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Need to gain weight

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#1 Drummergirl

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Posted 17 January 2013 - 04:54 PM

I am a 52 year old female, I was diagnosed with PD 17 yrs ago.
I take Sinemet and a low dose 0.5 mg of Azilect. I have always been slim and do strength exercises. Even when I discontinue the limited aerobic exercise, I still do not gain weight.
My weight is 110 I'm 5'5". I do not want to lose any weight, I would like to gain 10 lbs.

Eating protein has really become an issue.
Can you suggest a protein shake to take at bedtime?? Or any other suggestions you have.....I graze throughout the day since I can not eat large meals.

Any help appreciated,
Drummergirl
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#2 Kathrynne Holden, MS

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Posted 17 January 2013 - 07:40 PM

Karen, please see my response to your earlier post. I would not discontinue your exercises, these are just as important as the medications. Here are some possible reasons for weight loss, please let me know if any of these might apply:


- nausea
- tremor, dyskinesia, dystonia – may burn extra calories
- loss of the senses of smell and taste
- loss of appetite
-- sometimes due to medications
-- sometimes due to depression
- loss of manual dexterity
- eating very slowly, unable to finish meals; often because chewing and swallowing becomes tiring
- fear of choking
- difficulty swallowing

Please let me know as much information as possible; other data that may be helpful include:

- your usual body weight, and when you began losing weight
- the names of all medications used (both PD, and other medications, including over-the-counter medications, vitamins, herbal or other supplements)
- any other diagnosed conditions (such as elevated blood pressure, food allergies, diabetes, high cholesterol, etc.)
- any particular complaints or concerns such as nausea, edema, weight changes, constipation, sadness, etc.


I will help if I possibly can.
Best regards,

Kathrynne Holden, MS

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#3 Drummergirl

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Posted 17 January 2013 - 10:02 PM

Thank you for your response. Sorry for the double post. I didn't think the first posted.
I have lost 4-5 lbs. in the last year. I'm thinking it may be somewhat due to the dyskinesia which has become a problem in the last 4 months. I do not have much of an appetite. My blood pressure is on the low side. 105/60's. My Neuro had increased the Azilect to 1mg a day to help with the wearoff, but due to the lower BP 100/ 40's, he went back to .05mg.
I was also taking up to 2 daily as needed of 50/200 cr, in addition to the 25/100 sinemet up to 5 a day. Due to increased dykinesia I now, just started yesterday with the CR at bedtime only. Hoping this controls or eliminates the dyskinesia.
I still work FT, I have been very fortunate to this point of 17 years. I sometimes show very little signs of PD and my Neuro says I do not fit the typical PD patient. He did not dx me another Neuro did, and he started me on the sinemet.

Depression is not an issue for me, nor swallowing or choking. No nausea, sense of smell ok, taste is iffy and some constipation.

Protein from meats are a big issue, so I eat very limited of it and eat, graze throughout the day. I eat nuts, peanut butter as you suggested. I will try more of the oils.

I also take 1 clonazepam at bedtime to help with tremor in legs, and I take 40mg of propananol only when I have severe tremors.

Hope this info helps,
Karen


Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#4 Dr. Mahler

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Posted 18 January 2013 - 10:03 AM

Dear Drummergirl,
If you think that your difficulty with weight gain might be due to swallowing difficulties then please pursue an evaluation with a speech-language pathologist. The muscles important for swallowing can be affected by PD just as limb muscles. Rigidity or decreased strength of muscles used for swallowing cam make eating more challenging. An evaluation can determine whether this is a factor for you. This is particularly important since you have had PD for 17 years.

I wish you the best.

Leslie Mahler, PhD, CCC-SLP
Leslie Mahler, PhD, CCC-SLP

Associate Professor

University of Rhode Island

#5 Drummergirl

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Posted 18 January 2013 - 08:40 PM

Thank you Leslie,
Swallowing not an issue for me.
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#6 Kathrynne Holden, MS

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Posted 19 January 2013 - 06:35 PM

Dear Karen,
Cutting out the daytime Sinemet CR may be the answer to the dyskinesia; the CR cannot be titrated as closely as the regular Sinemet and often leads to dyskinesia, so hopefully it will no longer be a problem.

