The signs and symptoms of high B/P=Hypertension could be:

Usually, high blood pressure causes no signs or symptoms. That’s why healthcare providers call it a “silent killer.” You could have high blood pressure for years and not know it. In fact, the World Health Organization estimates that 46% of adults with hypertension don’t know they have it.

When your blood pressure is 180/120 mmHg or higher, you may experience symptoms like headaches, heart palpitations or nosebleeds. Blood pressure this high is a hypertensive crisis that requires immediate medical care.

Remember this, for many High blood pressure is known as the “silent killer” and its given that nickname for a reason.  For those patients with high B/P they don’t feel ANY SIGNS OR SYMPTOMS OF HIGH B/P to go to the doctor!  So they let their B/P get so high, never going to the MD or regularly checking their B/P on their own and puff they die awake or in their sleep due to the high B/P that caused the death!

You may not feel that anything is wrong, but high blood pressure could be quietly causing damage that can threaten your health. The best prevention is knowing your numbers and making changes that matter in order to prevent and manage high blood pressure.

Why not just buy a blood pressure monitor from the pharmacy which will help you keep an eye on your B/P or even keeping your B/P therapeutic and have no HTN!

A BIG factor in helping to reduce or decrease high blood pressure for those with hypertension is DIET alone will impact greatly.  Less SODIUM=Salt in the diet will have an impact in lowering your B/P!

Your provider will diagnose you with one of two types of high blood pressure:

• Primary hypertension. Causes of this more common type of high blood pressure (about 90% of all adult cases in the U.S.) include aging and lifestyle factors like not getting enough exercise.
• Secondary hypertension. Causes of this type of high blood pressure include different medical conditions or a medication you’re taking.

Most people with high b/p are asked to eat less sodium. Sodium attracts water and makes the body hold fluid. To pump the added fluid the heart works harder. Also sodium in the body causes the arteries to vasoconstrict increasing pressure in the vessels causing the pressure to rise.

Most people with high b/p are asked to eat less sodium at 2000mg or less a day and this is to prevent water retention and vasoconstriction in which both actions increase the blood pressure. Follow your doctor’s advice about your sodium intake.

Many prepared foods and spices are high in sodium. But, the most common source of sodium is table salt. Table salt is 40% sodium and 60% chloride. One teaspoon of table salt contains 2000mg of sodium.  Get rid of your table salt period will help you in trying to lower your B/P or keeping your B/P therapeutic (in the norm).

HINTS IN HOW TO LOWER YOUR SODIUM IN YOUR DIET:

What is Sodium (NA+)?  One it’s an important substance in our body. It helps your body balance the level of fluid inside and outside of the cells; this prevents the cells from becoming dehydrated. To keep up this balance, the body needs about 2000mg of sodium a day or less. Yet most of us eat 3000 to 6000mg of sodium each day.  On average Americans eat 3400mg of sodium a day and now it is recommended to eat 1500 mg a day.  A major start is no salt shaker on the table and don’t add salt to your foods unless you know the amount in them already with not going over 1500 mg of salt a day or what your cardiologist recommends who is the expert!

Other tips could  be:

-Season foods with fresh or dried herbs, vegetables, fruits or no-salt seasonings.

-Do not cook with salt or add salt to foods after they are on the table.

-Make your own breads, rolls, sauces, salad dressings, vegetable dishes and desserts when you can.

-Stay away from fast foods. They are almost all high in salt.

-Eat fresh, not frozen or canned, and do eat unsalted vegetables. These have less sodium than most processed foods. Read the labels and if they don’t have a label DON’T EAT IT. Read the labels and eat the portioned size it says to for 1 portion with keeping a diary of what you ate with adding the sodium and when it reached 2000mg no more food that day with salt in it unless the doctor prescribes less.

Know this frozen meals are often high in sodium. In fact, it’s estimated that around 70% of the sodium people consume in the United States comes from prepackaged, processed, and restaurant foods = high in sodium.

-Buy water packed tuna and salmon. Break it up into a bowl of cold water, and let stand for 3 minutes. Rinse, drain and squeeze out water.

-Don’t buy convenience foods such as prepared or skillet dinners, deli foods, cold cuts, hot dogs-one of the worst foods to eat to begin, frozen entrees or canned soups. These have lots of salt. Be picky on what you eat.

-Again, read all labels for salt, sodium or sodium products (such as sodium benzoate, MSG). Ingredients are listed in the order of amount used. A low sodium label means 140mg of less per serving. Try to buy products labeled low sodium/serving. Do not eat products that have more sodium than this per serving.

