Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinson’s Disease
Talk to your neurologist and your primary care provider before starting a new exercise regimen. They can:
- Counsel you on how intense your exercises can be.
- Recommend exercises appropriate for your individual health.
- Refer you to a physical therapist to create a personal exercise program.
- Warn about exercises to avoid based on your particular challenges or limitations.
Parkinsons Disease For Primary Care With Dr Albert Hung
December 5, 2022 By Matthew Watto, MD
Master the ins-and-outs of Parkinsons Disease! Were joined by Dr. Albert Hung, who teaches us pearls for the initial history and physical exam in a patient with undiagnosed Parkinsons, a framework for management of early and advanced motor symptoms, tips for treating autonomic symptoms and cognitive / psychiatric features, and more.
Claim free CME for this episode at curbsiders.vcuhealth.org!
- Producer, Writer, Show Notes, and Infographic: Malini Gandhi
- Cover Art: Kate Grant
- Hosts: Matthew Watto MD, FACP Paul Williams MD, FACP
- Reviewer: Emi Okamoto MD
- Showrunner: Matthew Watto MD, FACP Paul Williams MD, FACP
- Technical Production: PodPaste
Visit betterhelp.com/curb to save 10% off your first month.
Management Of Autonomic Symptoms
Autonomic symptoms, including constipation, urinary symptoms, and orthostatic hypotension, are very common in Parkinsons disease. Collaboration between multiple specialties, including urology, GI, neurology, and primary care, is crucial. Notably, dopamine replacement can exacerbate autonomic symptoms, and in more advanced Parkinsons disease the dose of dopaminergic agents may need to be decreased if autonomic symptoms are an issue. Constipation can be severe, and often require harnessing the full arsenal of bowel medications. Orthostatic hypotension is also a concern, and physicians should have a low threshold to check orthostatics in the office and encourage fluid / salt intake if there are hints of issues with dizziness on standing. More severe orthostatic hypotension may require agents like fludrocortisone or midodrine.
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What Were Fighting For
Health, social care, and benefits must meet your needs. And its clear that not everyones needs are being met.
So, we’re listening to your concerns and experiences, and we’re talking to the relevant governments and organisations to encourage them to take action, to make sure youre treated fairly.
Find out how you can get involved and support our campaigns to improve health, care and benefit services.
How To Get Prescription Assistance
Parkinsons disease can have a devastating effect on ones quality of life, but Rytary can help. Simplefill can ensure that youre never in a position in which you are unable to refill your prescription because you cant afford it.
To start getting prescription assistance, call Simplefill at 1386-0206 or apply online. Within 24 hours, youll be called by one of our patient advocates for a telephone profiling interview. Well use the information you provide to match you with the best Rytary assistance programs for your situation.
Well submit an application to each program we match you with, and if your application is approved, well handle the enrollment process for you. In just a short time, you could be paying much less for your Rytary.
Moving ahead, well continue to work on your behalf. Well make sure your Rytary prescription is always current, and well get you help paying for any additional medications that may be prescribed for you.
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Report Calls For National Telehealth Guidelines For Allied Health Professions In The Nhs
Human Resources for Health
Work led by scientists at Staffordshire University explores the organizational readiness of the 14 allied health professions to use telehealththe use of electronic information and telecommunications technologiesto support patient care and public health.
It is based on a survey of more than 600 clinicians and managers working for allied health professional services within the NHS. Responses showed that there was a disconnect between clinicians, who felt that some of the guidelines were ambiguous, and their managers. It also revealed gaps in the guidance when it comes to protection from litigation and dealing with emergencies
Senior author and Director of the Centre for Biomechanics and Rehabilitation Technologies, Professor Nachi Chockalingam explained that digital transformation was proceeding slowly when the COVID-19 pandemic hit and most AHP services found themselves unprepared for the delivery of telehealth services.
Professor Chockalingam said, “While health care systems typically need to develop policies and workforce training to move to a new model of care delivery, some of these phases were bypassed during the COVID-19 pandemic because of the urgency required.”
