Rabbits are clean and for the most part there are very few health risks involved with sharing our lives with them. However, some people may experience problems and it is always wise to know what signs to look out for and steps to take to try and prevent any problems occurring. It should be stressed that health problems from people contracting things from rabbits are rare, and owners should not lose sleep over them!

“NewYork-Presbyterian cares for one of the world’s largest populations of patients with movement disorders, through the Center for Parkinson’s Disease and Other Movement Disorders at NewYork-Presbyterian/Columbia University Irving Medical Center and the Parkinson’s Disease and Movement Disorders Institute at NewYork-Presbyterian/Weill Cornell Medical Center.

Our neurologists are experts at diagnosing and treating all types of movement disorders, from the most common to the rarest. Our neurosurgeons are exceptionally skilled and among the most experienced in the country offering treatments such as deep brain stimulation and high-intensity focused ultrasound (HIFU) for Parkinson’s disease and other select movement disorders.

Our multidisciplinary team also includes neuropsychologists, nurses, genetic counselors, registered dietitians, and physical, occupational, and speech/swallowing therapists, along with other specialists who collaborate to ensure that each patient receives the most effective care available.”

New York Presbyterian Hospital (Movement Disorders | NewYork-Presbyterian)

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!

“Every six minutes there is a new diagnosis of PD, which means that in April alone nearly 7,200 people in this country will learn they have PD. These people need to know that they are not alone, and that APDA is here for them,” states Leslie A. Chambers, President and CEO, APDA.

The American Parkinson Disease Association (APDA) is a nationwide grassroots network dedicated to fighting Parkinson’s disease (PD) and works tirelessly to assist the more than one million people with PD in the United States live life to the fullest in the face of this chronic, neurological disorder. Founded in 1961, APDA has raised and invested more than $252 million to provide outstanding patient services and educational programs, elevate public awareness about the disease, and support research designed to unlock the mysteries of PD and end this disease.”

American Parkinson Disease Foundation

(https://www.apdaparkinson.org/article/american-parkinson-disease-association-to-celebrate-the-power-of-a-supportive-community-during-parkinsons-disease-awareness-month/)

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 Motor function symptoms associated with Parkinson’s Disease:

• 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.

The Non-Motor function symptoms that are often associated with Parkinson’s Disease include:

-Cognitive impairment –Dementia –Psychosis –Depression –Fatigue -Sleep disturbances -Constipation -Sexual dysfunction -Vision disturbances.

As the disease progresses, walking may be affected. Patients may halt in mid-stride and “freeze” in place, possibly even toppling over.  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:

There isn’t a specific test to diagnose Parkinson’s disease;  it is based on factors such as signs/symptoms, patient history, physical examination, and a thorough neurological evaluation.

A doctor trained in nervous system conditions (neurologist) will diagnose Parkinson’s disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.

Your doctor may suggest a specific single-photon emission computerized tomography (SPECT) scan called a dopamine transporter (DAT) scan. Although this can help support the suspicion that you have Parkinson’s disease, it is your symptoms and neurological examination that ultimately determine the correct diagnosis. Most people do not require a DAT scan.

Furthermore, making the diagnosis is even more difficult since there are currently no blood or lab tests available to diagnose the disease. Your health care provider may order lab tests, such as blood tests, to rule out other conditions that may be causing your symptoms.  Some tests, such as a CT Scan (computed tomography) or MRI (magnetic resonance imaging) and PET Scans may be used to rule out other disorders that cause similar symptoms. Imaging tests aren’t particularly helpful for diagnosing Parkinson’s disease.  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.

Recommended Related to Parkinson’s

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?

5. Will I be able to keep up the activities, hobbies, and sports I do now?

6. What treatments do you suggest now?

7.Will that change as the disease progresses?

8. 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.

“Parkinson’s Awareness Month is the perfect time to brush up on your Parkinson’s facts. Here are 5 fast facts about PD:

1. Nearly 90,000 people in the U.S. are diagnosed with Parkinson’s each year.
2. Scientists believe a combination of environmental and genetic factors cause PD.
3. People with Parkinson’s experience both movement and non-movement related symptoms.
4. Symptoms can be managed through treatments like medications, lifestyle changes, exercise and in some cases, surgery.
5. Early-onset Parkinson’s disease occurs in people younger than 50 years of age.”

Parkinson’s Foundation (Parkinson’s Awareness Month | Parkinson’s Foundation)

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.

