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.

“Not everyone has a work schedule that resembles the traditional nine-to-five day. In fact, more than 22 million Americans work evening, rotating, or on-call shifts. You face many challenges when working non-traditional hours. It can be hard to keep up with family and friends. You may feel disconnected from the people you care about the most. You may have trouble organizing your time and activities. You may be frustrated to realize that most things are planned around the schedule of the typical day worker. It may seem like no one has your needs in mind.  Your physical health may also suffer from shift work. It can be very hard to get the sleep you need to stay well rested. This can make you more likely to get sick. It also makes you at potential that the job is hard for you to stay alert on the job.  Being tired increases the chance that you could suffer a work-related injury. Even driving home from work is a risk when you are sleepy.  Studies show that sleepiness can have a negative effect on any of the following:

1. Attention 2. Concentration 3. Reaction time 4. Memory  5. Mood.

A main challenge of shift work is that it forces you to sleep against the clock. You have an internal body clock in your brain that produces circadian rhythms.  If you work at night, you must fight your body’s natural rhythms to try and stay awake. Then you have to try to sleep during the day when your body expects to be alert.

It is a good idea to take a nap just before reporting for a night shift. This makes you more alert on the job. A nap of about 90 minutes seems to be best. Naps during work hours may also help you stay awake and alert. You may also want to take a nap during the night shift “lunch hour.” This can make you more productive and more satisfied”

UCLS Health (https://www.uclahealth.org/medical-services/sleep-disorders/patient-resources/patient-education/coping-with-shift-work)

Sleep isn’t just a time to rest and give your body and brain a break. It’s a critical biological function that restores and replenishes important body systems. Now, yet another study on shift workers shows that their unusual hours may be cutting their lives short—and that’s especially true for those who have rotating night shifts, rather than permanent graveyard duty.

You wake up, feel hungry, and fall asleep each day around repeating 24-hour “circadian” cycles controlled by your body’s internal clocks. These clocks are synchronized by a central pacemaker in the brain. Cycles of light and dark are important for the function of the brain’s master clock. Other cycles, such as the behavioral activities of eating and fasting or sleeping and waking, are important for peripheral clocks in the liver, gut, and other tissues.

When you stay awake all night or otherwise go against natural light cycles, your health may suffer. Long-term disruption of circadian rhythms has been linked to obesity, diabetes, and other health problems related to the body’s metabolism.

In a study published in the American Journal of Preventive Medicine, scientists led by Dr. Eva Schernhammer, an epidemiologist at Brigham and Women’s Hospital, studied 74,862 nurses enrolled in the Nurses’ Health Study since 1976. The nurses were an ideal group for studying the effects of rotating night shifts on the body, since RNs tend to have changing night shift obligations over an average month rather than set schedules.

After 22 years, researchers found that the women who worked on rotating night shifts for more than five years were up to 11% more likely to have died early compared to those who never worked these shifts. In fact, those working for more than 15 years on rotating night shifts had a 38% higher risk of dying from heart disease than nurses who only worked during the day. Surprisingly, rotating night shifts were also linked to a 25% higher risk of dying from lung cancer and 33% greater risk of colon cancer death. The increased risk of lung cancer could be attributed to a higher rate of smoking among night shift workers, says Schernhammer.

The population of nurses with the longest rotating night shifts also shared risk factors that endangered their health: they were heavier on average than their day-working counterparts, more likely to smoke and have high blood pressure, and more likely to have diabetes and elevated cholesterol. But the connection between more rotating night shift hours and higher death rates remained strong after the scientists adjusted for them.

You wake up, feel hungry, and fall asleep each day around repeating 24-hour “circadian” cycles controlled by your body’s internal clocks. These clocks are synchronized by a central pacemaker in the brain. Cycles of light and dark are important for the function of the brain’s master clock. Other cycles, such as the behavioral activities of eating and fasting or sleeping and waking, are important for peripheral clocks in the liver, gut, and other tissues.

When you stay awake all night or otherwise go against natural light cycles, your health may suffer. Long-term disruption of circadian rhythms has been linked to obesity, diabetes, and other health problems related to the body’s metabolism.

Previous studies have shown that some metabolites—the products of metabolism—in blood can have daily rhythms. An international research team led by Drs. Hans P. A. Van Dongen and Shobhan Gaddameedhi at Washington State University investigated whether disruptions in these rhythms are influenced by the central pacemaker in the brain or reflect behavioral activities, such as working the night shift. The study was funded in part by NIH’s National Institute of Environmental Health Sciences (NIEHS). Results were published online in the Proceedings of the National Academy of Sciences on July 10, 2018.

