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Let PDF Answer Your Questions!

Through our newly-named and expanded Parkinson's Information Service (PINS), the Parkinson's Disease Foundation (PDF) provides multiple avenues to help you find answers to your important questions about PD.

One of our most popular resources is the Ask the Expert feature on our website, www.pdf.org. This tool allows visitors to submit a question about any aspect of Parkinson's, from how to find a movement disorder specialist to understanding the side-effects of a medication. Questions are answered by our team of physicians and Parkinson's information specialists in eight to 10 working days. We archive the more common queries and highlight the most frequently-asked questions, with their answers, on the home page of our site. In this article, we share some recent questions that may involve issues you are currently facing.

Q: Should a person newly diagnosed with PD but not yet seriously affected by the illness take medications as soon as possible, or delay taking anything until the condition becomes truly troubling?

A: None of the medications currently available in the treatment of PD symptoms has been proven to slow or stop the progression of Parkinson's disease. For this reason, many doctors will recommend delaying pharmacologic therapy until the symptoms begin to significantly interfere with daily activities.

An exception to this approach may be considered when a newly-diagnosed patient wishes to participate in a clinical trial on neuroprotection. In these studies, scientists are trying to determine if a certain compound might offer protection to dopamine-producing cells and thus help to slow or stop the progression of the disease. Participation is usually limited to "de novo" patients, i.e., those not yet on drug therapy for their Parkinson's disease. To learn more about clinical trials, visit www.PDtrials.org.

Q: Does stress make the symptoms of Parkinson's worse?

A: It is well known that stress can temporarily worsen most neurological symptoms. Once the stress is eased and the person returns to a more "routine" life, the symptoms usually revert back to where they were before the stress occurred. This is why we frequently recommend that people find some sort of stress-management technique - such as meditating, yoga, deep breathing exercises or "visualization" - to help them through these temporary stressful periods.

If the stressful situation is likely to continue for any length of time, the treating neurologist may want to make changes in the PD medications that are prescribed.

Q: Since being diagnosed with PD at age 60, I seem to experience muscle stiffness in my legs, back and neck, as well as overall weakness. Is this caused by the disease? Is the best therapy to lift weights and walk frequently?

A: Muscle weakness is not usually part of Parkinson's but can be brought on by the decreased activity resulting from symptoms of the disease. Muscle stiffness, on the other hand, is a primary sign of PD. You may wish to speak with your neurologist about adjusting your antiparkinson medication regimen to address this concern.

Generalized stiffness can also be due to a lack of exercise. Regular exercises that target all the muscles of the body are essential to help keep these muscles healthy and mobile. While weight lifting is good exercise if you enjoy it (and will do it on a regular basis - several times per week), full range-of-motion exercises are usually more important in reducing stiffness in Parkinson's disease.

Q: If someone has been diagnosed as having both Parkinson's disease and diabetes, will these interact in any negative way? For example, if a person with Parkinson's is not controlling his diabetes, will this have a detrimental effect in terms of the PD symptoms?

A: Both PD and diabetes are common health issues in the elderly population. Fortunately, there are no negative "interactions" between the treatments used for PD and those suggested for diabetes. However, some of the long-term problems that can accompany diabetes could create difficulty for PD. For example, if vision is impaired by diabetes, and gait and balance are affected by Parkinson's disease, then walking might be even more difficult than if vision or gait alone were impaired.

Q: My mom has Parkinson's and is having trouble paying for her medications. Is there any way to get discounts for them?

A: One way to save is to buy generic formulations of the drugs through a discount-club store such as Costco. Such stores have the lowest percentage markup on generic drugs so the savings are more substantial than when generic drugs are purchased elsewhere.

There are also "by-mail" and Internet pharmacy services that, because of their larger client base and freedom from local overhead costs, typically sell medications at lower prices than a neighborhood pharmacy.

In addition, most pharmaceutical companies have in-house programs to provide their drugs to low-income patients either free or at a reduced price. They offer only their own preparations, so if your mother is taking multiple drugs (for PD or for other health concerns), she would have to contact each drug company. Her local pharmacist can provide company names and numbers for each medication your mother is taking.

A final suggestion is to ask your mother's neurologist for a referral to a social worker. Such professionals are trained to know the various financial aid programs for which your mom might qualify, as well as how to apply and what the various requirements are for eligibility.

If your mother qualifies for Medicare, turn to the article on page 4 for more information on Medicare Part D and prescription drug coverage.

Q: Can a person with PD drink alcoholic beverages?

A: Having a diagnosis of Parkinson's does not automatically mean that a person should never again enjoy a glass of wine or a cocktail. Much depends on how the alcohol, combined with the PD symptoms, affects the person's ability to function safely. For example, if even a small amount of alcohol causes the person to be unsteady, this condition, when combined with the balance instability of Parkinson's disease, could increase the risk of a fall.

Q: I have had Parkinson's for about 17 years, and lately I have been having bouts of "freezing." Can you suggest anything to ease or stop this problem?

A: The key question about freezing of gait (a phenomenon in which the feet suddenly stop for a few seconds while in the middle of walking) is whether it responds to antiparkinson medications. If it tends to occur when the effectiveness of medications wears off, as evidenced by the return of other symptoms such as stiffness, slowness or tremor, then it may respond to adjustments in Parkinson's medications. In this case, a common approach is to adjust the timing and dose of medications to prevent "wearing-off" freezing periods.

Things are different when the type of freezing is one that does not respond to medications, and occurs even when other PD symptoms are well-controlled. When freezing happens in the medicated "on" state, there is no reliable remedy. Some people use "tricks" and external cues to temporarily overcome it, such as imagining that one is taking a big step over an obstacle when they start walking. Others use a laser pointer to shine a light on the ground in front of them and attempt to step onto the light, or over it. Unfortunately, the effectiveness of such tricks often fades over time.

Q: How can I find a place for appropriate physical therapy for my husband who has Parkinson's? The local hospitals do not use Parkinson's as an identifier in their list of rehab services. Is there another term I should be looking for?

A: A physical therapist who routinely works with older people should be able to properly evaluate the abilities and limitations of a person with Parkinson's, and to design an exercise routine based on these observations. Specialty training in PD is not as necessary for physical therapists as it is for other types of health professionals, such as neurologists. What is important is to find a place that is convenient, and to develop a good relationship with the therapist to obtain the greatest possible benefit from the sessions.

To view more questions about Parkinson's disease, visit www.pdf.org and click on the Ask the Expert section. You can also use PINS to find answers to your questions by calling PDF, toll-free, at (800) 457-6676 or emailing info@pdf.org. PDF does not provide diagnoses or recommend specific treatments through this service.