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Health and wellness

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2018 trends to reduce stress

Efforts to reduce stress will emphasize 1) adequate nutrition and sleep, 2) relaxation techniques, 3) mindfulness mediation, and 4) emotional and spiritual well-being.

Thomas R. Milam, MD, Virginia Tech Carilion School of Medicine 

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Sentiments on Intrepidness

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Intrepidness – is a powerful word. People who overcome adversity are intrepid.   Intrepidness means resolutely fearless or undaunted. Synonyms for intrepidness are brave, courageous, or bold. To fully understand intrepidness, however, one must understand it’s polar opposite – trepidation. Trepidation is fear, alarm, turmoil, and anxiousness.

Fear can be a difficult topic to talk about. Fear is a barrier that holds us back from getting and becoming all that we desire. What is fear? It is a distressing emotion aroused by impending danger, evil, pain, whether the threat is real or imagined. Fear is crippling because it has to do with darkness and ignorance. At the root of fear is a lack of understanding.

Fear is the most insidious adversity we can face. Fear is the enemy within us that causes doubt and insecurity. After the bombing of Pearl Harbor on December 7, 1941, President Franklin D. Roosevelt proclaimed, “The only thing we have to fear is, fear itself.” Fear ultimately makes us weak and helpless.

Fear is a powerful, primal emotion. Everyone is afraid at some level and must either confront their fear or let it control them. To overcome fear everyone must pass through its darkness to get to the light. I have experienced my share of fear as I deal with the affects Parkinson’s Disease has had on my life. I have had to learn that I cannot just cope with my disease, or just survive, but I must overcome it. To do that I need to understand fear and make a resolute decision to be an overcomer.

I have learned that adversity and fear are internal, I allow them inside my mind. If I am distressed by anything, the pain is not due to the thing itself, but my perception of the thing; and I have the power to change that perception at any moment. Fear is a way of thinking – I must chose to a higher way of thinking to overcome fear. According to Mark Twain, “Courage is resistance to fear, mastery of fear – not the absence of fear.”

I sometimes become fearful and insecure when I’m out in public.   I feel that people are staring at me because of my dyskinesia caused by Parkinson’s. Dyskinesia like moving uncontrollably or becoming stiff and immobile. My fear is amplified when my medicine is not working well. These fearful thoughts only make my condition worse.

I also fear emotional suffering. I know there is no way I can avoid suffering. Everyone suffers to some degree or another. The negative thoughts that creep into my head are a mindset that leads to fear. When I’m angry, I’m afraid. When I’m frustrated, I’m afraid. When I feel like I’m losing control of my life, I’m afraid.   I have learned fear does not come from the Source of all life, the Source produces only love. Love is the most powerful ultimate force in the universe. Just as light drives out darkness, so love drives out fear.

So, what is my solution to overcoming fear? Marcus Aurelius said, “Our life is what our thoughts make it.” I must change my thought process. I must decide to take action and take my fears to the Source of all that is true. I need to remind myself of the truth – that I have a spark of the divinity living in me. The Creator of the Universe has given me the same Spirit that raised Jesus from the dead. Romans 8:11 states, “And if the Spirit of him who raised Jesus from the dead is living in you, he who raised Christ from the dead will also give life to your mortal bodies because of his Spirit who lives in you.” Thus, I have a choice in the matter – I have a decision to make. I can decide not to be fearful, but to focus my mind on the truth and thoughts that inform me I am an overcomer.

I have realized the Universe has an objective for me – to grow and improve myself. I must be still and allow the Source of all light and goodness to work and move through me. By doing so, I can help other people and have a positive impact on my part of the world. This gives my life meaning, direction, and a purpose.

I also realized I need to be open with my fears. Openness shines light into the darkness. I can learn to overcome my fears by seeking light. Talking about my fears helps to change my perspective on my thoughts and feelings. Just as I need to show my wounds to a doctor to be healed, I must reveal my fears to be healed. Dale Carnegie said, “Inaction breeds doubt and fear. Action breeds confidence and courage. If you want to conquer fear, do not sit home and think about it. Go out and get busy”.

A Japanese proverb says, “Fear is only as deep as the mind allows.” Thus, intrepidness and fear are at war in my mind – the battle is in my head. My thoughts are my life. The miracle is changing my perspective of the events in my life. I take fear captive by reminding myself of the truth. The truth is God can help me overcome my fears and I don’t have to be controlled by them. The truth is that only love overcomes fear. I must chose to focus my thoughts on the Source of all goodness, in whom there is only love and light, then fear and darkness will vanish, and I can overcome any adversity.

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Write it on your hand

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One challenge all Parkinson’s patients have is to take our medication at the right time and right dose.  I often struggle with not remembering when I last took my medication.  That can be frustrating and debilitating.  Well, I have come up with a practical solution.

