Author Archive

Speak up! Voice management in Parkinson’s disease

by Martha A. Nance M.D., medical director, Struthers Parkinson’s Center, an NPF Center of Excellence

May is Better Hearing and Speech Month, an excellent time to think about your voice. We all know that Parkinson’s disease makes the handwriting smaller, and causes short, shuffling steps. But sometimes we forget about the impact that PD has on the voice. If you have Parkinson’s disease, and have a soft, quiet voice, and if you are of an age where maybe some of your friends are a little hard of hearing, this can make for a difficult combination.

But you don’t have to accept having a small, soft voice. Just as in other aspects of Parkinson’s disease, if you work at it, you can make it better! If you are concerned about the quality of your voice, or if your family and friends often ask you to repeat yourself, then you should ask your doctor for a referral to a speech and language pathologist, or speech therapist. These trained professionals can evaluate your voice, recommend strategies to improve it, and in some cases, provide an intensive voice therapy program.

Not everyone with Parkinson’s disease has the same kind of changes in speech and voice.  Some people have a quiet, breathy, or even whispered voice. Others have a harsh, strained speech. Some have excess saliva, and a wet, gurgly-sounding voice (others have the opposite–a very dry voice, made worse by taking in too much caffeine or alcohol or cough drops and not drinking enough water!)  Some stammer or stutter, while others have difficulty coordinating their breaths with their voice, and run out of air in mid-sentence. For an occasional person in the later stages of Parkinson’s disease, the problem may be more of a cognitive one—difficult coming up with the right thoughts or words to say in the first place.

The correct treatment depends on identifying the problem, which is why an evaluation by the speech pathologist is so important. It is important to remember that other things can affect the voice besides Parkinson’s disease. Issues completely unrelated to Parkinson’s disease, ranging from gastrointestinal reflux (GERD) to poorly fitting dentures and emphysema, can all affect the voice. A speech therapist can help to determine whether your voice problems are caused by Parkinson’s disease or something else—or both!

For those with Parkinson’s-related voice changes, sometimes an adjustment in medications can be helpful (stopping a medication that is drying up the throat, for instance, or adding a medication to reduce excess saliva). Instruction in good “voice hygiene” helps many people (drink enough fluids, sit up straight, get those shoulders back, take a big breath before you speak, don’t eat and talk at the same time…) Many people—but not all—benefit  from a rigorous program to improve voice volume and control, called the “LOUD” program. Struthers Parkinson’s Center, we also have two group activities led by our speech and music therapists, called “Speech Boosters” and “CREATE Singers”, designed for anyone with Parkinson’s disease in the community who wants an opportunity to exercise his or her voice.

The next time you see a speech and language pathologist, stand up, put your shoulders back, take a deep breath, and give a nice, loud, THANK YOU!

Note: The information included on this blog is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Readers should always consult their own health care provider to determine the appropriateness of the information for their own situation. Readers should also contact their own providers if they have any questions regarding a medical condition or treatment plan. Reading the information on this blog does not create a physician-patient relationship.

 

 

An apple a day?

 by Martha A. Nance, M.D., medical director, Struthers Parkinson’s Center, an NPF Center of Excellence

An apple a day…keeps Parkinson’s disease away?

But only if you are a man.

This is the bottom line of a report published (by X. Gao, et al) in Neurology April 10, entitled “Habitual intake of dietary flavonoids and risk of Parkinson’s disease.” This remarkable study looked at information obtained from two very large studies; the Nurse’s Health Study (80,000 women), and the Health Professionals Follow-up Study (about 50,000 men).

Participants in these studies have completed annual questionnaires about their diet (among many other things) since the 1980s. By this time, 805 participants have developed Parkinson’s disease. Based on how much of what kinds of foods the participants said they ate, the researchers estimated their intake of compounds called “flavonoids,” and found that the 20 percent of people who had the greatest intake of flavonoids had a 40 percent lower risk of developing Parkinson’s disease than the 20 percent of people who had the least intake of flavonoids.

But they only found a significant difference in the study of men—not in the study of women. When they examined specific foods that are known to contain flavonoids, the most dramatic disease-risk lowering effect was for men who had five or more servings of apples per week. Drinking tea, red wine or orange juice did not have a noticeable effect on the risk of Parkinson’s disease. Higher intake of berries (strawberries and blueberries), which contain flavonoid pigments called anthocyanins, also lowered PD risk.

