December 18, 2014

My New Docs on My Meds: Blood Pressure, Yes. Cholesterol, No.

"Less is more" is one of my mantras. So is "anything worth doing is worth overdoing." I've spent much of my life bouncing back and forth between these mantras.

Last year, "less is more" drove me to ditch both my blood pressure (BP) and cholesterol (statins) meds. In both cases, I seized upon new recommendations from some medical authorities that the +75 elderly without coronary issues could stop taking these medications.

During the past month, I've talked with more doctors than I'd normally see in a year. I wanted a new internist who was also a geriatrician. I've also been consulting a variety of doctors about my recent dual blood pressure problem -- spikes that carry stroke risk, and sudden drops that bring the risk of falling.  

December 17, 2014

A Parkinson's Encyclopedia: News, Symptoms, Treatments, Diagnosis, Biochemistry, Causes, Prevalence, People with, Books, Organizations, etc.

My online rambles brought me to a website that includes everything you always wanted to know about PD but were afraid to ask.
For instance, who knew that the Amish in the American northeast have the second highest incidence of PD in the world, after rural illiterate Egyptians along the Nile River? Or that Albanians have the highest per capita incidence of PD, and Ethiopians the lowest? Or that country dwellers, redheads, welders and Caucasians all carry clearly increased risk of developing the disease?

The are also synopses -- with links to detail -- about PD symptoms, treatments, prevalence, diagnosis, causes (biochemical, toxic, genetic), and history. There's also a list of famous people with PD, strange facts about the disease, and lists of PD books and organizations.

December 16, 2014

Parkinson's Disease and Enhanced Creativity

A recent story from the Parkinson’s Disease Foundation has this headline: "Dopaminergic Therapy Spurs Creativity in People with Parkinson's Disease." The standard treatment for Parkinson's is levodopa, which boosts brain levels of the neurotransmitter dopamine, the depletion of which causes the symptoms of the disease.

The news comes from Tel Aviv University in Israel, where researchers conducted creativity analyses on 27 people with Parkinson’s taking dopamine, and a control group of 27 healthy individuals not taking dopamine therapy – matched with the first group by age and education.

"It began with my observation that Parkinson's patients have a special interest in art and have creative hobbies incompatible with their physical limitations," said Rivka Inzelberg, Tel Aviv University professor and study leader.

Not a New Connection
Inzelberg’s observations weren’t new. Through the years, anecdotal evidence has accumulated about Parkinsonians on dopamine therapy suddenly developing sudden bursts of creativity, like writing poetry.

But a key question has lingered about the dopamine-creativity connection. Is the new inventiveness a direct result of higher dopamine levels in the brain? Or is it an offshoot of the impulse control disorders (ICDs) frequently linked to PD medication, especially dopamine agonists? Those aberrant ICDs among Parkinsonians manifest most often as hypersexuality and gambling compulsions.

December 12, 2014

Reflections on the Five-Year Age Difference Between My Brother and Me

A few weeks ago when Buffalo was hit by a storm that dropped almost four feet of snow on the city, I called my brother Roger who still lives in our hometown of Ithaca, NY. I wanted to know how he was faring in the blizzard, forgetting that what hits Buffalo is often isolated "lake effect" snow. Cleveland, Buffalo, Niagara Falls, and other cities on the shores of the Great Lakes can be socked with massive snowfalls, while just a few miles away there is no snow at all.

That was the case this time. It hadn't snowed in Ithaca, but I was glad I called. I love my brother, but neither of us is very good at keeping in touch, by email or telephone. We had a nice chat when I called this time.

Roger is five years my junior. Carol, our deceased sister, was a year and a half younger than Roger. The three of us grew up in a rather small three-bedroom half-house. The Slatterly family owned the building and lived in the left side of the house. The Schappis rented the other half on the right.

Here's a photo taken on a visit to Ithaca recently:

215 (or was it 217?) Prospect St.
Chatting with Roger on the phone, I was reminded that the five-year age gap between us was a big deal for the first 20 years or so. Then that difference faded into insignificance. Now, it's becoming significant again.

December 11, 2014

Pfizer Offers Settlement to Parkinsonians Who Developed Sex and Gambling Compulsions

Earlier this week, Pfizer Australia confirmed offering a settlement to 150 people who claim to have developed addictions – especially to gambling and sex – after taking Cabaser (generic cabergoline), a drug for Parkinson’s disease (PD). 

Those individuals – who brought their class action suit in 2008 -- say they were not warned about the possible addictive side effects, for years a connection well-known in the medical literature. The Australian federal court is scheduled to rule on the case next year.

Patients said they’d never had compulsive issues before taking the drug, which is designed to enhance the availability of dopamine, sometimes thought of as a “feel-good” agent in the brain. An excess of dopamine is associated with risk-taking behavior.

Some of the people involved in the suit claim they became gambling addicts and lost hundreds of thousands of dollars after taking the drug. Others developed compulsive sexual or shopping activities. The unusual behaviors typically ceased after patients stopped taking the drug. Of course, discontinuing the drug brought a return of PD’s troubling symptoms... a difficult cycle.

For Years, an Acknowledged Link 
Drug companies and doctors have known for over a decade about the causative link between PD drugs and compulsive behaviors. Interestingly, in 2005 the Parkinson’s Disease Foundation (PDF) posted an article online -- "Gambling, Sex, and…Parkinson's Disease?" -- that suggested gambling and sexual addictions might even be symptoms of the disease itself, not simply a consequence of medications. The PDF also noted that PD meds could exacerbate the problems. Here’s how that article began:
Add impulse-control disorders such as pathological gambling and hypersexuality to the list of possible non-motor problems that can occur in individuals with Parkinson's disease (PD). Recent studies suggest that seriously disabling impulsive behaviors occur in three to five percent of PD patients, affecting individuals at all stages of the disease. The exact prevalence of such disturbances in PD is not entirely clear since the behaviors are often performed in secret, or because the association with PD seems improbable and is therefore never reported at doctor visits.

To further explore the connection between the PD drugs and these compulsive behaviors, researchers at the Institute for Safe Medication Practices in Alexandria, Virginia, analyzed 2.7 million serious drug side effects reported between 2003 and 2012 in the U.S. and 21 other countries. That's an impressive sample.