This will sound a little old school, inelegant, or perhaps even unsanitary, but a useful technique is to write down the last time I took my meds on my hand.  My wife hates this practice and tells me to use my cell phone to remind me.  I did put reminders on my phone, but I don’t always have it with me.  My hands, however, are never far from me.

So, I write codes on my hand, such as, “6as” for 6 o’clock Amantadine and Stalivo, or “9s” for 9 o’clock Stalivo.  Not fancy, but highly effective.

If God writes reminders on His hand, why shouldn’t I?  See in Isaiah 49:15-16, the Bible says,  “Can a mother forget the baby at her breast and have no compassion on the child she has borne?  Though she may forget, I will not forget you!  See, I have engraved you on the palms of my hands; your walls are ever before me.

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First Dose Group in Parkinson’s Stem Cell Trial Successfully Transplanted

April 26, 2017   by Magdalena Kegelstemcells

The fourth and last patient of the first group in a clinical trial of stem cell transplants in Parkinson’s disease has successfully received the transplant, the International Stem Cell Corporation (ISCO) reported. Researchers are now preparing for the next stage, in which patients will receive a higher number of cells.

So far, researchers have not recorded any adverse events among the four patients who had neural stem cells, called ISC-hpNSC, inserted into their brains.

If successful, the stem cell therapy has the potential to regenerate lost nerve cells — and revolutionize the way Parkinson’s disease is treated.

“We are very encouraged by the early clinical safety data for ISC-hpNSC,” Russell Kern, PhD, executive vice president and chief scientific officer of ISCO, said in a news release.

The Phase 1 clinical trial (NCT02452723) was launched in March 2016, and expects to enroll 12 patients with moderate Parkinson’s disease. Patients are divided into three groups of four patients each. The groups will receive increasing doses, ranging between 30,000,000 to 70,000,000 neural stem cells.

The main goal of the trial is to assess the safety of the treatment, with patients followed for 12 months after the transplants.

But researchers will also use brain scans to assess whether the cells survive once transplanted, and if they contribute to making the patients better. Participants are assessed using the Unified Parkinson Disease Rating Scale (UPDRS) and other tools, and although the study is small, researchers will evaluate any potential improvements in symptoms.

Parkinson’s symptoms typically appear when a large proportion of brain cells containing dopamine are already gone. And while treatments with added dopamine may improve symptoms, at least for some time, the treatment approach is fraught with dosing difficulties.

The ISC-hpNSC cells are derived from what researchers call human parthenogenetic stem cells. Parkinson’s animal models that received the treatment improved, making researchers and patients alike hope that the same will be seen in patients.

The cells are thought to provide neurotrophic support to brain cells still alive. This means they secrete factors that help dying neurons survive. They are also thought to replace the dead and dying dopamine neurons.

But as the trial started, researchers raised concerns that not enough was known about what the cells do in the brain. The group of researchers also questioned whether the safety follow-up of one year was sufficient, and argued that clinical trials of stem cell approaches may be a premature step, in an article in the Journal of Parkinson’s Disease.

Still, ISCO has an optimistic view of the trial continuation.

“We look forward to dosing our second cohort with 50 million cells and enrolling the rest of our clinical trial participants in 2017,” Kern said. “The Data Safety Monitor Board meeting will be held in the beginning of May and we expect to receive approval to start an accelerated enrollment of patients into the second cohort.”

From Parkinson’s News Today

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Six of the Best Apps for Chronic Illness Management

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January 3, 2018   By Wendy Henderson

Managing a chronic illness can be difficult. There are many different medications to take (often at different times), appointments to remember, symptoms to keep track of, and lots of information to absorb. Thankfully, living in a digital age means that there are numerous mobile apps that can help you manage your chronic illness.

We’ve put together a list of some of the best mobile apps for managing your chronic illness:

Medisafe is an app that helps patients manage medications. It helps with dosage and reminds you when you need to take your meds, increasing adherence rates. The information can also be shared with your health care team and pharmacy.

Pain Diary works for anyone with a chronic illness. It allows patients to chart and score pain as well as record and track other symptoms of the disease such as fatigue and mood swings. This app also has a feature where patients can connect with others living with the same chronic illness and swap best practices.

ZocDoc is a handy app if you’ve recently been diagnosed with a chronic illness, since one of the first things you’ll need to do is find a doctor to treat you. ZocDoc allows you to search for local specialist doctors who are approved by your insurance company. The app will even tell you when the doctor is available to see you.

MORE: How Parkinson’s disease affects your body

My Medical Info is an app that stores all your relevant health history and insurance details. This makes filling out those endless forms a little less challenging, since you won’t have to rely on your memory for all the details. The app will also allow you to program in doctors’ appointments and all the medications you’re taking.

