* Start now by clearing your cabinets and other hard to reach places. Re-arrange your cabinet items so that you most frequently used things are within easy reach, whether by standing or level with wheelchair or scooter accessibility. Invest in a device that helps extend your reach to capture hard to reach items.

* Utilize the latest gadgets and technology for items you use every day. Choose electric razors over manual ones; buy pre-made dental floss applicators over the kind you tear off yourself. Choose ergonomic hairbrushes, chairs, keyboards and furniture that will help you manipulate easier.

* Invest a little money in housekeeping services as well as lawn services. If you have trouble cooking, look into Meals on Wheels program or hire someone to prepare meals for you.

* Look into physical therapy and other exercise options that keep you moving and help with flexibility, muscle tone and more.

* Have ramps built for your home so you do not have to navigate the steps and consider a chair-lift if you have a second story home. Do not be bashful about using the motorized grocery cart when shopping or even using a walker as needed.

There are many more suggestions that can help your life be a bit easier as Parkinson’s disease progresses. You might want to consider working with consultant and have them examine your home for potential dangers that might hinder your movements and cause injury.

Many family and friends are well-meaning and may try to do things for you that you believe you can still do for yourself, albeit a bit slower. Be up front and honest with them and let them know what you can still do and what you want to do. At the same time, do not begrudge them their thoughtfulness either. Maintain a healthy and positive attitude toward your Parkinson’s disease as it progresses.

It is also important that you know when to concede on certain issues and get help. There is a difference between independence and stubborn hard-headedness. Not only do you have to think about your own safety but also others as well. If there is any task like driving or cooking that could possibly put you or others in danger, refrain from doing it and ask for help. You are not giving up all your independence by doing so. The bottom line is to be realistic not only about your disease but also your own capabilities.

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There is side effects to the medications that should be explained when the medication is first introduced to the patient. Adjustments to dosage can usually reduce or eliminate these side effects so it is important to tell the doctor about any side effects that are being experienced while on the medications.

It is really important that you have all of the medications filled at the same pharmacy so that the pharmacy can keep track of all the medications that you are taking so that interactions between medications can be caught before they are given to you avoiding any potential harm. Some drug interactions can be harmful even dangerous to the point of being life threatening, so it is vital that this precaution be taken. Your pharmacist and doctor should be also informed of any over-the-counter medications that you are taking and also let them know of any supplements such as herbs that you are taking too as these can also cause interactions.

No two patients will have the exact same drug regimen because every one is unique regarding the symptoms they have and any other medical conditions. There are many variables including symptom presentation, other health issues and what over-the-counter medications, supplements or herbal remedies you may also be taking. All the patient’s needs and their particular metabolism may also be considered when making medication decisions.

Common medications used to treat the symptoms of Parkinson’s disease include levodopa preparations, which are usually a “first choice” or initial prescription. Levodopa converts into dopamine by an enzyme in the brain and then released by brain cells and activates dopamine receptors which than allows for normal function in the movement control centers of the brain. Many doctors view Levodopa as the most effective medication for the treatment of Parkinson’s disease. In fact, it is often said that levodopa is the “gold standard” to which other treatments are measured.

Levodopa may be combined with carbidopa in order to prevent levodopa from being converted into dopamine in the bloodstream so that more of it reaches the brain. When carbidopa is used in conjunction with levodopa, less of the levodopa is necessary. One side effect of levodopa is nausea and vomiting, so when a smaller dose is needed, this side effect is diminished.

Drugs that may interact with levodopa include antacids, anti-seizure drugs, anti-hypertensives, and anti-depressants. High protein food also reacts negatively with levodopa.

A combination tablet that contains carbidopa, levodopa and entacapone is also used for patients that tend to experience end-of-dose “wearing off” of the medicine. Entacapone extends the time in which levodopa is active in the brain.

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Impulsive Behaviors as a Side Effect

Gambling and sex are not the only impulsive behaviors that have reared their ugly heads as a result of taking Parkinson’s medications. Compulsive shopping, eating and other habits manifest themselves to the extreme as well. Men have a tendency towards gambling, drinking and sex addictions while on certain medications while women lean towards the compulsive eating and shopping.

In most instances, once the medications were stopped and leached out of the body, those impulsive behaviors greatly declined or disappeared altogether. The primary culprits in all of these behaviors have been the very medications that have greatly helped reduce Parkinson’s disease symptoms – dopamine agonists such as Mirapax and Requip which work to mimic the chemical dopamine which the brain produces.