Ten men and four women, aged 22 to 34 years, stayed at a research lab for one week. Half had a night-shift sleep pattern for three days and half had a day-shift pattern. The night-shift pattern causes the central pacemaker and behavioral rhythms to be at odds. After three days, the volunteers were kept awake for one day in a constant routine with a constant level of temperature and light. They received identical snacks every hour and provided blood samples every three hours.

The research team found only small differences in the day-shift and night-shift patterns for melatonin and cortisol, which mark the activity of the brain’s master clock. This finding suggests that the master clock is resistant to influence from the night-shift pattern.

The team analyzed the levels of 132 metabolites during the 24-hour constant routine. About half (65) of the metabolites had a significant daily rhythm. Of these, 27 had a significant 24-hour rhythm for both sleep patterns. Only three of these metabolites (taurine, serotonin, and sarcosine) kept the same peak time, similar to the master clock markers melatonin and cortisol. The other 24 showed a 12-hour shift in rhythm for the night-shift pattern.

The researchers noted that the particular metabolites and pathways affected by the night-shift sleep pattern relate to the liver, pancreas, and digestive tract. These findings suggest that night-shift sleep patterns can disrupt certain metabolite rhythms and the peripheral clocks of the digestive system without affecting the brain’s master clock.

“No one knew that biological clocks in people’s digestive organs are so profoundly and quickly changed by shift work schedules, even though the brain’s master clock barely adapts to such schedules,” Van Dongen says. “As a result, some biological signals in shift workers’ bodies are saying it’s day while other signals are saying it’s night, which causes disruption of metabolism.”

Further research is needed to better understand the role of these metabolic pathways in obesity, diabetes, and other medical conditions for which shift workers are at increased risk.

Nearly 15 million Americans work a permanent night shift or regularly rotate in and out of night shifts, according to the Bureau of Labor Statistics. That means a significant sector of the nation’s work force is exposed to the hazards of working nights, which include restlessness, sleepiness on the job, fatigue, decreased attention and disruption of the body’s metabolic process.

Those effects extend beyond the workers themselves, as many of us share the road with night-driving truckers, count on the precision of emergency-room workers and rely on the protection of police and national security personnel at all hours.

Now, psychologists are gaining a better understanding of how exactly night and shift work affect cognitive performance and which interventions and policies could keep shift workers and the public safer.

“The basic take-home is that fatigue decreases safety,” says Bryan Vila, PhD, a sleep expert and criminal justice researcher at Washington State University–Spokane. Learning healthy sleeping practices is “just as important as occupational training,” he says.

Poor scheduling, combined with unhealthy attitudes about the need for sleep, can cause major problems for night workers. That’s because working at night runs counter to the body’s natural circadian rhythm, says Charmane Eastman, PhD, a physiological psychologist at Rush University in Chicago. The circadian clock is essentially a timer that lets various glands know when to release hormones and also controls mood, alertness, body temperature and other aspects of the body’s daily cycle.

Possible solutions

Of course, many workers can’t give up the night shift entirely. So the question is, how can night shift workers adapt to their schedules?

Charmane Eastman, PhD. Founding Director, Biological Rhythms Research Lab.  Her education is PhD, University of Chicago / BS, State University of New York at Albany.  Her Research Areas are:  Shift work, jet lag, human circadian rhythms (especially effects of bright light and melatonin), social jet lag, circadian misalignment

There are two ways, says Rush University’s Eastman. One is through symptomatic relief by using such stimulants as coffee and caffeine pills to stay awake during the night, then taking sedatives to sleep in the morning. The other way is to shift the body’s circadian clock so that it better tolerates working at night and sleeping during the day.

Eastman and her team are exploring the latter approach. “The circadian clock is very stubborn and hard to push around,” she says.

Previous research has established that you can delay the circadian clock by about one or two hours per day. To determine that, researchers measure the body’s circadian rhythm by monitoring “dim-light melatonin onset,” or the time at which the pineal gland begins to secrete melatonin, which is triggered by the circadian clock. Normally, it kicks in a couple hours before people are ready to sleep. “It’s an output that’s a way of seeing what the circadian clock is doing,” Eastman says. “It’s a very good marker of the phase of the time of the clock.”