I would like to address the use of clonazepam, as not all folks with PD do equally well on benzodiazepines. A fairly common side effect is appetite loss, followed by weight loss. If your decreased appetite and weight loss have occurred after beginning the clonazepam, I would discuss this with your physician. Could it be possible that the nighttime tremor in legs might be “restless leg syndrome,” a condition that is fairly common in PD? If so, this could be due to a need for iron, and I would especially ask that ferritin levels be checked. You might be able to discontinue the clonazepam, and perhaps your appetite would improve.

Meantime, it sounds as though you are doing very well at addressing your weight loss – grazing through the day is a good way to meet your calorie needs. I am only concerned that you get sufficient protein – as before, you need about .5 gram protein per pound of body weight daily in order to meet your needs – rebuilding cells and muscle and other body tissues. Nuts are very good, but I would try to include some animal protein – an egg, an ounce of fish, poultry, meat, or cheese, etc. throughout the day, taken well ahead of the Sinemet.

If this did not address your concerns, let me know, I’ll try again.
Best regards,

Kathrynne Holden, MS

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#7 Drummergirl

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Posted 19 January 2013 - 08:34 PM

Thank you again for your response and thoughts. My Neuo does think I have RLS, that is the reason he put me on the clonazepam.
He claims it has a longer effect that aids w/RLS during the night.

I couldn't say for sure the time table of clonazepam and appetite /weight loss, it has been at least 3-4 yrs. You maybe right, I will ask about the ferritin test. I just had CBC, Comprehensive, TSH and Differential Automated. I do not see on any of these Ferritin listed.
Is iron a seperate test?

I do eat fish, mostly salmon & tuna. Also we have our own chickens, so I do eat an egg or two 4-5 times a week. I will increase the cheeses as well.
I have already seen a decrease in the dyskinesia with the cut back of the CR.

Thank you kindy,

Karen
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#8 Kathrynne Holden, MS

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Posted 21 January 2013 - 05:37 PM

Karen, iron is measured in several ways -- hemoglobin (the oxygen-carrying pigment of red blood cells), hematocrit (red blood cell volume), and mean cell volume (measures average size of the red blood cells) which are often checked during one's annual examination; and ferritin (indicates total amount of storage iron; reflects deficient, excess, and normal iron status), which is not necessarily checked routinely. By measuring all of the iron indicators, the physician can more accurately assess iron status. Serum ferritin values diminish sooner than serum iron and can be a better indicator in some cases.

Your neurologist is doing all the right things, it's just that some people don't respond equally well to benzodiazepines, and thus it's best to discuss your appetite and weight loss and be certain that the clonazepam is the best treatment; and especially, make certain that iron deficiency has been ruled out as a cause of RLS. Here are some further thoughts:

"Restless leg syndrome" (RLS). The causes of RLS are mysterious, and seem to be different for different people. Some folks with RLS have an iron deficiency, and benefit from iron supplements; others benefit from supplements of calcium and magnesium, or potassium, all of which are involved in muscle movement. A prescription for quinine has helped some people, and others report that just drinking tonic water (which contains a small amount of quinine) helps. Still others report that if they put a bar of Ivory soap at the end of the bed, between the sheets, it helps RLS.

Regarding protein, here is a brief chart that shows the amount of protein in some common foods; it may help you determine whether you're getting the amount you need:

Food --- --- Grams Protein (approximate)
----------------------------------------------------------------------------------------------------
Bread, 1 slice (1 oz, 28 grams) --- 3 grams protein
Meat, poultry, fish, 1 ounce (28 grams) --- 7 " "
Vegetables, ½ cup (100 grams) --- 2 " "
Fruit, ½ cup (100 grams) --- 0 " "
Milk, 8 ounces (250 ml) --- 8 " "
Yogurt, 8 ounces (250 ml) --- 9 " "
Egg, large (about 2 ounces, 56 grams) --- 6 " "
Cheese, 1 ounce (28 grams) --- 7 " "
Cooked dried beans, 1 cup (200 grams) --- 20 " "
Nuts, 4 tablespoons (1 ounce, 28 grams) --- 4 " "
1 tablespoon peanut butter(1/2 ounce, 15 grams) --- 4 " "

I hope this is helpful; let us know how you are doing, or if you have more questions.
Best regards,

Kathrynne Holden, MS

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#9 Drummergirl

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Posted 21 January 2013 - 10:01 PM

Hi Kathrynne,
Thank you so much for sharing your knowledge!