How Dopamine Agonists Work

Of course, not everyone experiences impulsive behaviors on these dopamine agonists but there has been enough of a prevalence to make cause for concern and prompt doctors to start giving the warnings to their patients. The primary consensus among doctors and medical researchers is that these Parkinson’s disease medications over-stimulate the pleasure centers in the brain and not in a very uniform way either.

Patients who must take medications like Mirapax or Requip experience a significant reduction in Parkinson’s symptoms like tremors and balance problems but at what price should they continue if the result is poor impulse control in certain behaviors? The effects of these behaviors have the potential to be devastating, not only to a person’s financial health but physical health as well, particularly when compulsive or binge eating is the behavior in question.

When dopamine in the body works naturally, it often triggers the pleasure centers in the brain. For example, compulsive eaters get a type of “high” from gorging themselves on food but there is an inevitable crash and a feeling of the guilties and inadequacies. However, with Parkinson’s patients, because the dopamine is released at regular intervals, there is no inevitable low, therefore creating a big problem.

Luckily, most patients who discontinue the medication, with doctor supervision, notice an almost immediate improvement in impulsive behaviors. Of course, not all medications prescribed for Parkinson’s disease are the dopamine agonists. There are some drugs like levodopa that work to stimulate the brain itself to produce more dopamine on its own. These drugs do not manifest any propensity towards impulsive behaviors.

The bottom line is when patients are diagnosed with Parkinson’s disease they must directly ask the doctor about side effects and potential problems of the medications. Not enough doctors are fully informed yet of the risks some patients may have so the patients must take some responsibility to research it themselves and become educated in the possibilities. Knowing the potential problems can better help patients identify uncharacteristic behaviors in themselves and get help as soon as possible.

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If you are having eating difficulties such as chewing or swallowing, if you are experiencing weight loss due to your eating problems it is important to ask a registered dietitian or a nutritionist for help with your diet. Eat smaller more frequent meals. Avoid crumbly fibrous food is you are already experiencing difficulty swallowing. When eating make sure that the environment is quiet and somewhere that you can relax during the meal. Eating while sitting in a high backed chair is better. When you suck on ice for a few minutes before a meal it may make swallowing easier for you. Drink an iced drink to aid your swallowing. It is also a good idea to add a little bit of liquid to your food in your mouth as a way to help with swallowing. Put a spoonful or forkful of food in your mouth and before swallowing take a sip of drink and then swallow.

Stress can make your symptoms worse so do all you can to either avoid stress in your life or if that is not possible learn how to cope with the stress by learning some relaxation techniques. This may require reducing your work hours, retiring early, getting help with your finances or getting help with housework or lawn care.

If you have Parkinson’s and are traveling there are some things that you can do to make traveling easier. Make sure you rest the day before you travel. There are plenty of services that you can take advantage of to make traveling easier at airports, railroads, and on cruise ship terminals such as letting you board or exit in advance of the other passengers, use a wheelchair service, or a motorized cart to get around airport terminals or railroad stations. If you are doing your traveling by car make frequent stops to walk around or get some light exercise. Limit how many miles you travel in a day. Try to conserve your energy. Never travel for long periods of time in hot weather. Keep medications in original container and store in the carry-on baggage never in checked-in baggage as this baggage may be lost or stolen and you will lose your medication.

Gather your support system around you including your medical team, your family and friends. Especially right after you receive the diagnosis you will be emotional and will be able to lean on others until you have adjusted to the news.

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One thing that you should know before reading the symptoms is that not everyone with Parkinson’s disease will develop all of the symptoms that are associated with the disease. Some people experience one primary symptom and never develop other common symptoms. Another thing that may differ from one person with Parkinson’s to another is the fact that for some, the disease progresses rather quickly and for others the disease moves along more slowly. The symptoms may start out mild and progress slowly or they may start out in full swing and progress rapidly.

Primary Symptoms:

The following are some of the primary symptoms of Parkinson’s disease. These are the symptoms most commonly seen by doctors when diagnosing the disease.

Tremor – Tremors normally appear in the early stages of Parkinson’s. Approximately 70% of Parkinson’s disease patients experience tremors. They may start out as slight tremors in the hand or foot on just one side of the body. It is not as common for tremors of the face or jaw as it is for the hand or foot. The tremor is sometimes referred to as a “resting tremor” because when the tremor is associated with Parkinson’s it appears when the person is at rest. In other words, when the body part is not in motion, it is at rest. As the disease progresses the individual will notice that instead of being isolated to just one side of the body, now the tremors are appearing on both sides of the body. The tremors may appear as a “beating”, or as an “oscillating movement”. Although the tremors may now be on both sides of the body, the side that the tremors first appeared on will have tremors that are more pronounced and more apparent.