By exposing experimental subjects to intermittent bright light during their night shifts and having them wear sunglasses on their way home and sleeping in very dark bedrooms, Eastman and her team have found that within about a week, they can shift someone’s circadian rhythm to align perfectly with working a night shift and sleeping during the day.

Through WebMD.com it points out March 2010 the following:   In terms of lifestyle, working odd hours leads to some obvious problems. People who do shift work tend to have sleep disturbances and sleep loss. They might feel isolated, since their jobs cut them off from their friends and families. They might find it harder to exercise regularly, and may be prone to eat junk food out of a handy vending machine, says Scheer.

Including in this note, I myself, being a RN 35 years basically, who has worked all shifts (mostly 12 hr shifts than driving home and for the past 4.5 years a 2 hr drive to and back to the hospital) disagree with this statement in that preventing junk food and of course exercise in your week you need discipline in obtaining right foods, exercise and habits.  It is a challenge with no question but can be obtained if the right mind is set to it.

As WebMD points out, “The long-term effects of shift work are harder to measure. But researchers have found compelling connections between shift workers and an increased risk of serious health conditions and diseases.”.  It really depends on what where you prior to going into night shift, is it 12 hr shifts or 8 hr shifts or part time or perdiem.  It messes up the circadium cycle but you can bounce back depending on often you work night shift. ”

Remember, I point out night shift is not 3 to 11 pm but 11pm and on till am in long hours.  Since many don’t fall asleep till after 10pm and on.  Another major ingredient I would like to point out is, what is your medically history? Is this a worker with no medical history/in shape/ and great health habits? What is your age? Is this worker someone who is with diabetes?, cardiac disease?, overweight? etc…  We need to look at the whole picture always!

Scheer backs my statement up with the following: “”There is strong evidence that shift work is related to a number of serious health conditions, like cardiovascular disease, diabetes, and obesity,” says Frank Scheer PhD,. “These differences we’re seeing can’t just be explained by lifestyle or socioeconomic status.”

Scheer in Web MD states “It’s important to keep the risks in perspective. Even if performing shift work is a risk factor for some diseases, it’s only one of many — just like not getting enough sleep or eating too many sweets. If you’re in good health to begin with, the overall risks to any given person performing shift work remain low.  Scheer states he cautions that the implications of the study, which was published in the Proceedings of the National Academy of Sciences in 2009, are limited. A small laboratory experiment can’t fully reflect what’s happening to actual shift workers. It’s also possible that some of these health effects might improve as people get used to shift work. On the other hand, it’s also possible that these effects would just worsen over time. For now, we don’t know.

Keep in mind the things listed in books, internet and etc… are all based on experiments with including theory/principle based on knowing how the anatomy and physiology of the body works under stress or not stressed and how the body is taken care of by that individual is a major role in the turn out of night shift working.

10000 steps=5 miles

April is National Foot Health Awareness Month and research shows that approximately 20 percent of Americans experience at least one foot problem each year. These issues can be the result of an underlying health problem such as obesity, diabetes, or peripheral neuropathy.

Today Dr. Amanda Bartell and Dr. Andrew Bartell of North Florida Foot & Ankle Center in Jacksonville, FL, Southside, and Duval County are sharing their tips for happy, healthy feet!

• Examine your feet each day, using a mirror – if needed – to inspect the bottom of your feet for cracks, peeling, injuries or dry skin. This is particularly important if you have diabetes to avoid a non-healing wound.
• Wear shoes in public areas where your feet can be scratched or cut, leading to infection, athlete’s foot or plantar warts.
• Replace the shoes you wear to exercise every six months or 500 miles to avoid heal and foot pain when the inside of the shoe begins to lose support.
• Stretch your ankles, lower legs and feet daily and before any activity to avoid injury.
• Thoroughly dry your feet and between your toes after bathing to reduce the risk of fungal infections. Follow up by applying a good moisturizer.
• Don’t leave polish on nails all the time as it can lead to fungal toenails.
• Apply sunscreen on ankles and between toes to avoid sunburn and guard against skin cancer.
• There is a good chance you will not wear the same size in shoes your entire life, so have them measured on a regular basis.
• Maintain a healthy weight because extra weight puts pressure on the feet, often causing heel or foot pain, circulatory problems, arthritis, and stress fractures.
• Try to wear shoes with good support and a low heel and use custom orthotics to provide proper arch support.