The report highlights that digital inclusion approaches are needed to ensure that vulnerable population groups at risk of exclusion can benefit as digitally enabled care goes mainstream across the NHS.
The report is published in the journal Human Resources for Health.
Citation
Preparing For Your Next Doctor Visit
Keeping your doctor informed about symptoms and how theyre impacting your or your loved ones life is essential to managing Parkinsons disease.
Can we make a suggestion? Try our conversation starter, below.
In just minutes, you’ll create a personalized conversation starter of your or your loved one’s OFF episodes and/or dyskinesia symptoms to share with your doctor at your next appointment.
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Studies Id Ways To Help Young Adults Avoid Health Impacts Of Stress
by Matt Shipman, North Carolina State University
Forecasting
It’s well established that experiencing stress can hurt our physical health. Now two new studies find that younger adults who take preemptive steps to respond to stress are better able to avoid those negative health outcomes.
“The fact that we have two studies with the same results highlights the importance of proactive coping for younger adults when it comes to handling stress,” says Shevaun Neupert, corresponding author of a paper on the two studies and a professor of psychology at North Carolina State University.
“These results are important for helping us work with people to build resilience, since proactive coping refers to skills that can be taught. The findings also suggest that younger adults, in particular, can benefit significantly from these skills.”
Proactive coping is an umbrella term for behaviors that allow people to avoid future stressors or prepare themselves to respond to those stressors. These can be behavioral, such as saving money to deal with unexpected expenses, or cognitive, such as visualizing how to deal with potential challenges.
“You can also think of proactive coping as a way of helping people continue to work toward their goals, even when dealing with challenges,” Neupert says.
The participants then completed daily surveys for the next eight days, recording the stressors they experienced each day, as well as their physical health symptoms.
More information:Forecasting
Management Of Motor Symptoms
Initial treatment
Carbidopa / levodopa is the oldest and most effective medication for Parkinsons disease. Dr. Hung notes that if there is limited access to neurology or it is going to take a significant period of time for a patient to see a neurologist, it is reasonable for primary care providers to start carbidopa / levodopa themselves. Starting carbidopa / levodopa will not interfere with the process of making the diagnosis of Parkinsons disease in fact, it can actually help diagnostically, as idiopathic Parkinsons disease should respond to the medication while other parkinsonian syndromes may be more refractory .
In terms of initialdosing of carbidopa / levodopa , Dr. Hung recommends starting at a low dose and gradually increasing. He usually starts a patient on ½ tablet twice per day , then increasing to ½ tablet three times per day , and then finally increasing to 1 tablet three times per day. He advises patients to take levodopa / carbidopa before meals, since taking the medication with food can interfere with absorption.
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Need Help Accessing Gocovri Or Learning About Financial Assistance
If you and your doctor determine that GOCOVRI is right for you, GOCOVRI Onboard can help you determine if youre eligible for any of our patient support programs.
A GOCOVRI Care Coordinator can work directly with you to see if you are eligible for assistance with paying for GOCOVRI.*
If you have a commercial health plan and participate in the GOCOVRI Co-pay Assistance Program, youll pay a $20 co-pay per prescription until the maximum annual benefit is reached
If you dont have insurance, your insurance doesnt cover GOCOVRI, or if you cant afford GOCOVRI, the Patient Assistance Program may help you get GOCOVRI at no cost
If you do not qualify for these programs, you still may be able to get help with access to GOCOVRI.
See Terms & Conditions for these programs.
*For details, see terms and conditions for the Co-pay Program, the Patient Assistance Program, and the Independent Charitable Foundations Program.Financial and medical eligibility requirements vary by organization.After prior authorization and appeal processes have been exhausted.
§No purchase of GOCOVRI or enrollment in GOCOVRI Onboard is required. See terms and conditions here.