Rigidity – Some individuals refer to rigidity as, “increased muscle tone”. Rigidity looks like stiffness or muscles that are inflexible. Usually your muscles stretch when you move, and then the muscles relax when the body part is at rest. When an individual has rigidity, the muscle tone of the body part is always stiff and does not relax when the body part is at rest. This stiffness may result in a decrease in the range of motion that the affected body part is able to perform. If a person has rigidity, he or she may not be able to swing his or her arms when walking because the arm muscles are too stiff. The person may experience cramping and pain in the affected body part.

Bradykinesia – Also known as “slow movements”, bradykinesia usually accompanies incomplete movement, or difficulty initiating a movement or sudden stopping of an ongoing movement. Those who have bradykinesia may appear to shuffle while they walk (festination).

The symptoms bradykinesia and rigidity may occur in the facial muscles, which will then reduce the individual’s range of facial expressions so that the person look’s as if they have a “mask-like” appearance.

Postural instability – Also known as “impaired balance and coordination”, postural instability is often experienced when standing or when there is a need for balance or coordination of movement. The person has an increased risk of falling when the symptom, postural instability combines with bradykinesia. It will be difficult for an individual with postural instability or impaired balance and coordination to make turns, or abrupt movements. They may also experience something called, “freezing”, which is when the person will feel like they are “stuck to the ground” and unable to initiate movement. This symptom of slowness and incompleteness of movement can also affect the ability to speak or swallow.

Secondary Symptoms:

Secondary symptoms are those that can be non-motor, such as depression, or are qualities of speech. These symptoms are not as easy to detect unless you look carefully or pay special attention.

These are the secondary symptoms of Parkinson’s disease:

Changes in speech patterns

Loss of facial expressions

Small and cramped handwriting

Swallowing becomes difficult

Drooling

Pain

Confusion

Disturbances in sleep pattern

Constipation

Problems with skin

Depression

Anxiety and or fear

Slow thinking or memory difficulties

Sexual dysfunction

Difficulty with urination

Aches

Fatigue

Loss of energy

Compulsive behavior

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Surgical treatment for Parkinson’s disease was first developed over 50 years ago. There are new developments such as deep brain stimulation (DBS) that was developed in the 1990s and has since become standard treatment for the disease. Individuals who have disabling tremors, or who experience “wearing-off” or medication-induced dyskinesias deep brain stimulation can be very effective.

Electrodes are inserted into the targeted part of the brain during deep brain stimulation surgery. An MRI and neurophysiological mapping is used to assist the surgery sot hat the electrode is implanted in the correct place within the brain.

Before undergoing any surgery, the patient should be given all the information necessary regarding the surgery, the risks involved and the benefits of the surgery before making any decisions regarding having the surgery.

There are many factors that the neurologist will use to evaluate the appropriateness of surgery including the diagnosis of idiopathic Parkinson’s disease, the positive response the patient had to levodopa, the absence of atypical features of Parkinson’s, any presence of advanced disease, age (younger than 75), normal cognitive ability, absence of active psychiatric disease, and also good social support.

The surgeon makes an evaluation as to which procedures may be of benefit to the patient, and has close collaboration with the neurologist. The decision-making process may involve the surgeon and the neurologist as well as the patient or patient’s caregiver.

Once the decision is made to have the surgery a workup is conducted that may include the following:

A brain MRI in order to rule out other conditions and to find out the degree of brain atrophy. If there is a significant amount of atrophy it would increase the risk for perioperative hemorrhage.

Neuropsychological testing will be conducted in order to rule out cognitive impairment, which may be worsened during the surgical procedure.

A psychiatric evaluation may be ordered so that active psychiatric disease can be ruled out and any past psychiatric history can be evaluated.

A fluorodopa PET scan to rule out multiple system atrophy.

Lastly, a medical examination will be done so that the general health of the patient can be determined prior to surgery in order to determine if the patient is fit for surgery.

The purpose of surgery is for management of the symptoms of Parkinson’s disease and to promote better quality of life. Surgery is not a cure for Parkinson’s and is not a preventative for the progressive nature of the disease.