As I read other posts I have come across Gastroparesis. This is the first I have heard of it, and I am thinking it is an issue for me as well.
Over a year ago I complained to my PCP and Neuro about having a full feeling and belching. No burning of acid, just a full gassy feeling. Usually constipation is a problem at this time. (comes and goes) It affected my breathing especially at night since it sits right at the esophagal area. This would certainly be a reason for the wearoff, dyskinesia symptoms I have been experiencing.

My PCP had me undergo pulminary tests. Of which the Pulmunolologists all but told me it was in my head!.....This didn't set well with me. Anyway, you mentioned low magnesium as a possible RLS cause and I know it has bowel benifits to it as well. Which supplement of magnesieum should I try? There are a few. Thank you,
Karen
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#10 Kathrynne Holden, MS

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Posted 24 January 2013 - 07:08 PM

Karen, regarding gastroparesis, this is not uncommon at all among people with PD, and your doctor can test to see if it is present. I recommend you print out the following and take it to your doctor:


Nervenarzt. 2012 Oct;83(10):1282-91. doi: 10.1007/s00115-012-3575-9.
[Gastrointestinal dysfunction in idiopathic Parkinson's disease].

[Article in German]
Del Tredici K, Jost WH.

Source

AG Klinische Neuroanatomie (Abteilung Neurologie), Zentrum Klinischer Forschung, Universität Ulm, Ulm, Deutschland.

Abstract

Gastrointestinal dysfunction is frequent during all stages of Parkinson's disease. The entire gastrointestinal tract becomes involved and symptoms include sialorrhea, dysphagia (difficulties swallowing), delayed gastric emptying, absorption problems and constipation. These non-motor symptoms can be manifested even prior to the initial Parkinson diagnosis, i.e. during the so-called premotor phase of the disorder and may serve as prodromal markers of the early non-motor disease phase. In addition to causing patients major discomfort and a reduced quality of life, such gastrointestinal complaints can also negatively influence the therapy with antiparkinsonian medications. Thus, delayed gastric emptying is an important cause of unforeseen motor fluctuations.Gastrointestinal dysfunction is attributable in part to the presence of synucleinopathy (Lewy pathology) both in the dorsal motor nucleus of the vagus nerve, which supplies the parasympathetic innervation of the gut from the distal esophagus to the left colonic flexure, as well as in the intramural Meissner and Auerbach plexuses of the enteric nervous system (ENS). In all probability the development of the lesions in the lower brainstem and in the ENS precedes neurodegeneration of the dopaminergic nigrostriatal system. From a diagnostic standpoint, neurologists need not only a carefully taken patient history and the clinical findings but also esophagography (barium study), gastric scintigraphy and assessment of the colonic transit time. The therapeutic options for impaired upper gastrointestinal tract motility are still limited. Sialorrhea can be reduced by prescribing anticholinergics or injections of botulinum toxin and the peristalsis can be modulated by domperidone. In the lower gastrointestinal tract, constipation can be conservatively treated by using macrogol (polyethylene glycol) and, in the future, perhaps by serotonine (5-HT4) agonists.

PMID: 22743836 [PubMed - in process]
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Publication Types
2.

J Neurol Sci. 2012 Aug 15;319(1-2):86-8. doi: 10.1016/j.jns.2012.05.010. Epub 2012 May 25.
Plasma levodopa peak delay and impaired gastric emptying in Parkinson's disease.

Doi H, Sakakibara R, Sato M, Masaka T, Kishi M, Tateno A, Tateno F, Tsuyusaki Y, Takahashi O.

Source

Pharmaceutical Unit, Sakura Medical Center, Toho University, Sakura, Japan.

Abstract

OBJECTIVES:

Whereas delayed gastric emptying is believed to be a causative factor for producing delayed-on and motor fluctuation in Parkinson's disease (PD), few studies have directly measured levodopa pharmacodynamics and gastric emptying together. In order to determine the relationship, we measured these two parameters in a single PD patients cohort.
METHODS:

Thirty-one patients with PD were enrolled in the study. They were 11 men and 20 women; age, 68.1 ± 7.8 years; disease duration, 4.2 ± 3.8 years; Unified Parkinson's Disease Rating Scale Part 3 Motor Score 18.37 ± 8.60; bowel movement <3 times a week in 20; all taking 301 mg ± 94 mg/day levodopa/carbidopa. All patients underwent levodopa pharmacokinetic study and the gastric emptying study using (13)C-octanoic acid expiration breath test. Statistical analysis was performed by Student's t-test and Mann-Whitney's U test.
RESULTS:

Pharmacokinetic study showed that the plasma levodopa peak was at 2 hours in 42% (13/31 patients) whereas at 1 hour in 58% (18/31 patients), total of 50.7 ± 16.4 min (mean ± standard deviation) in all 31 patients. The gastric emptying study showed that T(max) ((13)C)>60 min was more common in patients with a plasma levodopa peak at 2 hours (14/18, 69%) than in those with a plasma levodopa peak at 1 hour (4/13, 22%) (p<0.05), total of 50.7 ± 16.4 min in all 31 patients.
CONCLUSION:

We found a significant relationship between levodopa pharmacokinetics and gastric emptying in PD patients, suggesting that delayed gastric emptying is a causative factor for producing delayed-on in PD. Therefore, studies of improved gastric emptying in order to ameliorate delayed-on in PD are warranted.
Copyright © 2012 Elsevier B.V. All rights reserved.

PMID: 22632782 [PubMed - in process]
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3.

Parkinsonism Relat Disord. 2012 Jun;18(5):433-40. doi: 10.1016/j.parkreldis.2011.12.004. Epub 2011 Dec 29.
Gastroparesis and Parkinson's disease: a systematic review.

Heetun ZS, Quigley EM.

Source

Alimentary Pharmabiotic Centre, Department of Medicine, University College Cork, Cork, Ireland.

Abstract

Some of the gastrointestinal (GI) symptoms commonly experienced by patients with Parkinson's disease (PD) have been attributed to gastroparesis; however, the precise prevalence and relevance of gastric emptying delay in PD is unclear. The definition of gastroparesis varies; currently the most widely accepted definition (from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium) is the presence of appropriate symptoms (including nausea, retching, vomiting, stomach fullness, and inability to finish a meal) for ≥ 12 weeks, together with delayed gastric emptying on scintigraphy and the absence of any obstructive lesions on upper GI endoscopy. In PD patients, gastroparesis has the potential to affect nutrition and quality of life, as well as the absorption of PD medications, including L-dopa. This reduced absorption of L-dopa has implications for the control of the PD motor symptoms for which it is administered. We performed a systematic review of the literature on gastroparesis in PD with the aim of developing an evidence-based approach to its management. Based on this review, we conclude that while gastric emptying has been reported to be frequently delayed in PD, the existing data do not permit definitive conclusions concerning its true prevalence, relationship to the underlying disease process, relevance to PD management, or the optimal therapy of related GI symptoms. Further study of these important issues is, therefore, required.
Copyright © 2011 Elsevier Ltd. All rights reserved.

PMID: 22209346 [PubMed - indexed for MEDLINE]
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4.

Neurobiol Dis. 2012 Jun;46(3):559-64. doi: 10.1016/j.nbd.2011.10.014. Epub 2011 Oct 25.
Pathological correlates of gastrointestinal dysfunction in Parkinson's disease.

Cersosimo MG, Benarroch EE.

Source

Parkinson's Disease and Movement Disorder Unit, Hospital de Clinicas, University of Buenos Aires, Argentina. mgcersosimo@gmail.com

Abstract

Gastrointestinal dysfunction is a prominent manifestation of Parkinson's disease (PD). Gastrointestinal symptoms in PD include reduced salivation, dysphagia, impaired gastric emptying, constipation, and defecatory dysfunction. Constipation may precede the development of somatic motor symptoms of PD for several years. Neuropathological studies show early accumulation of abnormal alpha-synuclein (a-SYN) containing inclusions (Lewy neurites) in the enteric nervous system (ENS) and dorsal motor nucleus of the vagus (DMV) both in PD and in incidental Lewy body disease (ILBD). These findings provided the basis for the hypothesis that a-SYN pathology progresses in a centripetal, prion-like fashion, from the ENS to the DMV and then to more rostral areas of the central nervous system. Colonic biopsies may show accumulation a-SYN immunoreactive Lewy neurites in the submucosal plexus of PD patients. Salivary gland involvement is prominent in PD and a-SYN pathology can be detected both at autopsy and in minor salivary gland biopsies.
Copyright © 2011 Elsevier Inc. All rights reserved.