If your doctor determines GOCOVRI is right for you, GOCOVRI Onboard can help. To receive GOCOVRI, our specialty pharmacy partner needs to speak to you
Once our specialty pharmacy confirms your address over the phone, they will arrange express delivery of GOCOVRI directly to your door, with no need to go to the pharmacy
what is gocovri?
Financial Assistance For Parkinson’s Medication
Michigan Parkinson Foundation can assist people with Parkinson’s disease obtain some relief for PD medication cost . Qualified individuals must be a Michigan resident. We take into consideration not only annual income but how much you pay out of pocket for medical bills. Once you complete the application and meet all criteria, your medications will be mailed directly to you.
To apply for medication assistance, complete the application and return to MPF by , fax, or mail to:
Michigan Parkinson Foundation
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Stay On Top Of Insurance
If you were always the one who handled questions of insurance coverage, great but if not, you may want to familiarize yourself with the terms of your health insurance. Youll need to know details about if and to what extent your plan covers prescriptions, therapy sessions and other unexpected items.
We Understand That Parkinsons Disease Treatments Are A Financial Burden
Assistance for PD care, including medications, services, and equipment can be accessed through various non-profit organizations. For all of these programs, eligibility is based on household size and household income. Special circumstances are considered when appropriate because financial hardship can occur at all income levels.
Complete the free financial assessment above to see which programs you may qualify for!
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What Future Medications May Be Available For Parkinsons
There are numerous studies investigating new treatments for Parkinsons disease.
There has been new information about the role of autoimmunity and T-cells in the development of Parkinsons disease, possibly opening the door to a role for biologics.
Stem cells are also being investigated as a treatment option for Parkinsons disease.
Are You Currently Enrolled In The Myrytary Patient Support Program
INDICATION
RYTARY extended-release capsules is a prescription medication that contains a combination of carbidopa and levodopa for the treatment of Parkinsonâs disease, Parkinsonâs disease caused by infection or inflammation of the brain, or Parkinsonâs disease like symptoms that may result from carbon monoxide or manganese poisoning.
IMPORTANT SAFETY INFORMATION
Do not take RYTARY with antidepressant medications known as nonselective monoamine oxidase inhibitors because taking these two drugs within two weeks of each other can result in high blood pressure.
Taking RYTARY may result in falling asleep while engaged in normal activities, even without warning and as late as one year after starting RYTARY. This may affect your ability to drive or operate machinery. Do not do anything that requires alertness until you know how RYTARY affects you.
Tell your healthcare provider if you have any heart conditions, especially if you have had a heart attack or irregular heartbeats if you experience hallucinations or abnormal thoughts and behaviors , if you have intense urges to gamble, increased sexual urges, other intense urges, and the inability to control those urges if abnormal involuntary movements appear or get worse during treatment with RYTARY or if you have ever had a peptic ulcer or glaucoma.
Please read the full Prescribing Information. For more information talk to your healthcare provider.
INDICATION
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Are There Any Risks Of Exercising With Parkinsons Disease
Some symptoms, like Parkinsons tremors, may seem worse during exercise. But exercise generally improves tremors and other symptoms in the long run.
Reduce challenges by stretching before and after exercise. Use good form to prevent injury. And avoid slippery floors, poor lighting and tripping hazards. If you have pain, stop and rest.
Pushing yourself too hard during exercise can lead to injury. Start slowly and increase intensity and duration over time. Keep a log to track your exercise choices and how you feel. Eventually, youll learn what works best for you.
Generic Vs Branded Drugs
Currently, there are multiple pharmaceutical companies that manufacture a generic formulation of carbidopa-levodopa, dopamine agonists, monoamine oxidase inhibitors, and anticholinergics. The U.S. Food and Drug Administration requires that generic drugs show a similar risk and benefit to the branded drug prior to market approval, but in rare cases this standard is not high enough.
A review supported by the Parkinsons Foundation reports evidence that if you are in more advanced stages of the disease, switching from branded drugs to generic, or from one generic to another, may have somewhat variable effects. The authors, including Parkinsons Foundation National Medical Advisor Michael S. Okun, MD, believe that the standards for approving generic drugs for PD may not be strict enough to demonstrate that the generic alternatives are equally effective.