Your doctor will go over all of the surgical procedures offered for Parkinson’s along with the projected benefits, and the risks that are associated with each of the procedures. It is possible that there may be multiple surgeries that will be necessary in order to manage the disease as the years go by.

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There are several things you can watch out for in your own home to reduce falling hazards. Here are a few ideas:

1. Grab bars in the bathroom shower and around the toilet are helpful for as devices to support you without falling. Non-skid area rugs and strips in the shower also aid the cause as well as shower chairs.

2. Rearrange the furniture to create clear paths around everything and avoid changing it once you are accustomed to the positioning. Discard throw rugs as they are a slipping hazard unless you install special skid-resistance backing on them. Consolidate cords by tying them together and tucking them out of the way.

3. Ensure the stairs in and outside of your home are free of hazards. Tap in nails and secure rugs. Install stair railings as necessary, on both sides if they are open. If the stairs become hard to navigate, consider installing a chair rail seat that is motorized to take you up and down the stairs.

4. Lighting should be strategically places in the stairways, hallways and entrances to buildings. Employ night lights in interior hallways and bathrooms to better navigate with at night. Keep your light source within easy reach whether they are lamps or light switches.

5. In the kitchen, use non-skid mats around the stove and sink area not only as cushioning for the feet but also to prevent falling. If something gets spilled on the floor, it must be cleaned immediately so as to prevent slippage.

Maintaining the Balancing Act

Balance is another area that must be improved on to prevent falling. With Parkinson’s, as motor coordination is affected, you may notice your arms do not swing as much when you walk. This swinging motion is part of what helps you maintain your balance. You must make a conscious effort to swing your arms as this will help you keep balanced as well as encourage you to maintain good posture.

Do not walk with both hands occupied. Use a fanny pack to carry items instead of a purse. A backpack is also another option as it keeps your hands free should you need to grab onto something if you lose your balance. Pick up your feet when you walk to try and avoid the Parkinson’s shuffle which can cause balance issues. Maintain balance when standing by positioning your feet about shoulder distance apart. When your feet are closer, this means there is less weight distribution between your feet and an increased chance of losing your balance.

When you must change course in the midst of walking, make deliberate movements as they will keep your balance in check. Instead of pivoting and doing an about face maneuver, gradually make a u-turn. Avoid shoes with gripping soles like rubber as they can “catch” on the surface of where you are walking. Most of all, consider assistive devices if you notice some mobility issues such as balance and coordination. A simple walker or scooter can help you maintain your independence as long as possible while avoiding injury at the same time.

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Safety First

When you get the diagnosis of Parkinson’s, you will want to be sure and familiarize yourself with a few general safety guidelines that will serve you in good stead later as the disease progresses. Program emergency numbers into your cell phone and home phone including neighbors and family you can call should trouble arise. Have the number easily accessible should something happen to you and another person needs to call on your behalf.

Remove fire hazards such as portable space heaters and ensure the smoke and carbon monoxide detectors work properly. Carry your cell phone or cordless phone extension with you in your pocket at all times for easy accessibility.

Consider Assistive Equipment

While physical therapy and drug protocols can help you slow the progression of Parkinson’s, you should still look into equipment for your home and office that can ease the burden of daily activities. Special utensils can help with your grip; grab bars can provide a stable place to regain balance. Electric powered chairs and beds can ease the ache of getting out of them while scooters and wheelchairs provide additional mobility.

In the kitchen

Create a workspace that is low enough for you to use for those times when you cannot stand. Use reacher devices to grab items that you cannot reach through normal arm extension. Utilize as many kitchen appliances as possible to make your life easier when opening jars, cutting food, pouring liquids, open packages and more. Non-skid mats, pans with large bases and plastic containers can all make life a littler easier in the kitchen as well.

In the bathroom

Use safety rails around the toilet and shower areas to help you with leveraging yourself in and out of the areas. Use non-skid mats in the bathtub and shower to prevent losing your balance. Use lever extensions for the faucets and toilet handle and use an elevated toilet seat if you need extra height to avoid bending over.

In the living areas

Arrange your furniture with enough space to easily maneuver around and ensure lamps and other appliances are close to electrical outlets to avoid the use of extension cords that can trip you. Firm cushions will keep you from sinking into furniture, requiring help to get out, especially as Parkinson’s gets worse. Touch and sound operations lights and appliances can make life easier as well as handrails along hallways and staircases.

Because your life is going to get complicated by Parkinson’s disease, you will want to make your home and work area a safe haven for you as well as a relaxing one. Use aromatherapy in the form of potpourri or candles or brighten your space with flowers or plants. Anything that will uplift your spirits can only make your attitude more positive when you are tackling the disease.