Fooducate helps you keep track of your diet and make healthy choices. Eating well is an integral part of managing any chronic illness and this app will help you to eat the right foods and get you to a healthy body weight. You can program in how many calories you want to consume a day and then add in the food choices you make, the app will work out the nutritional values of everything you eat and tell you how many calories you’ve consumed. It also works in conjunction with many fitness apps to add in details of any physical activities and calories burned.

Sleep Cycle helps you get the best out of your sleep. The app analyzes how much sleep and the quality of sleep you get each night and you can also have the alarm set to wake you when you’re in your lightest sleep, leaving you feeling less groggy and more refreshed each day.

MORE: The five stages of Parkinson’s disease

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.

 

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High-Intensity Exercise Delays Parkinson’s Progression

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Participants enrolled in the Study in Parkinson Disease of Exercise (SPARX) were at an early stage of the disease and not taking Parkinson’s disease medication, ensuring the results of the study were related to the exercise and not affected by medication.

The randomized clinical trial included 128 participants ages 40 to 80 years old at Rush University Medical Center, Northwestern University, the University of Colorado, and the University of Pittsburgh. Rush recruited two-thirds of the participants in the study.

The researchers examined the safety and effects of exercise three times weekly for six months at high intensity (80 to 85 percent of maximum heart rate) and moderate intensity (60 to 65 percent of maximum heart rate). They compared the results to a control group who did not exercise.

“The study results suggest that people who exercised at high intensity delayed the progression of Parkinson’s symptoms, while moderate-intensity workouts had no effect,” said Dr. Deborah Hall, associate professor in the Rush Department of Neurology and a co-lead author of the study results. Dr. Cynthia Comella, professor of neurology at Rush, was also a lead neurologist in the conduct and publication of the study.

Although there have been past exercise studies, this study is the first time scientists have tested the effects of high-intensity exercise on untreated people with Parkinson’s disease and demonstrated both efficacy and safety. Previous studies suggested that high-intensity exercise improves symptoms, but the evidence wasn’t sufficient to determine whether exercise intensity modifies symptoms or disease progression.

In addition, most studies have not precisely measured or controlled exercise intensity, and none have been conducted at 80 to 85 percent maximum heart rate. It was thought that high-intensity exercise was too physically stressful for individuals with Parkinson’s disease. However, in this study, the participants were able to maintain the high-intensity treadmill exercise at least three times weekly for six months at the target heart rate.

Researchers confirmed it was safe for the participants to do high-intensity exercise by giving them a cardiologist-supervised graded exercise test to evaluate the heart’s response to exercise.

The results warrant further exploration of the optimal exercise regimes for Parkinson‘s disease and to evaluate whether exercise could slow progression of the disease itself, according to Hall and Comella.

“The earlier in the disease you intervene, the more likely it is you can prevent the progression of the disease,” said co-lead author Daniel Corcos, PhD, professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine. “We delayed worsening of symptoms for six months. Whether we can prevent progression any longer than six months will require further study.”

Parkinson’s disease symptoms include progressive loss of muscle control, tremors, stiffness, slowness and impaired balance. As the disease progresses, it may become difficult to walk, talk and complete simple tasks. Most people who develop Parkinson’s disease are 60 and older.

Parkinson’s disease is the second most common neurodegenerative disorder and the most common movement disorder. It affects more than a million people in the United States. Although medications may improve symptoms, there can be side effects associated with drugs, and reduced benefit over time.

It is clear that new approaches to treatment are needed, according to Hall. With the SPARX study, there is now strong evidence that people with the disease should consider vigorous exercise as a treatment, and one that gives them control over their disease.

The study was funded by grants from the National Institutes of Health and the Parkinson’s Disease Foundation.

MEDIA CONTACT

Nancy Difiore

Associate Director, Media Relations
(312) 942-5159
nancy_difiore@rush.edu

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Cognitive impairment in Parkinson’s Disease

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Taken from michaeljfox.org

Cognitive impairment, disturbance of memory, thinking and/or language abilities, is a non-motor symptom that can be associated with Parkinson’s. Cognitive disturbances can arise at any time in the course of Parkinson’s disease (PD) and vary widely in severity. Some people don’t experience any problems; others have subtle changes only detectable on formal testing. Still others have issues they describe as mild or somewhat annoying, and some will go through more significant changes that interfere with the ability to perform daily activities.

Cognitive impairment in PD primarily impacts “executive function,” which can lead to difficulty with:

  • Multitasking
  • Planning and organizing
  • Problem solving

Attention, thought processing and word finding also are commonly affected.

  • What is mild cognitive impairment and how is it managed?
  • What is dementia and how is it treated?
  • Why do cognitive changes occur?
  • How are cognitive changes evaluated?
  • How is brain health maintained?
  • What is the current research surrounding cognition and Parkinson’s?

