Monthly Archives: May 2013

What do I need to know about vitamins?


Medication Assistance is availableThe vitamin and supplement industry is a multibillion dollar business. If you search the internet, browse your pharmacy aisle or read a magazine you will discover many claims about a supplement treating a multitude of symptoms, cure disease, or increase vitality. Watch out for these claims, especially the wonder pill that treats so many problems that it sounds too good to be true- it most likely is. Is there true benefit or is it marketing hype? Ask you healthcare provider or nutritionist about the evidence if any that exist behind these claims. Here are some common claims or statements you may have heard.

So why do we take vitamins? When asked, most people say they are taking vitamins to stay healthy, ward off disease and colds and to make up for a healthy diet.

There is no data to support the claim that vitamin supplements will keep you healthy and in the absence of deficiency will not treat disease. Expecting your vitamin pill to take the place of a well balanced vitamin and nutrient rich diet is like trying to make a full course dinner by tossing together a few key ingredients. If health is your aim, remember diet, exercise, stress reduction, emotional and social health are the key ingredients. Nonetheless, there may be a place for vitamins such as B vitamins in people with stroke, vitamin D  in MS and Parkinson’s and vitamin B12 and folate for people with cognitive disorders and depression. Ask your doctor if vitamins a right for you and be sure to read about the good and the bad…

It is just a vitamin so it can’t hurt me (or substitute it is just an herb or natural supplement). Yes it can! The following examples illustrate this point:

  • Vitamin A, D, E and K are fat soluble vitamins. These vitamins are stored in our body’s fat cells and high doses can accumulate to toxic levels.
  • Vitamin E is a powerful antioxidant, helping the body reduce damage caused by free radicals. Although the evidence is inconsistent, one met analysis (review of the effect based on examining outcomes of many studies) found higher rate of mortality from all causes in people on high dose vitamin E. High dose vitamin E has multiple toxic consequences. Miller 2005. Ann Intern Med. Jan 4 2005;142(1):37-46
  • Over ingestion of vitamin D may be associated with calcification of blood vessels in elderly and African Americans.
  • High dose preformed vitamin A, known as retinol (found in animal foods) can cause headache, seizures, muscle aches, osteoporosis, skin and stomach problems. Provitamin A such as beta carotene found in fruits and vegetables such as carrots is safer than preformed vitamin A so read your vitamin label carefully.
  • Excessive doses of vitamin C are used by some during cold and flu season. Very high doses of vitamin C can cause kidney stones from uric acid, diarrhea and increase iron absorption (this is a problem if iron is stored in excess).
  • Excessive iron can be deposited in our body’s tissues leading to problems liver, skin, joint and intestinal symptoms. Iron is used to treat certain types of anemia. Many postmenopausal women and men do not need iron so talk to your doctor about whether you need iron.

So should I take a multivitamin?

Few Americans are vitamin deficient. In part because the processed foods we buy off the shelf are fortified with vitamins and minerals. A multivitamin will never substitute for the health benefits of a balanced diet that includes 8-10 servings of fruits and vegetables, whole grains, vegetable protein, omega 3 fats such as in certain fish, and high fiber (20-30G). Turn to food and vitamins to be sure you get a variety of vitamins and minerals in your diet.

However, some people are at higher risk for deficiencies:

  • Vegetarians- may be deficient in B12, iron, calcium depending on diet
  • Elderly
  • Intestinal Malabsorption problems  such asCeliac,Sprue.
  • Long-term users of stomach acid depleters ,
  • Alcoholics
  • Pregnancy

There is no simple answer as to whether a vitamin is needed for you. Talk with your doctor before choosing a vitamin.   Specific questions to ask include:

  • Do I need iron?
  • Should I take a calcium supplement?
  • What about vitamin D or B vitamins?
  • What dose of vitamin E and A is safe for me?
  • How much B vitamins, calcium and D should I take?

Steps you can take if you do take a vitamin

  • Read the label on your vitamin bottle.
  • Avoid mega-doses unless recommended by your doctor. This is especially true for vitamin E and A.
  • Take iron only, ie. restless leg syndrome, premenopausal women on doctor’s advice
  • Pay attention to how much calcium you are getting in your diet and vitamin. Does it add up to the recommended dose given you by your doctor (1000-1200mg is the average daily requirement for older adult needs).
  • Look for 100% RDA of vitamin C, B12, folate,B2,  B6, thiamin, niacin, A (preferable in provitamin beta-carotene form). Gender specific or other specialty vitamins may differ slightly but the true value of these costly formulas is unknown.
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Filed under Nutrition, Vitamins and Supplements, Self-Care

When do I need to see a physical therapist?


Physical Therapist Working with PatientChances are you will benefit from a physical therapy (PT) evaluation and treatment if you have movement symptoms associated with Parkinson’s disease or other brain condition. However PT does more than simply treat movement symptoms. The objectives of PT vary with individual needs but do include these general goals:

  • Evaluate movement problems and recommend therapy early in disease before problems and bad habits occur
  • Reduce symptoms of disease associated with imbalance, rigidity, slowness, involuntary movements
  • Reduce or delay symptoms of disease progression through targeted exercise such as balance and falls
  • Optimize independence
  • Optimize your home exercise program with a focus on general health, stamina, disease symptoms and long-term compliance
  • Evaluate and recommend specific braces, orthotics, and ambulatory assist devices such as canes and walkers
  • Improve safety, enhance confidence and reduce fear of activity such as fear of falling
  • Neuro re-education designed to combat the abnormal movement associated with physiologic brain changes of disease, programs such as ‘Big and Loud’
  • Promote neuroplasticity or enhanced brain activity through movement
  • Promote healthy lifestyle changes to improve activity levels, quality of life and well-being both now and long-term

Don’t wait.

What is most important is that you advocate for yourself and take a proactive stance by seeking out a therapist even before you have problems. Most people wait until symptoms are significant or cause serious problems such as falls, pain or joint disease.
Advocate for your care.
Ask your doctor of healthcare provider if you can have a referral to a rehabilitation specialist.
Use this checklist to see how rehabilitation and other specialists can be of help to you and as a guide for discussion with your doctor or therapist.
Download and complete your Comprehensive-Care-Worksheet.

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Filed under Exercise, Self-Care, Symptoms, Diagnosis and Progression

Can you give any additional information about Othello Syndrome in the context of PD?


Othello syndrome describes a form of psychosis in which one has delusional thoughts about their partner having an affair or similar relationship that does not exist. They may misinterpret ‘clues’ to support this delusion.

Delusions and hallucinations can be seen with certain psychiatric disorders and in the setting of Parkinson’s disease with the following conditions:
-High dose dopamine medicines especially dopamine agonists, amantadine and selegiline
-Other medicines that can cause confusion such as anticholinergics, muscle relaxants and pain medicines (narcotics)
-Illicit (street) drugs)Cognitive problems suggestive of dementia
-Coexisting medical conditions such as thyroid disease, vitamin deficiency (B12),infection or dehydration

Treatment includes:
-Reducing medicines when possible
-Occupational therapy evaluation to analyze how someone is taking medicines and help family administer medicines in the event the person with PD is taking more than prescribed
-Antipsychotic medicines- namely clozaril or quetiapine
-Cognitive enhancing medicines such as rivastigmine
-Counseling and psychiatric evaluation to evaluate for other conditions
-There is little evidence to date about the effect of a new antipsychotic.
-A combined neurology and psychiatry evaluation may be needed for this difficult problem.

See related article on hallucinations

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Filed under Caregiving, Cognitive Health, Emotional Health, Medication Side Effects