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 1.5 million people in the U.S. who suffer from Parkinson’s disease – approximately 1-2% of people over the age of 60 and 3-5% of the population over age 85. The incidence of PD ranges from 8.6-19 per 100,000 people. Approximately 50,000 new cases are diagnosed in the U.S. annually. 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 the Medifocus Guidebook on Parkinson’s Disease was developed, a comprehensive 170 page patient Guidebook that contains vital information about Parkinson’s disease and is so helpful.

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:

 The theories regarding the underlying causes of Parkinson’s disease.

What Are the Possible Risk factors that can be a cause of Parkinson’s Disease?

 The Parkinson’s Disease Foundation notes even after decades of intense study, the causes of Parkinson’s disease are not really understood. However, many experts believe that the disease is caused by several genetic and environmental factors, which can vary in each person.

1-Genetic Factors

For 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.

“In April we’re spreading the word to remind both children and adults: as you suit up for outdoor activities this spring, don’t forget to protect your face and head. Spring often brings a flood of patients suffering with head, mouth and facial injuries resulting from sports-related accidents to doctors’ offices and emergency rooms. Many oral and facial injuries can be easily prevented with the use of sports safety equipment like helmets and mouth guards.

National Facial Protection Month is sponsored by the Academy for Sports Dentistry, American Academy of Pediatric Dentistry, American Academy of Pediatrics, American Dental Association, American Association of Oral and Maxillofacial Surgeons and the American Association of Orthodontists. Together we encourage children and adults to enjoy the pleasures of the season by using common sense and taking the necessary precautions to prevent sports injuries.”

American Association of Oral and Maxillofacial Surgeons (National Facial Protection Month – AAOMS | AAOMS)

April is National Facial Protection Month, founded by the AAOMS to promote the use of protective gear — such as mouth guards and helmets — to prevent dental facial injuries resulting from sports and recreational activities.

Five of the nation’s top dental associations want to remind young athletes to play it safe by wearing a mouth guard during recreational and organized sports this spring.  Research estimates that about 2 percent of all children or adolescents who participate in sports eventually will suffer a facial injury severe enough to require medical attention.

“A properly fitted mouth guard is an essential piece of any athlete’s protective equipment,” says Dr. Paul Nativi, DMD, FASD, and past president of the Academy for Sports Dentistry.  “Mouth guards protect the teeth from being knocked out, broken and displaced.  Mouth guards prevent injuries to the bone and tissues around the teeth. They also help prevent injuries to the mandible (lower jaw) and temporomandibular joint in the jaw. Tooth loss incurs a tremendous financial, emotional, and psychological expense.  Protect what you have – wear a properly fitted mouth guard.”

The Academy for Sports Dentistry (ASD), American Academy of Pediatric Dentistry (AAPD), American Association of Oral and Maxillofacial Surgeons (AAOMS), American Association of Orthodontists (AAO), and the American Dental Association (ADA) are collaborating to promote National Facial Protection Month in April.  National Facial Protection Month strives to raise public awareness and remind parents/caregivers, coaches and athletes to play it safe while playing sports.

According to the American Academy of Pediatric Dentistry’s Policy on Prevention of Sports-related Orofacial  Injuries, sports accidents reportedly account for 10 to 39% of all dental injuries in children and are most often caused by direct hits with a hard object, such as a puck or ball, and player-to-player contact.

The dental associations offer the following five tips to help prevent facial injury:

1. Wear a mouth guard when playing contact sports: Mouth guards are significantly less expensive than the cost to repair an injury, and dentists and dental specialists can make customized mouth guards that hold teeth in place and allow for normal speech and breathing.
2. Wear a helmet: Helmets absorb the energy of an impact and help prevent damage to the head.
3. Wear protective eyewear: Eyes are extremely vulnerable to damage, especially when playing sports.
4. Wear a face shield to avoid scratched or bruised skin: Hockey pucks, basketballs and racquetballs can cause severe facial damage at any age.
5. Make protective gear mandatory for all sports: Athletes who participate in football, hockey and boxing are required to wear mouth guards.  If  mouth guards have been proven to significantly decrease the risk of oral injuries, why is it not mandatory in every sport for kids to be required to wear them, particularly when participating in:

“A risk factor is anything that increases your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

Several risk factors can increase your chance of developing cervical cancer. People without any of these risk factors rarely develop cervical cancer. Although these risk factors can increase the odds of developing cervical cancer, many with these risks do not develop this disease.

When you think about risk factors, it helps to focus on those you can change or avoid (like smoking or human papillomavirus infection), rather than those you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it’s even more important for those who have these factors to get regular screening tests to find cervical cancer early.”

American Cancer Society (Cervical Cancer Risk Factors | Risk Factors for Cervical Cancer | American Cancer Society)