PMID: 22048068 [PubMed - indexed for MEDLINE]
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Publication Types, MeSH Terms
5.
Neurodegener Dis. 2011;8(3):95-108. doi: 10.1159/000316613. Epub 2010 Dec 23.
Nonmotor disturbances in Parkinson's disease.

Bassetti CL.

Source

Neurocenter of Southern Switzerland, Lugano, and Neurology Department, University of Zurich, Zurich, Switzerland. claudio.bassetti@eoc.ch

Abstract

Nonmotor disturbances (NMDs) affect most patients with Parkinson's disease (PD) and often have a profound impact on their quality of life. NMDs such as depression, anxiety, fatigue, REM sleep behavior disorder, constipation, delayed gastric emptying, altered olfaction and pain can precede the onset of motor symptoms. Other NMDs, including hallucinations, dementia, excessive daytime sleepiness, insomnia, orthostatic hypotension and bladder disturbances, typically appear later in the course of PD. For most NMDs of PD, nondopaminergic and non-nigrostriatal mechanisms (e.g. neurodegeneration of other transmitter systems in the cortex and brainstem, side effects of medications, genetic and psychosocial factors) are considered more relevant than the 'classical' dopaminergic-nigrostriatal dysfunction. The recognition of NMDs requires a high degree of clinical suspicion, the use of specific questionnaires and ancillary tests. Pharmacological and nonpharmacological approaches can be effective, but for most forms of treatment of NMDs, the scientific evidence is limited.
Copyright © 2010 S. Karger AG, Basel. PMID: 21196687 [PubMed - indexed for MEDLINE] ======================================================================= Regarding magnesium, magnesium citrate is well absorbed, and may be a good choice for general use. Magnesium glycinate may be the best choice for constipation, and magnesium malate is often a good choice for muscle pain and RLS. But to keep it simple, magnesium citrate is fine. It's best to take it in divided doses -- about 100 mg, 2 or 3 times daily -- as smaller amounts increase absorption.
Best regards,

Kathrynne Holden, MS

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#11 Drummergirl

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Posted 31 January 2013 - 05:53 PM

Hi Kathrynne,
I am a bit confused on your suggestion of taking magnesium citrate. The only way I can find this is in liquid form in the bottle used as a laxative. Is this the one I should use?

Thanks,
Karen
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#12 Kathrynne Holden, MS

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Posted 02 February 2013 - 06:01 PM

Hi Karen,
There are a number of companies who make magnesium citrate in tablet form -- Twinlab, Solgar, Thorne, NOW are some examples. For yet more choices (I do not promote this particular site, it's just an example) see:

http://www.iherb.com...um citrate#none

Mind you, any form of magnesium can have laxative effects with overuse; but if you use it in moderation -- 100 to 300 mg per day -- it should be fine. Let me know how you are doing.
Best regards,

Kathrynne Holden, MS

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#13 Drummergirl

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Posted 06 February 2013 - 07:08 PM

Hi Kathrynne,
An update on my Jan 19th post. Reducing the CR Carb/ Levo has lessend the dyskinesia. In regards to the Magnesium Citrate, I will have to order on- line since I have exhausted all options to purchase locally in a dose under 500mg.

I did forward the information you sent me on Gastroparisis to my Neuro. I will see him mid March. Will keep you posted.
Thanks,
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#14 Kathrynne Holden, MS

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Posted 08 February 2013 - 05:57 PM

Karen, no need to order online, you can successfully use any form of magnesium, it's just that some excel in certain areas. But any of these will serve your purpose; for example, all forms in large amounts can be laxative. In your case, I would use whatever is inexpensive and readily available.

I will look forward to your report on gastroparesis, and let me know if you have other questions.
Best regards,

Kathrynne Holden, MS

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#15 Drummergirl

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Posted 20 February 2013 - 06:45 PM

Hi Kathrynne,

Just wanted to let you know that the magnesium has helped significantly with constipation and my RLS has been minimal.

Overall I am doing better! Not sure if it's all due to the magnesium, but I am liking it!

I also met with my Gyno to have my hormone levels checked. I know low estrogen can be an issue with the effectiveness of the meds.
Will let you know when I have those results.

Thanks again,
Karen
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#16 Kathrynne Holden, MS

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Posted 22 February 2013 - 07:50 PM

Karen, I'm so happy to hear that both constipation and RLS have improved. If this has occurred since you started the magnesium, then I wouldn't be at all surprised if that was the reason -- magnesium has helped many folks, both with RLS and with constipation.