-AHA states, “If you drink, limit your alcohol consumption to no more than two drinks per day for men and no more than one drink per day for women. A drink is one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits or 1 oz. of 100-proof spirits.

I’ve read that red wine is heart healthy — can I drink as much as I’d like?
Unfortunately, red wine as a miracle drink for heart heath is a myth. The linkage reported in many of these studies may be due to other lifestyle factors rather than alcohol. Like any other dietary or lifestyle choice, it’s a matter of moderation and disciplining yourself in almost anything especially junk food, processed foods, foods high in fat or fried should once in awhile in aiding yourself in controlling your blood pressure.  Don’t only do moderation when the B/P goes high instead make the moderate eating of bad foods a regular part of your life and high odds it will only aid in helping your B/P to stay normal or to get in a therapeutic range.  The other way is only a high potential to aid in getting hypertension or increasing your b/p.

If you need help–
If cutting back on alcohol is hard for you to do on your own, ask your healthcare provider about getting help.

The AHA says your lifestyle plays an important role in treating your high blood pressure. If you successfully control your blood pressure with a healthy lifestyle, you might avoid, delay or reduce the need for medication.

Foods to keep out of your diet or ever have on a regular basis and have maybe have once every 3 months or less

-Canned Vegetables, sauerkraut. Self rising flour and corn meal. Prepared mixes (waffle, pancake, muffin, cornbread, etc…)

-Dairy Products high in fat- like buttermilk (store-bought), canned milks unless diluted and used as regular milk).  I personally switched to skim milk and drink it every day and with other things taken in my life in moderation with trying to watch my weight still keeps my b/p under 120/80.   Egg substitute limit to ½ cup/day. Eggnog (store bought) and salted butter or margarine do not buy everyday but have eggnog around holiday time is what I do and that’s it.  I limit my butter intake where it is on bread and never add it to cooking or have extra on the table for like mashed potatoes.  Trust me processed foods have plenty in them and bakery goods without question.

-Soups: Boullon (all kinds), canned broth, dry soup mixes, canned soups are severely high in sodium especially the noodles you add water to.  Just have one of them and your already over 1000mg of salt.  Surprise, Dietary Guidelines for Americans recommends adults limit sodium intake to less than 2,300 mg per day—that’s equal to about 1 teaspoon of table salt! Salt is in the majority of foods so look on the back of the food and read the amount of fat,carbohydrates and salt is in a serving with seeing what the food’s size of a serving is.  It may make you fall in the chair.

-Meats and meat substitutes not to buy=Canned meats, canned fish, cured meats, all types of sausages, sandwich meats, peanut butter, salted nuts.  High in sodium again.

-Prepared mixes (pie, pudding, cake) or store bought pies, cakes, muffins.

-Cooking ingredients to use low sodium type or limit to 2 tbsp/day=ketchsup, chili sauce, barbecue   sauce, mustard, salad dressing.  Read the label!

-Drinks to stay away from Athletic Drinks (such as energy drinks-caffeine/Gatorade), canned tomato or vegetable juice (unless unsalted).  Caffeine is a commonly used neurostimulant that also produces cerebral vasoconstriction by antagonizing adenosine receptors. Chronic caffeine use results in an adaptation of the vascular adenosine receptor system presumably to compensate for the vasoconstrictive effects of caffeine=vasoconstriction of all blood vessels=this increases your b/p.

NIH=The National Library of Meidicine found this with caffeine (https://www.ncbi.nlm.nih.gov/books/NBK202224/):

The West Florida Vein Center states this about caffeine:

“Caffeine is a drug found in coffee, soda and tea, doesn’t just wake you up. It sets your whole body into a different motion, stimulating the nervous system and constricting blood vessels. Caffeine is safe when ingested in moderation, but excessive consumption can lead to vascular complications like high blood pressure, poor circulation and narrow blood vessels.  I have 2 cups a day on average.  Being a night RN I have one in the morning to have one at night.  When off of work just one or two in the am.

Upon consumption, caffeine gives you your morning jolt of energy. It achieves this by attaching to your adenosine receptors, which ordinarily dilate your brain’s blood vessels. Instead, your blood vessels constrict, also known as vasoconstriction. When vasoconstriction of the brain occurs, the pituitary gland sounds an alarm and reacts as if in an emergency state. It then releases adrenaline, which leads to increased heart rate.“

Know adrenaline is released in fight or flight and adrenaline causes peripheral vasoconstriction which further increases the B/P due to pressure build up in the vessels away from the core or center of the body.  That is what peripheral means.

