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Dr. Fernandez

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Dr. Fernandez last won the day on July 12 2012

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About Dr. Fernandez

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  • Birthday 01/01/1970

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  1. Well, the short and easy answer to your question is....we still don't know! Or, "maybe!". Our preliminary studies have shown that most likely, Co-Q10 is safe and well tolerated in PD patients. Also, those exposed to very high doses of CoQ10 (1200 mg per day) may have done better motorically than those exposed to low dose or placebo pills. Therefore, we (meaning the scientific community) are currently conducting the definitive clinical trial testing high dose (1200mg) versus very high dose (2400 mg) versus placebo to see if our preliminary observations hold true. We will keep you posted with the results.
  2. Hmmmm.....I'm with his other doctors on this. I also don't think it is the PD or the PD medications that his causing the itchiness and rash. The one typical condition seen in PD sometimes is seborrheic dermatitis---somewhat greasy scaly skin, typically on the forehead and scalp. This does not seem like the rash you describe. Yours,
  3. Michael, you are doing all the right things! Knowledge is power so the more you know about your illness, the better you will be. Joining this forum is one nice way. Another way is going to the resources section of the National Parkinson Foundation website and requesting for those free brochures and pamphlets about PD. The other great thing that you are doing is exercise. You will reap the benefits of this over years to come! Keep it up! Yours,
  4. Hi, thanks for writing us. I am not sure that I can explain what exactly happened. Hopefully, you were just a little undermedicated. But then, you also mention that an extra dose of sinemet did not work. The other thing about PD is that the motor symptoms can be affected by virtually anything...your emotional state, the food you ate, how well you slept the night before, even the weather and altitude! So my best advice to you is to try to make those long trips as comfortable as possible. To do this, you may need to prepare a little...such as having your water bottle, snacks and medications ready, putting a nice comfortable back rest or cushion for your buttocks, etc. Good luck!
  5. Hi, Gustavo. I don't think you have to worry too much about this drug. Rasagiline is one of the most well-tolerated drugs in PD. In fact, in clinical trials, especially in early PD, the side effect profile of patients who received the drug was so comparable to the patients who received placebo! Of course, anything is possible, so you can check your blood pressure every now and again, but I bet you that you will be fine. Good luck to you!
  6. We have tested the dose up to 2 mg per day, however, in general, the 2 mg dose only gave a little more benefit compared to 1 mg, with a little more side effect also. Therefore, the recommendation is to keep it a 1 mg. I personally rarely go above this with my patients. Yours,
  7. Hi, Woody. We no longer recommend drug holidays. this is for several reasons: 1) it can be rather uncomfortable not being on sinemet, often times requiring hospitalization because of difficulty moving, feeding, etc; 2) it is potentially dangerous and can result in a condition called neuroleptic malignant-like syndrome. This is a potentially lief threatening condition where ones blood pressure goes haywire; 3) the benefits from levodopa holidays are transient at best and your are back to square one after a few months. So hopefully, I scared you enough not to consider levodopa holidays. The challenge here is how to minimize dyskinesias. You will need to see a PD specialist to help you with this, but there are several strategies....including adjusting your levodopa, adding amantadine, and if all else fails, considering deep brain stimulation surgery or participating in the levodopa pump clinical trial. Yours,
  8. Hi! Thanks for your note. Indeed, it is fairly common, as the disease advances, or when PD affects the very old age group that dementia can be part of the picture. Interestingly, one of the features seen in PD dementia are fluctuations in alertness, such as the one you describe. There is also another illness very close to PD dementia, called Dementia with Lewy Bodies or Lewy body disease (in fact, some authorities feel that these two illnesses are probably the same) that present with parkinsonian features, cognitive impairment and fluctuations in consciousness or alertness. My prediction is that it will happen every now and again. You should not panic. I suggest you mention this to his doctor, and his doctor will need to do due diligence and probably obtain and EEG (brain waive testing to rule out seizures). The EEG will most likely be normal or unremarkable, and he will probably get the diagnosis of PD with dementia or Dementia with Lewy Bodies. The only other suggestion I have is, typically, in your dad's age group, and also with his clinical picture, we try to avoid using Mirapex or other adjunctive PD medication. They may cause more confusion and give more side effects. It may be best to stick to good old carbidopa/levodopa to control his PD symptoms. Talk to his neurologist about this. Best of luck to you and your father.
  9. Hi and thanks for your note. Yes, definitely, I agree that the seroquel (quetiapine) should be added first. Her paranoia and hallucinations should be first controlled, her doctor can try to optimize her medications. Good luck!
  10. If he is not agitated or too bothered by the hallucinations, I would stick with it for a few more weeks and see if it eventually goes away. the higher doses sometimes will do the trick. However, if you or he is quite bothered by it, then by all means, you should call your doctor so that alternative treatments can be considered since the trend is not going the right direction. Yours,
  11. It is tough to say as I cannot assess how you are doing with your PD. In general though, if your PD is generally well controlled, I would agree with your doctors that if they feel you are a good candidate for bariatric surgery, you should not let PD prevent you from doing this. However, you should be careful about replenishing the vitamins and minerals that may be less absorbed after the surgery... Best of luck to you!
  12. HI! My best guess is that your FIL is experiencing eyelid dystonia (or also called apraxia of eyelid opening). This can be seen in PD. Indeed, botulinum toxin injection is the best treatment. Most likely, either the dose needs to be improved or the technique/injection sites need to be modified a little. Perhaps he needs a second chance for botulinum toxin? Yours,
  13. Hi! I am not sure whether the symptoms you experience are from too much or too little PD medications. It sounds like a combination of both. The symptoms that gets worse when PD meds wear off and gets better when PD meds are taken are probably from too too little meds. The symptoms that gets worse when you take more sinemet are probably form too much. And the symptoms that are not related to medications are probably intrinsic to PD. Autonomic dysfunction can be part of PD--symptoms of these include low blood pressure, heat and cold intolerance, sweats, etc. Hopefully, you are being followed by a PD specialist. If not, it is time to get at least a second opinion. If all adjustments fail, you may want to consider deep brain stimulation surgery or participating in the duodopa study (intestinal levedopa gel). Yours,
  14. Hmm...typically loss of sense of taste is not part of PD. Some patients have loss of sense of smell, and when you can't smell well, the taste is occasionally dampened also. But the sense of taste is generally preserved in PD. I suspect that you may have other things going on that may or may not be part of PD. Perhaps some of the medications, or your fibromyalgia might be contributing. Depressed patients also lose their sense of smell. I'm not saying that you are depressed, but it can contribute. Experiment also on the timing of your meds to see if they make a difference...? Sorry i cold not be more specific. Yours,
  15. Insomnia in PD is very common but the reasons for this is far from uniform. In some, it is because they have slept the whole day (or take lots of frequent naps because of medication side effects making them sleepy during the day) therefore they are unable to sleep well at night. Soon, the day-night cycle is altered or sometimes even reversed! In others it is because they are not well medicated at night and they are uncomfortable. Therefore giving PD meds at night might make sense. In some, it is because there is concomitant depression and insomnia (or too much sleeping) is a symptom of depression. In others, they have sleep apnea (making them sleepy during the day, and insomniacs at night), or other sleep disorder that is unrelated to PD; others take or drink stimulants at night such as coffee, tea, soda, etc; others have a true sleep disorder. You may need to see a sleep specialist. a Polysomnography may need to be performed to get a diagnosis. Then sleeping aids may need to be tried. Yours,
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