Managing Mild Cognitive Impairment

When cognitive problems are more than what is expected with normal aging but not enough to significantly interfere with daily activities, they may be due to mild cognitive impairment (MCI). This non-motor symptom occurs in about 30 percent of people with Parkinson’s. Those with MCI may complain of feeling distracted or forgetful, or losing their train of thought in conversation. Individuals in fast-paced jobs might find it more challenging to concentrate or manage multiple projects.

No medications are currently available to treat MCI. Adaptive strategies — making notes, relying on a calendar, keeping objects (such as keys) in the same location to avoid misplacing them — can help. Your doctor may recommend cognitive rehabilitation, in which a therapist teaches memory exercises through a structured program.

Mild cognitive impairment can, but doesn’t always, progress to dementia.

Diagnosing and Treating Dementia

Dementia is a decline in memory, thinking and/or language abilities severe enough to interfere with daily routines, job performance or social functions. The dementia associated with Parkinson’s disease (PDD) tends to impact executive skills; visuospatial function (interpreting where objects are in space); and, to a lesser extent, short-term memory. It may also affect motivation, mood and behavior, and can be associated with visual hallucinations (seeing things that aren’t there) or delusions (firm, false, often paranoid, beliefs). If dementia does develop, it is often in the later stages of Parkinson’s disease.

It can be difficult to differentiate PDD from Alzheimer’s dementia (since there is no specific test to diagnose either), although Alzheimer’s typically causes more pronounced memory loss and confusion, and also lacks the motor symptoms of Parkinson’s (although stiffness and slowness may develop in very late stages). When dementia starts at the same time or within a year of the onset of Parkinson’s motor symptoms, Lewy body dementia (LBD), a form of atypical parkinsonism, may be the cause. LBD is characterized by dementia and the motor symptoms of Parkinson’s as well as fluctuating levels of alertness and visual hallucinations. (Read more about LBD here.)

Medications may ease the symptoms of dementia. Exelon (rivastigmine) is FDA-approved for the treatment of mild to moderate levels of PDD. It works by blocking an enzyme that breaks down acetylcholine, a brain chemical that supports cognition. The drug may therefore improve cognition, lessen associated behavioral changes (such as agitation or aggression) and delay the need for alternative living situations, such as nursing homes. (Read more about this medication on the Non-motor Medications page.) In some situations, your doctor may prescribe other medications that work in the same manner, such as Aricept (donepezil), which is used for Alzheimer’s dementia.

Why Cognitive Changes Occur

The exact causes of cognitive impairment and dementia in PD are not fully known but are likely due to a combination of chemical and structural changes. In addition to dopamine, Parkinson’s affects a number of brain chemicals — acetylcholine, norepinephrine and serotonin — that support cognition, attention and mood. Parkinson’s also causes loss of and/or changes in cells in areas of the brain that are responsible for these functions.

Evaluating Cognitive Problems

The first step to evaluating cognitive impairment is letting your doctor know that you’re concerned. It may be normal aging, Parkinson’s or a separate medical condition, but you can’t figure it out unless you bring it up. Doctors will ask about mood disturbances, such as depression or anxiety, and sleep problems, as these can impact memory and require different evaluation and management strategies. They’ll review your prescription and over-the-counter medications to ensure that these aren’t contributing to cognitive problems. (Anticholinergic and pain medications commonly contribute to memory and thinking issues.)

No brain imaging or blood tests can specifically diagnose MCI or PDD, but tests may exclude other conditions, such as thyroid problems or vitamin B12 deficiency, which also can affect cognition. Your doctor may recommend formal detailed memory testing — neuropsychological testing — to determine exactly what problems might be present and establish a baseline for future comparison.

Maintaining Brain Health

While there is no definitive practice or therapy to prevent cognitive impairment, there are actions you can take to promote a healthy brain, including regular exercise and healthy diet. Some studies suggest that by adopting an “active cognitive lifestyle,” individuals may be able to slow cognitive decline. Practice mentally challenging tasks such as completing crosswords or puzzles, learning to speak a foreign language or playing a new instrument to “work out” your brain. Attend a get-together where you’ll have to remember the names of new acquaintances and make conversation about current events. This has the added benefit of keeping you social.

Ongoing Research in Cognition and Parkinson’s

Researchers are trying to learn more about why cognitive dysfunction occurs in Parkinson’s. At the same time, they are looking for better ways to diagnose, monitor and treat these problems. Several therapies, including aerobic exercise, physical therapy, medications and cognitive rehabilitation programs, are currently being studied to determine if they can treat cognitive problems in Parkinson’s. One drug, which works on the serotonin chemical pathway, is recruiting for a Phase II trial for PDD, which brings us one step closer to potentially addressing an unmet need in Parkinson’s.