The West Florida Vein Center further states:

“With vasoconstriction comes faster heart rate but slower blood flow. A study by “Human Brain Mapping” found heavy caffeine users experienced “reduced cerebral blood flow by an average of 27 percent.” What this means? Excessive caffeine intake leads to unnecessary stress on your venous system. Because your brain receives an inadequate amount of blood, your whole venous system operates under stress to compensate for the blood flow changes.

When stressed, veins are at greater risk of disease. Venous conditions like varicose veins and deep vein thrombosis can occur with vasoconstriction. Narrow blood vessels can prevent sufficient blood flow, causing clotting and inflammation.  To avoid stressing your venous system, limit coffee intake to 24 ounces per day.” OR we say less if you can!  Even better is decaffeinated coffee and no venous constriction will occur or if you need the caffeine have one glass or 12 ounces of caffeinated and the rest of the day decaffeinated coffee.

So yes, long term caffeine heavy users do get overall VASOCONSTRICTION that increases your blood pressure in the body, including in the brain.  While there’s no broad percentage of caffeine dependence in the US population, smaller studies have been conducted. According to a study conducted by the University of Florida, 28% fulfilled the criteria for caffeine dependence compared to 50% for alcohol and 80% for nicotine.  From this study 2 factors cause vasoconstriction Nicotine and Caffeine.  Remember one of the symptoms of high B/P is a headache! So change your diet if you need to in your life, based on this information and hope it is useful!

Remember Moderation to stopping completely out of your diet things that increase your blood pressure is the key to helping you reach normal blood pressure with other factors like obesity, and disease from Diabetes to Athero- sclerosis (which is partly or completely blocking an artery vessel) including arteriosclerosis which is brittle arteries and Renal Failure (acute or chronic).

(Updated 5/12/24)

Understand the numbers in your B/P!

“Hypertension Stage 1 is when blood pressure consistently ranges from 130 to 139 systolic or 80 to 89 mm Hg diastolic. At this stage of high blood pressure, health care professionals are likely to prescribe lifestyle changes and may consider adding blood pressure medication.

Hypertension Stage 2 is when blood pressure consistently is 140/90 mm Hg or higher. At this stage of high blood pressure, health care professionals are likely to prescribe a combination of blood pressure medications and lifestyle changes.

Hypertension Stage 3-This stage of high blood pressure requires medical attention. If your blood pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and then test your blood pressure again. If your readings are still unusually high, contact your health care professional immediately. You could be experiencing a hypertensive crisis!

Experiencing new symptoms with your B/P this high than call 911!

American Heart Association (https://www.heart.org/en/health-topics/high-blood-pressure-understanding-blood -pressure-readings)

Know the numbers of concern and know yours to keep your health well and avoiding problems from High B/P. We will review S/S with more tomorrow continuing the topic hypertension (HTN).

  Systolic BP is heart at work, Diastolic BP is heart at rest!

High Blood Pressure – what is it?

High Blood Pressure or Hypertension affects 80 million Americans and nearly half of the people in the UK between the ages of 65 and 74, and a large percentage of those between the ages of 35 and 65. One of the problems associated with high blood pressure is that you will probably not even know you have it until you happen to have your blood pressure taken during a routine physical examination.  In our B/P you have 2 numbers one on the top that is called your systolic b/p that will always be higher that the bottom number b/p.  What do they mean? The top number systolic B/P will be the number representing your heart pressure at work whereas the bottom number called diastolic B/P will always be lower that the top number representing the B/P at rest.  Normal B/P for some is 90/50 for those who are a work out nut, in good shape, and at their normal weight level or body mass index (BMI).  For others normal B/P can go has high as 120/80 or less.  High B/P is over 120/80.  In earlier years 122/80 was considered the norm now its not.  Where do you really see problems for a high B/P?  Well looking at a B/P chart this should give you some direction:

Remember in the nursing and medical field a systolic B/P of 180 these professional get concerned for stroke or a vessel somewhere about to burst (Ex. like a abdominal aneurysm which many don’t feel since its in their abdomen making room for the pouch vessel to grow making the vessel wall weaker to pop and than for many when realized its too late, take the actor John Ritter!)  With a stroke it can be caused by a hemorrhagic stroke-this meaning a vessel ruptures (most commonly high B/P) or ischemic stroke a build up of a blockage or blockages of a vessel in the brain).

