Dr. Victor Emanuel MD

Most people can recognize a clear-cut case of Parkinson’s disease. Unfortunately, one only has to take a look at still the most recognized sports figure of all time, to see the tremor, slow, festinating gait, the slurred speech, hypersecretion of sebum and the rest. Most of us know it as a condition that affects how you move. But the breakdown of nerve cells in Parkinson’s disease can cause other symptoms. These other symptoms, also called “non-motor” symptoms include:

– Constipation. This is a common problem, mostly related to the breakdown of the nerve cells that control involuntary body functions (the autonomic nervous system). Some medicines for Parkinson’s disease can also cause constipation. To avoid constipation:

• Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
• Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
• Get some exercise everyday, or at least five days a week, if possible.
• Take a fiber supplement, such as Metamucil, everyday if needed. Start with a small dose and very slowly increase the dose over a month or more. Doc may suggest you use a medicine (different types) to help with constipation.
• Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.

– Sexual problems, including erectile problems, reduced sensitivity, and difficulty reaching orgasm. These can be caused by the disease itself, medicines used to treat the disease, and mood problems like depression. Some sexual problems can be treated with a change in medicine or counseling. Men may be able to use sidenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra) for erectile problems.

– Dizziness, lightheadedness, and fainting. This is caused by low blood pressure, especially when moving from a sitting or lying position to standing (called orthostatic hypotension). Many of the medicines used to treat Parkinson’s disease can make the dizziness worse. Your doc may be able to suggest things that can help.

– Urinary incontinence. In Parkinson’s disease, this can be caused by changes in how your bladder fills and empties. Parkinson’s disease can also change how well you can tell if your bladder is full. Doc may be able to recommend lifestyle changes or medicines that can help with urinary incontinence.

– Excessive saliva and drooling. Changes to the muscles of the face can cause problems with eating and swallowing. You may be able to control this problem by changing what and how you eat. Your doc may be able to suggest medicines that can control drooling if it is severe.

– Sweating and intolerance to heat. These are also problems for people with Parkinson’s disease. These symptoms are mostly related to changes to the nerves that control automatic body processes (like body heat).

– Sleep problems, including:

• Excessive daytime somnolence (EDS), which means you fall asleep suddenly during the day or feel very tired all the time. This can be caused by medicines used to treat Parkinson’s disease and is worse with some medicines than with others. Doc may be able to switch your medicine or give you medicine to help you feel more awake during the day.
• Insomnia. In Parkinson’s, insomnia can mean that you have trouble falling asleep or that you wake up often during the night. Many things can cause problems sleeping, including medicines for Parkinson’s disease or a tremor that keeps you awake. You may be able to change medicines or the amount of medicine you are taking to help with insomnia. Taking melatonin may also help.
• Restless legs syndrome (RLS) and periodic limb movement of sleep (PLMS). Medicines that are used to help with other Parkinson’s disease symptoms such as levodopa and dopamine agonists, can also help with RLS and PLMS.
• REM sleep behavior disorder, (RBD). People with REM sleep behavior disorder act out their dreams during the time they are in the stage of sleep called REM (rapid eye movement) sleep. This can be dangerous to the person with the disorder and his or her bed partner. Doc may be able to suggest medicines that can help with RBD.
• Fatigue. Many people with Parkinson’s disease experience fatigue. If you are having fatigue that is overwhelming, tell the doctor. He or she may change the type of medicine you are taking for Parkinson’s disease or change the amount you are taking. There are also medicines that can help treat fatigue in Parkinson’s disease.

– Anxiety. Anxiety and depression often happen together in people who have Parkinson’s disease. Some people may need medicine to control anxiety.

– Depression. Parkinson’s disease can cause depression, and so can having a long-term disabling illness like Parkinson’s disease. Talk to people about how you feel. Your doc may be able to suggest counseling or medicines to help.

– Psychosis. Some people in the later stages of Parkinson’s have problems telling the difference between what is real and what isn’t. Some of this can be caused by the disease, and some of it by medicine used to treat Parkinson’s disease. Medicines can be used to treat psychosis if it is severe or dangerous.

– Dementia. Dementia may develop in up to one-third of people who have late-stage Parkinson’s disease. Dementia symptoms may include disorientation at night, confusion, and memory loss. Medicines that are used to treat Parkinson’s can also play a role in this problem. Other medicines used to treat dementia may help.

See you next week.

People of the north, Dr. Victor Emanuel will be in Portsmouth on Fridays from 8 am to  3 pm at Bayside Medical Center across from the police station.