Page logo
css3menu.com

An Introduction to Parkinson's Disease by Joseph H. Friedman, MD

Parkinson's disease is a disorder that affects small regions in the brain that control movement, posture and balance. It is a complex disease that has many different symptoms, so that not everyone with the condition suffers from the same problems.


Read more

"Atypical Parkinsonism" and "Parkinson Plus" syndromes by Joseph H. Friedman, MD

"Atypical Parkinsonism" and "Parkinson Plus" syndromes by Joseph H. Friedman, MD

"Parkinsonism" means "looks like Parkinson's disease." To neurologists this means that the person has a somewhat flexed posture, moves slowly, is stiff and usually walks slowly, with small steps and reduced or no armswing. We call the syndromes "atypical" because they usually differ from PD in a few ways:


Read more

Comebacks At Work: Using Conversation to Master Confrontation

No doubt you've been put on the spot or cornered in conversation or didn't quite feel you could say what you wanted to say. Maybe this happened with your doctor, spouse, friend, son or daughter. There just didn't seem to be a good way to tell them what you were thinking. Then, to make matters worse, you wasted hours— maybe even days—dwelling on the event and rolling it over and over in your mind. Then, suddenly in it came to you. "I should have said....


Read more

Death in PD by Joseph H. Friedman, MD

Death in PD by Joseph H. Friedman, MD

This article was written at the request of a PD patient who wanted to know how patients die from PD.

Most patients die with PD and not from it. The illnessess that kill most people are the same as those that kill people with PD. These are heart conditions, stroke and cancer. As we age we become increasingly aware that more than one bad thing can happen to our bodies. However, there are two areas in which PD may bring about death.


Read more

Diagnosing Parkinson's Disease by Joseph H. Friedman, MD

Diagnosing Parkinson's Disease by Joseph H. Friedman, MD

Although Parkinson's disease is a specific, well defined disease that can be reliably diagnosed at autopsy, it is defined in life by clinical criteria. This means that the diagnosis rests entirely on the information (history) that the patient provides plus the physical examination. There is no test to diagnose PD. When a doctor orders a test when evaluating a patient who he thinks has PD the test is really being obtained to make sure that there isn't some other disorder that might look like PD. When I am convinced that a patient has PD I order no tests at all. No CAT scan, no MRI, no EEG, no spinal tap, no blood tests. Nothing. The reason is that if any of these tests was to show an abnormality, it would mean to me that the patient had PD plus some other disorder that has nothing to do with why the patient was seeing me in the first place. Generally I'd rather not know.


Read more

Constipation in Parkinson's Disease by Neil R. Greenspan, MD FACG

Constipation is the most common gastrointestinal complaint affecting approximately 15 % of the North American population. Certain subgroups have an even higher risk (e.g. in the over 65 population 26% of men and 34% of women are affected). It is remarkable that for such a common disorder there is great debate on the definition of constipation. A committee of experts in the field include in the definition 2 or more of the following: abnormalities of stool frequency (less than 3 times weekly), abnormal stool form, straining at stool, sense of incomplete evacuation or obstruction to passage of stool, and the use of manual maneuvers to aid in passage of stool (>= 25% of the time).


Read more

Eye Problems in Parkinson's Disease by Elliott Perlman, MD

Eye Problems in PD Patients

PD patients often have a lot of difficulty with their vision, although, when I examine them in the office, the visual acuity is often normal. Problems can come from difficulty in moving the eyes and eyelids, as well problems with blinking and dryness. Most of these conditions arise from PD itself, while others may be caused by the medications required to treat PD.


Read more

Good Days, Bad Days by Joseph H. Friedman, MD

Good Days, Bad Days by Joseph H. Friedman, MD

One of the many issues that PD patients often have that no one understands are good days and bad days. So many times, PD patients come into the office and the patient or family says, "Today's a good day, he's not usually this good at home." "Today's a bad day. Usually he can walk a lot better than you see." I have given up trying to figure out what makes one day good and another bad. They seem to occur pretty randomly. These variations are very different than the variation that occurs during the usual day. "Mom's good in the morning but by the afternoon she gets more tired and weaker and doesn't move well by the end of the day." "Dad's always terrible in the morning so we schedule everything we can for the afternoon because he's usually doing well then."


Read more

Pain in Parkinson's Disease by Joseph H. Friedman, MD

Pain in Parkinson's Disease by Joseph H. Friedman, MD

Pain is an unfortunately common problem in Parkinson's disease. Of course, pain is common in the general population, especially among older people. A recent American study found that pain affected about twice as many people with PD than those of the same age and gender without PD. About 50% of PD patients in that study suffered from painful disorders. Men and women seem to be about equally affected. A very well described scenario is the patient who is followed for a painful frozen shoulder for a year or so before a tremor develops leading to a diagnosis of PD. Pain clearly plays a major role in quality of life. Everyone with chronic pain enjoys life less, leading to a vicious cycle in which pain causes depression or isolation which in turn leads to more pain.


Read more

Pain in Parkinson's Disease: Part II Treatment by Joseph H. Friedman, MD

Pain in Parkinson's Disease: Part II Treatment by Joseph H. Friedman, MD

As is true for most medical conditions, there is no single treatment for "pain in PD", and it must always be kept in mind that what works for one person may not work for another. Pain, in particular, has so many different facets, that it is impossible to make specific recommendations. The first recommendation is to avoid adding new medications, if possible. The second recommendation is to avoid letting pain control your life. Of course, recommendation number two often leads to violation of recommendation number one.


Read more

Rhinorrhea in Parkinson's Disease by Joseph H. Friedman, MD

Rhinorrhea in Parkinson's Disease by Joseph H. Friedman, MD

Rhinorrhea is the technical term for runny nose. It literally means "fluid from the nose" and can refer to anything flowing from it. Carol Jacques, the nurse practitioner who worked with me for several years, pointed out many years ago that a lot of our patients with Parkinson's disease had a runny nose. I didn't think much of it. She found that a nasal spray worked very well and she'd prescribe it, with wonderful results. I patted her on the back and paid little attention.


Read more

Slowness in PD by Joseph H. Friedman, MD

Slowness in PD by Joseph H. Friedman, MD

One of the major problems in PD is called "bradykinesia," which means "slow" (brady) "movement" (kinesia). This is somewhat different than "akinesia" which is discussed in a different section.


Read more

There's Only One Reason to Nag by Joseph H. Friedman, MD

There's Only One Reason to Nag by Joseph H. Friedman, MD

Some of the lessons that doctors learn are incorporated into clinical practice but may never get written down because these common sense, hard learned observations aren't "publishable." They comprise the "art" of medical practice.


Read more

Tremor in Parkinson's Disease by Joseph H. Friedman, MD

Tremor in Parkinson's Disease by Joseph H. Friedman, MD

Although many lay people, and even PD patients themselves think of tremor as being the main problem in PD, it isn't, at least not for most patients. Tremor is common in PD. It affects about 80% of patients with PD, but not 100%. One in five PD patients does not have tremor. And for most patients, tremor is annoying but not debilitating. It is an uncommon patient whose tremor is the main problem.


Read more

Weakness in PD by Joseph H. Friedman, MD

Weakness in PD by Joseph H. Friedman, MD

It is common for PD patients to feel weak. They frequently describe their legs as feeling, "like they're made out of lead," "like they're in concrete." But they will also feel weak all over, or describe weakness in their hands or arms. In fact, when PD patients are tested for strength they are normal but they do fatigue easier. That is, with repeated muscle contractions they do lose force, so it is more difficult for a PD patient to do repetitive tasks.


Read more