Upon diagnosis, you may wonder why you never saw it coming. Most people don’t. Only those with severe high blood pressure experience any warning signs at all.

These signs can include headaches, impaired vision, and black-outs.

What is blood pressure ?

It is the measurement of the force that blood applies to the walls of the arteries as it flows through them carrying oxygen and nutrients to the body’s vital organs and systems. Naturally, our blood is under pressure as it rushes through our arteries. Even those with blood pressure in the normal range will experience an increase in their blood pressure during rigorous physical activity or during times of stress. It only becomes a problem when the blood continues to run high. This condition of blood pressure is known as hypertension or high blood pressure and in 95% of the cases, the cause of it is never known. However, we do know the factors that set a person up to develop hypertension.

Factors influencing High Blood Pressure:

They are as follows:

NON-MODAFIABLE RISK FACTORS ARE 4:

1. HEREDITY-HIGH B/P RUNNING IN THE FAMILY

2. AGE-THE OLDER, THE HIGHER PROBABILITY YOU WILL END UP WITH B/P DEPENDING ON YOUR HEALTH AND HOW GOOD YOU TAKE CARE OF YOURSELF.

3. GENDER or SEX-MALES VS FEMALES.  THE GENDER THAT BEATS THE OTHER EASILY IS MEN!

4. RACE-HIGHIER IN AFRO-AMERICAN AS OPPOSED TO WHITE.

MODAFIABLE RISK FACTORS=FACTORS YOU CAN CONTROL IN YOUR LIFESPAN:

1-Obesity=Those with a body mass index of 30 or greater.

2-Drinking more than 2 to 4 alcoholic drinks a day.

3-Smoking

4-High cholesterol

5-Diabetes

6-Ongoing Stress/Anxiety

7-Continuous use of excessive salt consumption

Possible causes of High Blood Pressure

Sometimes the cause of a person’s high blood pressure is determined, but this happens in only 5% of the cases. When a cause is found, the person is diagnosed with secondary high blood pressure [hypertension]. In most of these cases, the cause can be linked to an underlying illness such as kidney disease, adrenal gland disease, or narrowing of the aorta. Contraceptive pills, steroids, and some medications can also cause secondary high blood pressure [hypertension], though instances of this are not all that common since in most cases these can be stopped or with medications changed if a med is still needed to resolve high blood pressure.

Reviewing High Blood Pressure and the important numbers

We hear the numbers, but do we really know what they mean? Since your blood pressure numbers can help you to understand your overall health status, it is important that you keep track of it. By knowing where your numbers are right now, you can head off such serious high blood pressure complications as angina, heart attacks, stroke, kidney damage, and many others that might surprise you – like eye problems and gangrene.

Hear is a review of understanding what blood pressure means and tells our medical professionals from RN’s who see the pt the most and see the vital signs with doctors being told who generally provide your blood pressure to you in terms of two numbers – a top one and a bottom one. For example, if your blood pressure is 120/80, they may say that you have a blood pressure of 120 over 80. Here is a definition again for these numbers:

The top number– this is your systolic blood pressure. It measures the force of blood in the arteries as your heart beats. The top number means the pressure is reading your heart at work.  That is why this number is always highier.

The bottom number – this is your diastolic blood pressure. It is the pressure of your blood when the heart is relaxed in between the times when it is pumping. Means the pressure is reading your heart at rest.  That is why the number is always lowest.

Your blood pressure requires monitoring when you have a systolic blood pressure of 140 or over and/or a diastolic blood pressure of 90 or over. Those with diabetes must maintain a lower blood pressure that those who don’t have the condition. Diabetics should maintain a blood pressure of less than 130/80.  It would be ideal at 120/80 and there are some that do.

Monitors for measuring High Blood Pressure

It is wise to monitor your blood pressure at home in addition to having it taken at your doctor’s office. This will allow you to provide your doctor with readings that have been taken over time, providing a more in depth look at your personal health condition. This will help him or her to prescribe the right hypertensive medication and treatment for your specific condition.