Thanks for updating us, and I'll look forward to hearing about future test results, and wishing you the very best.
Best regards,

Kathrynne Holden, MS

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#17 Drummergirl

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Posted 30 March 2013 - 07:08 PM

Hi Kathrynne,
Just an update after seeing my neuro and sharing the info on Gastroparesis. I also shared with him the positive results with the magnesium citrate. Unless I'm really cleaned out on occasion I still have some breathing issues, feeling full or, like something is pushing on or pressure at the bottom between my ribs.
So he suggested I see a GI to get there thoughts and then evaluate.
My hormone results came back "askew". My estrogen a bit high for being peri-menopausal, so that may account for PD meds to be up and down as well. Overall, I'm feeling pretty well, waiting the arrival of spring weather after a long dark winter.

Thanks,
Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#18 Kathrynne Holden, MS

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Posted 01 April 2013 - 04:56 PM

I agree with your neuro, I would certainly ask your primary care physician to rule out gastroparesis, That, along with SIBO (small intestine bacterial overgrowth, which in some cases can be due to gastroparesis) are not at all uncommon among folks with PD, and can be a hidden cause of weight loss. Here is some information on SIBO to present to your PCP:

Mov Disord. 2011 Apr;26(5):889-92. doi: 10.1002/mds.23566. Epub 2011 Feb 1.

Prevalence of small intestinal bacterial overgrowth in Parkinson's disease.

Gabrielli M, Bonazzi P, Scarpellini E, Bendia E, Lauritano EC, Fasano A, Ceravolo
MG, Capecci M, Rita Bentivoglio A, Provinciali L, Tonali PA, Gasbarrini A.

Internal Medicine Department, Catholic University of Sacred Heart, Rome, Italy.
mauriziogabrielli@gmail.com.

BACKGROUND: Parkinson's disease (PD) is associated with gastrointestinal motility
abnormalities that could favor the occurrence of small intestinal bacterial
overgrowth. The aim of the study was to assess the prevalence of small intestinal
bacterial overgrowth in PD patients.
METHODS: Consecutive PD patients were enrolled. The controls were subjects
without PD. All patients and controls underwent the glucose breath test to assess
small intestinal bacterial overgrowth.
RESULTS: Forty-eight PD patients and 36 controls were enrolled. The prevalence of
small intestinal bacterial overgrowth was significantly higher in PD patients
than in controls (54.17% vs 8.33%; P < .0001; OR, 2.24; 95% CI, 3.50-48.24).
Multivariate analysis showed Hoehn and Yahr stage (OR, 3.07; 95% CI, 1.14-8.27)
and Unified PD Rating score (OR, 1.12; 95% CI, 1.02-1.23) were significantly
associated with small intestinal bacterial overgrowth in PD patients.
CONCLUSIONS: Small intestinal bacterial overgrowth is highly prevalent in PD.
Gastrointestinal motility abnormalities might explain this association. © 2011
Movement Disorder Society.

PMID: 21520278 [PubMed - in process]

And, yes, you are absolutely correct, your hormone levels can and do affect PD symptoms and medications effects; it's entirely likely that these are fluctuating somewhat during perimenopause and contributing to symptoms. Let me know how you're doing, and what your PCP determines regarding gastroparesis and/or SIBO.
Best regards,

Kathrynne Holden, MS

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#19 Drummergirl

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Posted 15 July 2013 - 08:27 PM

Hi Kathrynne,
Glad to report no Gastroparisis, no H pylori or other GI issues. I recently had a colonoscopy and endoscopy. Both normal!

Just the typical pd slowness in emptying.

Happy summer!
Karen


Karen

Dx in 95' at 35- Normal MRI, Abnormal Da t Scan- Resting tremor- right foot, leg tremors. RX- 25/100 Carb/ l =600 mg,
0.5 Azilect 1 daily Comtan 200mg 2 day, 0.5 mg Clonazepam 1 daily.

#20 Kathrynne Holden, MS

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Posted 18 July 2013 - 05:54 PM

I'm very, very happy to hear there are no GI issues, that's one less thing to deal with; and establishing a baseline via upper and lower scopes is a very good idea as well. I'm wondering if the RLS is still improved, and if so, if you can discontinue the clonozepam. I would like to see you regain some weight, and I remain concerned that the Clonozepam might be a factor by reducing your appetite.
Best regards,

Kathrynne Holden, MS

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