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Two pesticides in particular – DDT and dieldrin – are particular candidates in the contribution of Parkinson’s development. These pesticides were used quite a bit in farming and while they were outlawed in the United States in the late 1970s, these pesticides can still be found in the soil, albeit in low percentages. Basically, some scientists believe that prolonged and repeated exposure to these pesticides (think farmers and pest control people in particular) fast forwards a Parkinson’s diagnosis by as much as ten years!

Some studies do not focus on a particular pesticide while others do. It just depends on what science center or university does the testing. All agree that the timetable for Parkinson’s is pushed up considerably or even kick starts the disease in someone who could be predisposed to it but likely might not have gotten it if not for the pesticide exposure. Comparison studies of brain tissue in sample groups of Parkinson’s patients versus those with no evidence of the disease shows in many cases, there were levels of pesticides up to four times the average of the control group with no disease.

Exposure to the pesticides is likely through skin contact or even inhalation. Scientists believe that the pesticides start an oxidation process in which free radicals attack the nerve cells in the brain, the very cells that produce dopamine, a chemical neurotransmitter that carries messages to other parts of the brain.

Scientists do concur that while pesticides alone could cause Parkinson’s disease in a small percentage of patients, it is a combination of other factors such as genetic history that puts another percentage of patients over the top for getting the disease. Many universities such as Harvard have been working on the tie-in to pesticides and say that avoiding exposure as children decreases chances of disease as the brain cells are still forming and are at their most vulnerable. However, after a study of almost 150,000 people, Harvard researcher believe that exposure to pesticides increases the likelihood of Parkinson’s disease by over 65%!

While pesticide use is more regulated these days in its application, there is some slight danger through exposure in the foods people eat. Often, there is residue of pesticides in the foods bought at the market, particularly raw fruits and vegetables. It is important that people wash them thoroughly, even if the packaging says it is washed, to thoroughly remove any residue. While cooking does destroy the toxicity, there are still many raw foods that are meant to be eaten in its original state, thus the importance of washing.

All in all, minor exposure to pesticides, such as garden sprays or bug sprays, hold minor dangers in regards to upping Parkinson’s risk – unless of course you decide to sniff or mainline the stuff! Wear gloves, eye protection and face masks when using chemicals like pesticides – it’ll add years to your life.

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There have already been some success stories that have come out of the clinical gene therapy trials. The jury is still out though because the clinical trial was very small and it will take longer time and larger pools of participants to thoroughly test different types of gene therapy to determine its total effectiveness on a wide variety of Parkinson populations.

So far though, medical researchers involved in the gene therapy study have said no harm physically or through toxic means has occurred. This is a far cry of the speculation that occurred before the gene therapy trials started. Some researchers thought that a wide variety of symptoms such as fever might occur, especially when gene therapy involves injecting billions and billions of particles into the brain areas affected by the disease.

A Look into the Therapy Itself

Gene therapy involves the injection of a virus into the brain. This virus is genetically engineered and injected into the STN or subthalamic nucleus region of the brain. This area becomes somewhat hyperactive and causes a number of Parkinson’s symptoms such as tremors and rigidity of limbs. However, this genetically engineered virus invades these brain cells and turns on a special chemical communication which soothes the STN area, thereby calming the symptoms of the disease.

While Parkinson’s disease does affect both hemispheres of the brain, researchers right now are only concentrating gene therapy into one half of the brain for safety reasons. The result of this one-sided gene therapy is readily apparent in clinical trials. The side of the body that is controlled by the part of the brain that got the gene therapy shows remarkable improvement that for many, continued for a prolonged period of time, in some cases over a year so far.

Some skeptical scientists say that because Parkinson’s disease varies quite a bit and there are highs and lows with the symptoms, the results of the gene therapy could be just coincidence. However, most of the medical community area waking up to the fact that gene therapy is showing real promise in the world of Parkinson’s disease.

While Parkinson’s medications are still needed for those “down” times when symptoms are enhanced, for the most part, the people in the clinical trials for gene therapy have not had to rely much on drugs. However, as the testing for gene therapy is still in its early stages, many scientists are taking a wait and see approach. Becoming too optimistic, they say, means that something could be missed in the trials and testing phases.

While the next wave of gene therapy trials takes place, it is heartening to know that some of those pioneering patients in the first trials are still doing great almost two years later.

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