Tips to help reduce your B/P:

The best you could do over 50 or if already diagnosed with high blood pressure than monitor it at home with automatic B/P machines or get a manual one with a stethoscope for taking your B/P measurement with your pulse for some that you take from the upper arm at home each day when you first get up. Especially have a B/P monitor is recommended in taking your B/P meds to eval how good the med is working but if on lopressor or metoprolol (commonly used antihypertensives) or any selective beta blocker which can lower your B/P and pulse. Since with metoprolol or lopressor if the b/p is 90/60 or the pulse is lower than 60 you should call the M.D. first since readings that low could bottom out your B/P and pulse with making them too low putting the pt at problems with dizziness, feeling weak to bottoming out so bad you just sleeps or better falls.  So call your doctor immediately before taking the med.  Always take the B/P from the upper arm above the elbow unless your M.D tells you otherwise.  You’ll also want to make sure that the blood pressure monitor you are considering has been proven in clinical trials. Trusted name brands include those made by Omron, LifeSource, Mark of Fitness, Micro Life, and A and D Instruments. There are other brands available – the important thing is to do your research.

Always check with you cardiologist preferred or your general practitioner before making any changes in your lifestyle in anyway for safety.

Updated 5/07/24

“Key facts

Parkinson’s disease is the second most common progressive, neurodegenerative disease after Alzheimer disease. Parkinson’s disease is named after James Parkinson, a 19^th century general practitioner in London.

Parkinson’s disease is characterised by pathologic intra-neuronal α–synuclein-positive Lewy bodies and neuronal cell loss. Classically this process has been described as involving the dopaminergic cells of the substantia nigra pars compacta, later becoming more widespread in the CNS as the disease progresses. However, recently there has been a growing awareness that the disease process may involve more caudal portion of the CNS and the peripheral nervous system prior to the clinical onset of the disease.¹ Parkinson’s disease affects movement, muscle control, balance, and numerous other functions.

TREATMENTS:

MEDS: The combination of levodopa and carbidopa (Brand names Sinemet, Parcopa, Duopa^® (as a combination product containing Carbidopa, Levodopa=Rytary^® (as a combination product containing Carbidopa, Levodopa).

Levodopa and carbidopa are used to treat the symptoms of Parkinson’s disease and Parkinson’s-like symptoms that may develop after encephalitis (swelling of the brain) or injury to the nervous system caused by carbon monoxide poisoning or manganese poisoning. Parkinson’s symptoms, including tremors (shaking), stiffness, and slowness of movement, are caused by a lack of dopamine, a natural substance usually found in the brain. Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain. This allows for a lower dose of levodopa, which causes less nausea and vomiting.

Medications are commonly used to increase the levels of dopamine in the brain of patients with Parkinson’s disease in an attempt to slow down the progression of the disease. Dopaminergic agents remain the principal treatments for patient with Parkinson’s disease, such as Levodopa and Dopaminergic agonist. In many patients, however, a combination of relatively resistant motor symptoms, motor complications such as dyskinesias or non-motor symptoms such as dysautonomia may lead to substantial disability in spite of dopaminergic therapy. In recent days, there has been an increasing interest in agents targeting non-motor symptoms, such as dementia and sleepiness.

As patients with Parkinson’s disease live longer and acquire additional comorbidities, addressing these non-motor symptoms has become increasingly important. Among anti-depressants, Amitriptiline and SSRI are commonly used, while Rivastigmine became the first FDA approved medication for the treatment of dementia associated with PD.

SURGERY:   Surgery for Parkinson’s disease has come a long way since it was first developed more than 50 years ago. The newest version of this surgery, deep brain stimulation (DBS), was developed in the 1990s and is now a standard treatment. Worldwide, about 30,000 people have had deep brain stimulation.

Lifestyle modifications have been shown to be effective for controlling motor symptoms in the early stages of Parkinson’s disease. The surgical treatment options available for Parkinson’s patients with severe motor symptoms are pallidotomy, thalamotomy and Deep Brain Stimulation (DBS).

The novel approaches for treatment of Parkinson’s disease that are currently under investigation include neuroprotective therapy, foetal cell transplantation, and gene therapy.

What is Deep Brain Stimulation (DBS) as a treatment?

DBS was introduced two decades ago and has gained widespread popularity as a surgical treatment for medically refractory Parkinson’s disease. DBS is a reversible procedure that has advantage over surgical lesioning (pallidotomy) and unilateral brain stimulation. DBS is comparable in efficacy to unilateral surgical lesioning⁷ while bilateral subthalamic nucleus stimulation is superior to pallidotomy. DBS is FDA approved for the treatment of medically refractory Parkinson’s disease and ET. DBS has proven its efficacy in the treatment of cardinal motor features of Parkinson’s disease such as bradykinesia, tremor and rigidity and it is unresponsive for non-motor symptoms such as cognition, speech, gait disturbance, mood and behaviour. Long-term studies have demonstrated that many of these effects last for long as long as levodopa responsiveness in maintained

During deep brain stimulation surgery, electrodes are inserted into the targeted brain region using MRI and neurophysiological mapping to ensure that they are implanted in the right place. A device called an impulse generator or IPG (similar to a pacemaker) is implanted under the collarbone to provide an electrical impulse to a part of the brain involved in motor function. Those who undergo the surgery are given a controller, which allows them to check the battery and to turn the device on or off. An IPG battery lasts for about three to five years and is relatively easy to replace under local anesthesia.