The article was accompanied by a nice editorial by Walter Kukull, Ph.D., which explained all the possible flaws in the research. It is a little difficult to explain why noticeable results were found in men, but not women. Was there a difference in how the research studies were done that obscured any benefits that women might actually be getting from these kinds of foods? Or is there something different about what causes Parkinson’s disease in women? Or is there something else that apple-eating men do or have, that is really the thing that lowers the risk? The researchers checked for things such as alcohol use, caffeine intake and cigarette smoking, but they couldn’t check for everything!

So, maybe these interesting results will hold up in future studies and maybe they won’t. But, short of biting into a worm (!), it’s hard to imagine that eating an apple a day is going to hurt you. Gentlemen, start munching! And, if you get tired of apples, sprinkle some berries on your cereal or ice cream. And ladies, even if we don’t have proof that eating apples and berries lower the risk of PD in women, nobody thinks that it is harmful.

So, go ahead—indulge!

Note: The information included on this blog is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Readers should always consult their own health care provider to determine the appropriateness of the information for their own situation. Readers should also contact their own providers if they have any questions regarding a medical condition or treatment plan. Reading the information on this blog does not create a physician-patient relationship.

What we know and don’t know about Parkinson’s disease

by Martha Nance, M.D., medical director, Struthers Parkinson’s Center, an NPF Center of Excellence

As April and Parkinson’s Awareness Month come to a close, it is a good time to reflect on what we know and don’t know about this disease. It is also a good time to replace the misunderstanding and despair that are often associated with this disease, with hope, optimism and energy.

The National Parkinson Foundation estimates that there are one million people in the United States with Parkinson’s disease, making it the second most common neurodegenerative disease. Alzheimer’s is the most common. About 50,000 new diagnoses are made each year. Based on these data, we estimate there are about 20,000 Minnesotans wrestling with the complex effects of this disease. This number is expected to double over the next 30 years as we age.

Unfortunately, among the primary features of this disease are a slowing of gait, poor balance, smallness of movement and quietness of speech. You don’t tend to see people with Parkinson’s disease in the community and they don’t shout very loudly on their own behalf. It is easy to ignore elderly people who speak quietly and move slowly; they just melt into the furniture.

Even more unfortunately, this sends a discouraging, and incorrect, message to people who have Parkinson’s disease: “Sit. Stay. There’s not much else to be done.”

It is 2012.  That message is simply wrong.

Not everyone with Parkinson’s disease has great-grandchildren or even grandchildren. Although the average age of diagnosis is between 60 and 65, many are in their 50s and some in their 40s. We even have patients who are in their 30s when symptoms begin.

Treatments—medication, rehabilitation therapies, sometimes surgery—combined with a favorable attitude and proper education, have converted Parkinson’s into a manageable chronic disease. Vigorous physical exercise, in particular, appears to stabilize function and preserve brain cells. Parkinson’s disease must be dealt with, and the impact on people’s lives is significant. But, like diabetes and breast cancer, it is a disease that a person can live with, and live well, for many years.

My patients not only WERE amazing people, they ARE amazing people. They work as doctors, nurses, accountants, teachers, mechanics, musicians and business owners. They climb Mt. Kilimanjaro. They win 5K races.  They write books. They participate in Civil War reenactments. And (only in Minnesota) they prepare an annual lutefisk dinner for 50 relatives. One was featured in the newspaper last year for his Christmas light display.  Amazing people. It is a privilege for me to belong to the Parkinson’s disease community.

There is much that we don’t know about Parkinson’s disease—in particular, how to stop or reverse the gradual loss of brain cells. But the patients of today have opportunities not available 50 years ago. They can actively pursue aggressive management of their symptoms and live well for many years after the diagnosis. And if they want, they can be part of the solution. Clinical research is focusing more and more on treatments to address the disease process itself, as well as better ways to manage symptoms. These research studies need participants, advocates, financial support, and an interested and engaged community. Only together can we find better solutions to the problems presented by Parkinson’s disease.

I will talk in future blogs about current treatments, new research breakthroughs. If I am feeling brave enough I may write about areas of controversy or disagreement. But for today, the message is “Parkinson’s awareness.”

If everybody would tell one other person about Parkinson’s disease, invite one other person to the Moving Day Twin Cities walk, or an educational program, or a fundraising event, we would double the energy available to fight this disease!

Note: The information included on this blog is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Readers should always consult their own health care provider to determine the appropriateness of the information for their own situation. Readers should also contact their own providers if they have any questions regarding a medical condition or treatment plan. Reading the information on this blog does not create a physician-patient relationship.

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