Work with your doctor to develop a tailored treatment plan. Using generic drugs will likely provide a cost savings. Infrequently, a person living with PD may require brand medication.
If you make the switch, follow these tips:
- Report to your physician on the effectiveness of the drugs.
- Carefully keep a diary of any side effects.
- Record dose adjustments made by your physicians .
- Try to stay with a single drug manufacturer for your generic medications. You may need to ask your pharmacist to special order for you.
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Medicare Coverage For Parkinsons Disease
- Medicare covers medications, therapies, and other services involved treating Parkinsons disease and its symptoms.
- Physical therapy, occupational therapy, and speech therapy are all included in this coverage.
- You can expect some out-of-pockets costs, even with your Medicare coverage.
Medicare covers medically necessary treatments for Parkinsons disease, including medications, different types of therapy, and hospital stays. Based on the type of coverage you have, you may have some out-of-pocket expenses, such as copays, coinsurance, and premiums.
Medicare may not cover all of the services youll need, such as assistance for normal daily living.
If you or a loved one has Parkinsons disease, its important for you to understand which parts of Medicare cover which treatments to avoid large, unexpected expenses.
Radical New Therapy For Parkinsons Will Use Stem Cell Transplants
Lab-grown nerve cells will replace those destroyed by disease scientists hope treatment may be available in five years
Early next year, a radical new treatment for Parkinsons disease involving tissue transplants will receive its first trial with patients including a group from the UK.
Stem cells grown in the laboratory and transformed into nerve cells will be used to replace those destroyed by the disease. It is hoped that these will stop the spread of debilitating symptoms.
It has taken a long time to get to this stage but hopefully results from these trials will mean that, in a few years, we might be able to offer tissue transplants as standard treatments for Parkinsons, said Prof Roger Barker, of Cambridge University. It is certainly a promising approach.
In the UK, about 145,000 people live with Parkinsons and about 18,000 new cases are diagnosed every year. The disease is triggered when nerve cells that supply dopamine to the brain start to die due to a combination of genetic and environmental factors.
Dopamine helps a person control movement. When supplies drop, the result is shaking, stiffness, depression and other symptoms that can end with patients using a wheelchair or being bed-ridden. The diseases progress can be slowed by the drug L-dopa, which replaces some of the lost function of dopamine cells. Treatments become less effective over the years. Scientists have been searching for years for new approaches.
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Senior Health Insurance Benefits Assistance
Medicare recipients, individuals over the age of 55, and disabled persons of any age are welcome to contact a team of certified volunteer counselors at the SHIBA program for help making informed health insurance decisions. SHIBA volunteers can help individuals select a Medicare Part D plan that best meets their prescription needs to avoid gaps in coverage. To connect with your local SHIBA team, visit www.shiba.oregon.gov or call 1-800-722-4134.
Be Sure Medications Are Taken
This is crucial: If your loved one is forgetting his or her medicine, he or she may not be functioning as well as possible.
To avoid making mistakes or having to bug or nag your loved one, develop a tool you both agree works, such as a smartphone reminder or a hard-to-miss wall calendar. Being consistent with medication can make a difference in both of your lives and lifestyles.
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Role Of Imaging In Diagnosis
For a patient presenting with symptoms of typical idiopathic Parkinsons disease and no other abnormal exam findings, imaging is usually not necessary.
Dr. Hung notes that he will typically order an MRI in the following situations:
- Atypical symptoms some atypical parkinsonian syndromes can have particular MRI correlates that mary be useful
- Lower-body predominant parkinsonism For patients with significant lower-body parkinsonism without significant tremor or upper-body bradykinesia, an MRI is important to obtain to rule out the following causes of lower-body parkinsonism : 1) Vascular disease significant frontal white matter disease can cause symptoms of lower-body parkinsonism, and 2) Normal pressure hydrocephalus can cause parkinsonian symptoms involving the gait.