Is DBS Right for Me?

Although DBS is certainly the most important therapeutic advancement since the development of levodopa, it is not for every person with Parkinson’s. It is most effective – sometimes, dramatically so – for individuals who experience disabling tremors, wearing-off spells and medication-induced dyskinesias.

Deep brain stimulation is not a cure for Parkinson’s, and it does not slow disease progression. Like all brain surgery, deep brain stimulation surgery carries a small risk of infection, stroke, or bleeding. A small number of people with Parkinson’s have experienced cognitive decline after this surgery. That said, for many people, it can dramatically relieve some symptoms and improve quality of life. Studies show benefits lasting at least five years.

Gamma Knife radiosurgery

 Gamma Knife radiosurgery is a painless procedure that uses hundreds of highly focused radiation beams to target deep brain regions to create precise functional lesions within the brain, with no surgical incision. Gamma Knife may be a treatment option for patients with Parkinson’s tremor who are high risk for surgery due to medical conditions or advanced age.

As the nation’s leading provider of Gamma Knife procedures, UPMC has treated more than 12,000 patients with tumors, vascular malformations, pain, and other functional problems.

It is very important that a person with Parkinson’s who is thinking of treatment from meds to surgery to possiby Gamma Knife radiosurgery be well informed about the procedures and realistic in his or her expectations. This means there’s no standard treatment for the disease – the treatment for each person with Parkinson’s is based on his or her symptoms.

Advanced treatments

MRI-guided focused ultrasound (MRgFUS) is a minimally invasive treatment that has helped some people with Parkinson’s disease manage tremors. Ultrasound is guided by an MRI to the area in the brain where the tremors start. The ultrasound waves are at a very high temperature and burn areas that are contributing to the tremors.

Remember Parkinson’s disease can’t be cured, but medications can help control the symptoms, often dramatically. In some more advanced cases, surgery may be advised.

Your health care provider may also recommend lifestyle changes, especially ongoing aerobic exercise.

In some cases, physical therapy that focuses on balance and stretching is important.

A speech-language pathologist may help improve speech problems.

There is always support groups for Parkinson’s Disease for patients diagnosed with it and the family involved also!

“Biomarker testing is the analysis of a person’s tissue, blood and other substances, known as biomarkers, that can provide information about a disease. While most current applications of biomarker testing are in oncology and autoimmune diseases, there is research underway to benefit other patients including those with neurological conditions like Parkinson’s.

While biomarker testing can provide people with critical information about their health, insurance coverage is failing to keep pace with innovation. We urge states to take legislative action to require health plans, including Medicaid, to cover biomarker testing so that more individuals have access to this important health care tool.

Legislative action on biomarker testing access coincided with the MJFF’s groundbreaking news, announced in April 2023, that researchers have discovered a new biomarker tool that can reveal a key pathology of the Parkinson’s: abnormal alpha-synuclein — known as the “Parkinson’s protein” — in brain and body cells.

Last year, twelve states passed legislation related to expanding insurance coverage for biomarker testing — Arizona, California, Georgia, Kentucky, Louisiana, Maryland, New Hampshire, Nevada, New Mexico, New York, Oklahoma and Texas. In 2024, MJFF is pursuing legislation in Colorado, Connecticut, Hawaii, Indiana, Iowa, Maine and Pennsylvania.”

Michael J. Fox Foundation for Parkinson’s Research

(https://www.michaeljfox.org/news/shaping-future-parkinsons-states-2024-policy-priorities)

What are the signs and symptoms (s/s) of this disease?

The early signs and symptoms of Parkinson’s disease that are often overlooked by both patients and doctors because the symptoms are subtle and the progression of the disease is typically slow. S/S of parkinson’s disease are:

Parkinson’s disease does not affect everyone the same way. In some people the disease progresses quickly, in others it does not. Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and different symptoms are more troublesome.

