetables are rich in potassium
drjohnhong blood_chemistry Comments (0) » |
3
May
2007
Welcome to Podbean.com. You can edit this post by clicking “Manage” Tab then “Posts” sub-Tab after you log into your Podbean Dashboard. Podbean.com provides an all-in-one service for video and audio podcast/blog. You can customize your podcast/blog site on mouse clicking, see where your audiences come from on a geographic map powered by Google, moderate your comments with a built-in anti-Spam filter, easy to customize your iTunes podcast page in the iTunes preview page. Learn more at http://news.podbean.com. Have question ? check out Podbean.com FAQ Blog. Happy Podcasting!
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