• The tremors associated with Parkinson’s disease has a characteristic appearance. Typically, the tremor takes the form of a rhythmic back-and-forth motion of the thumb and forefinger at three beats per second. This is sometimes called “pill rolling.” Tremor usually begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. In three out of four patients, the tremor may affect only one part or side of the body, especially during the early stages of the disease. Later it may become more general. Tremor is rarely disabling and it usually disappears during sleep or improves with intentional movement.                                
• Rigidity, or a resistance to movement, affects most parkinsonian patients. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible not just because one muscle becomes more active, but because the opposing muscle relaxes. In Parkinson’s disease, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the patient’s arm, which will move only in ratchet-like or short, jerky movements known as “cogwheel” rigidity.
• Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it is unpredictable. One moment the patient can move easily. The next moment he or she may need help. This may well be the most disabling and distressing symptom of the disease because the patient cannot rapidly perform routine movements. Activities once performed quickly and easily — such as washing or dressing — may take several hours.
• Postural instability, or impaired balance and coordination, causes patients to develop a forward or backward lean and to fall easily. When bumped from the front or when starting to walk, patients with a backward lean have a tendency to step backwards, which is known as retropulsion. Postural instability can cause patients to have a stooped posture in which the head is bowed and the shoulders are drooped.

As the disease progresses, walking may be affected. Patients may halt in mid-stride and “freeze” in place, possibly even toppling over. Or patients may walk with a series of quick, small steps as if hurrying forward to keep balance. This is known as festination.

A detailed overview of the Unified Parkinson’s Disease Rating Scale that is used by doctors to follow the course of disease progression and evaluate the extent of impairment and disability.

Abstract

The Movement Disorder Society Task Force for Rating Scales for Parkinson’s Disease prepared a critique of the Unified Parkinson’s Disease Rating Scale (UPDRS). Strengths of the UPDRS include its wide utilization, its application across the clinical spectrum of PD, its nearly comprehensive coverage of motor symptoms, and its clinimetric properties, including reliability and validity. Weaknesses include several ambiguities in the written text, inadequate instructions for raters, some metric flaws, and the absence of screening questions on several important non-motor aspects of PD. The Task Force recommends that the MDS sponsor the development of a new version of the UPDRS and encourage efforts to establish its clinimetric properties, especially addressing the need to define a Minimal Clinically Relevant Difference and a Minimal Clinically Relevant Incremental Difference, as well as testing its correlation with the current UPDRS. If developed, the new scale should be culturally unbiased and be tested in different racial, gender, and age-groups. Future goals should include the definition of UPDRS scores with confidence intervals that correlate with clinically pertinent designations, “minimal,” “mild,” “moderate,” and “severe” PD. Whereas the presence of non-motor components of PD can be identified with screening questions, a new version of the UPDRS should include an official appendix that includes other, more detailed, and optionally used scales to determine severity of these impairments.

How Parkinson’s disease is diagnosed based on factors such as signs/symptoms, patient history, physical examination, and a thorough neurological evaluation.

Furthermore, making the diagnosis is even more difficult since there are currently no blood or lab tests available to diagnose the disease. Some tests, such as a CT Scan (computed tomography) or MRI (magnetic resonance imaging), may be used to rule out other disorders that cause similar symptoms. Given these circumstances, a doctor may need to observe the patient over time to recognize signs of tremor and rigidity, and pair them with other characteristic symptoms. The doctor will also compile a comprehensive history of the patient’s symptoms, activity, medications, other medical problems, and exposures to toxic chemicals. This will likely be followed up with a rigorous physical exam with concentration on the functions of the brain and nervous system. Tests are conducted on the patient’s reflexes, coordination, muscle strength, and mental function. Making a precise diagnosis is essential for prescribing the correct treatment regimen. The treatment decisions made early in the illness can have profound implications on the long-term success of treatment.

 Questions to Ask Your Doctor About Parkinson’s Disease

Since you’ve recently been diagnosed with Parkinson’s disease, ask your doctor these questions at your next visit.

1. What stage is my illness in now?

2. How quickly do you think my disease will progress?

3. How will Parkinson’s disease affect my work?

4. What physical changes can I expect? Will I be able to keep up the activities, hobbies, and sports I do now?

5. What treatments do you suggest now? Will that change as the disease progresses?

6. What are the side effects of medication?…

Because the diagnosis is based on the doctor’s exam of the patient, it is very important that the doctor be experienced in evaluating and diagnosing patients with Parkinson’s disease. If Parkinson’s disease is suspected, you should see a specialist, preferably a movement disorders trained neurologist.

A comprehensive overview of the major non-motor complications that are often associated with Parkinson’s disease, including:

-Cognitive impairment –Dementia –Psychosis       -Fatique–Depression -Sleep disturbances -Constipation -Sexual dysfunction -Vision disturbances.

“VA uses the term “military sexual trauma” (MST) to refer to sexual assault or threatening sexual harassment experienced during military service. MST includes any sexual activity during military service in which you are involved against your will or when unable to say no. People of all genders, ages, sexual orientations, racial and ethnic backgrounds, and branches of service have experienced MST. Like other types of trauma, being PTSD.  MST can negatively affect a person’s mental and physical health, even many years later. Examples include:

• Being pressured or coerced into sexual activities, such as with threats of negative treatment if you refuse to cooperate or with promises of better treatment
• Sexual contact or activities without your consent, including when you were asleep or intoxicated
• Being overpowered or physically forced to have sex
• Being touched or grabbed in a sexual way that made you uncomfortable, including during “hazing” experiences
• Comments about your body or sexual activities that you found threatening
• Unwanted sexual advances that you found threatening”

U.S. Dept of Veteran’s Affair (https://www.mentalhealth.va.gov/msthome/index.asp)

Parkinson Disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

There are three types of Parkinson’s disease and they are grouped by age of onset: 

1-Adult-Onset Parkinson’s Disease – This is the most common type of Parkinson’s disease. The average age of onset is approximately 60 years old. The incidence of adult onset PD rises noticeably as people advance in age into their 70’s and 80’s.

2-Young-Onset Parkinson’s Disease – The age of onset is between 21-40 years old. Though the incidence of Young-Onset Parkinson’s Disease is very high in Japan (approximately 40% of cases diagnosed with Parkinson’s disease), it is still relatively uncommon in the U.S., with estimates ranging from 5-10% of cases diagnosed.

3-Juvenile Parkinson’s Disease – The age of onset is before the age of 21. The incidence of Juvenile Parkinson’s Disease is very rare.

Impact of the disease:

Parkinson’s disease can significantly impair quality of life not only for the patients but for their families as well, and especially for the primary caregivers. It is therefore important for caregivers and family members to educate themselves and become familiar with the course of Parkinson’s disease and the progression of symptoms so that they can be actively involved in communication with health care providers and in understanding all decisions regarding treatment of the patient.

According to the American Parkinson’s Disease Association, there are approximately an estimated 1 million Americans living with Parkinson’s disease and more than 10 million people worldwide.  That number is expected to rise as the general population in the U.S. ages. Onset of Parkinson’s disease before the age of 40 is rare. All races and ethnic groups are affected.

Knowledge is Critical when Dealing with a Life-Altering Condition such as Parkinson’s Disease and being able to make the changes to last longer and at your optimal level of functioning! First step is accept you have it!

If you or a loved one has been diagnosed with Parkinson’s disease, it’s critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That’s why we created the Medifocus Guidebook on Parkinson’s Disease, a comprehensive 170 page patient Guidebook that contains vital information about Parkinson’s disease that you won’t find anywhere in a single source.

The Medifocus Guidebook on Parkinson’s Disease starts out with a detailed overview of the condition and quickly imparts fundamentally important information about Parkinson’s disease, including:

Possible factors that could impact someone in being diagnosed with this disorder:

1-Genetic Factors

In some patients, genetic factors could be the primary cause; but in others, there could be something in the environment that led to the disease. Scientists have noted that aging is a key risk factor. There is a 2-4% risk for developing the disease for people over 60. That is compared to 1-2% risk in the general population.

2-Environmental Factors

Some scientists believe that PD can result from overexposure to environmental toxins, or injury. Research by epidemiologists has identified several factors that may be linked to PD. Some of these include living in rural areas, drinking well water, pesticides and manganese.

Some studies have indicated that long term exposure to some chemicals could cause a higher risk of PD. These include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb. In 2009, the US Veterans Affairs Department stated that PD could be caused by exposure to Agent Orange.

We should remember that simple exposure to a single toxin in the environment is probably not enough to cause PD. Most people who are exposed to such toxins do not develop PD but could be a risk.

The Parkinson’s Disease Foundation notes that even after decades of intense study, the causes of Parkinson’s disease are not really understood. However,they agree in saying that many experts believe that the disease is caused by several genetic and environmental factors, which can vary in each person.