Monday, April 13, 2020

PD Caregivers Survey

Make your voice heard! Help identify gaps in knowledge and support among Parkinson’s caregivers.

Caregivers are often spouses, partners, children, parents, friends or even neighbors. No matter their relationship to you, they are often at the frontlines of providing support and encouragement for their loved ones living with chronic conditions like Parkinson’s disease.

With the help of PMD Alliance and Davis Finney Foundation, Kyowa Kirin recently launched a survey to identify gaps in knowledge and support for Parkinson’s caregivers in the hopes of improving the resources available to patients and their caregivers.

If you or someone you know are providing care for a loved one with Parkinson’s disease, I highly encourage that you take the survey available here: https://bit.ly/2xCAwn1

                     Image: Pixabay

Monday, January 20, 2020

Finding basic information about Parkinson's Disease - Updated

If you live in the US, there is a terrific website with current information about Exercise and about Support Groups for each state. Parkinson & Movement Disorder Alliance has taken on the work of identifying each PD-specific Exercise group and Support group.  They even have information about local, regional, and national organizations. Try to Google this yourself, and you will appreciate just how much work this is.  Exercise groups will help improve your symptoms and may even slow progression - and can often become a support group, as well.  Support groups provide a place to ask questions, discover local resources, and get support - for the pwp and for the care-partner/family.

     https://www.pmdalliance.org/resources/

If you live outside the US, to find Parkinson's specific exercise, Google

     Parkinson's exercise your-geographical-area

To find Parkinson's specific support groups, Google

     Parkinson's support your-geographical-area

For a list of national/international Parkinson's organizations by world geographical area:

     https://www.worldpdcoalition.org/page/Partners

A really great book for pwp and their families/friends is Every Victory Counts.  Its focus is on how one can live well with PD.  There are contributions by pwp, families and care-partners, physical therapists, doctors, and more.  Included is information about diet, exercise, speech therapy, how to talk to your doctor, useful checklists, and much more. Best of all, it's free and downloadable online so that it's instantly available; a print version is often available, too.  I have both.  Kudos to the Davis Phinney Foundation for making this available and updating it regularly.

     https://www.davisphinneyfoundation.org/resources/every-victory-counts-2017/

Other information that may help:

     How to find info on research http://parkiesupport.blogspot.com/2019/09/where-to-find-latest-on-parkinsons.html

     Who are all these PD organizations?  http://parkiesupport.blogspot.com/2018/01/who-heck-are-all-these-organizations.html

     What to know when first diagnosed  http://parkiesupport.blogspot.com/2019/05/what-i-wish-i-had-known-being-first.html



Monday, January 13, 2020

Exercise that's different - the Theracycle

One of the earliest discoveries about PD was accidental.  A pwp rode a tandem bicycle with a doctor at Ragbrai, an annual cross-Iowa cycling event.  She was pedaling faster than she would have, because of her partner - and by the end of the week, many of her PD symptoms had improved markedly.  That experience grew into a whole series of experiments that demonstrated that when rats - and people - have to exercise faster than they ordinarily would, their PD symptoms improve (in the rats' case this was PD-like symptoms).

That Ragbrai experience on the tandem bike was forced exercise.

The Theracycle is reminiscent of a stationery bicycle, with important differences - it doesn't have a bike seat (and that's good, for there is very little comfortable about a bike seat), and it has a motor that enables you to pedal faster than you'd choose to pedal on your own.  You could use it as a stationery bike, but you can have it assist you to go faster - that's the forced exercise.

There are cheaper versions of the Theracycle, but they lack a critical safety feature - do you want the bike to keep pedaling when your feet are attached to the pedals - if you fall off the bike?  Me, neither.  The Theracycle has a "deadman" switch similar to treadmills; you pin it to your clothing so if you fall the cord pulls a magnet off its target and the machine stops.

We purchased a Theracycle used, almost new, for under $2,000, less than half the cost of new (which would be $4,800 for this model.)  My husband found it on Craigslist.

I gotta warn you - like a treadmill, it's boring.  My husband, bless him,  hooked up a tablet clamped to the right of the display, so I can watch Youtube.

For awhile I used the forced exercise aspect of the Theracycle, but it is a bit too energetic for my additional diagnosis (myelitis, which is similar to MS; see previous blog).  Now, I'm only allowed to do moderate exercise, not vigorous at all - and when I do vigorous exercise now I end of stiff (unable to move stiff), exhausted for 24-48 hours, and sorry.  This is frustrating since I became a real exercise nut before.

But I can stay on the Theracycle for long periods if I set the speed lower.  Possibly I can build up to a faster speed at some time in the future.  For now, I can work out at a lower speed but for quite awhile; typically I walk on the treadmill for 15 or 20 minutes, then use the Theracycle for 20-40 minutes more.  If I'm tired, I skip the treadmill and use just the Theracycle. Even at the slower rate my legs are stronger.

So the Theracycle has been a boon for both conditions.

Image from https://www.theracycle.com/forced-exercise-bikes-for-pd/theracycle-200/

Monday, January 6, 2020

Additional diagnosis - myelitis

Well, I've found out why my balance just kept getting worse, while most of the rest of my symptoms did not seem to be progressing, thanks to regular vigorous exercise.  Part (or all?) of my balance issues seem to be the result of myelitis.  A few years back, I had a nasty lupus flare - think itchy rash all over my body - and ever since, my balance has been slowly deteriorating.

Anyway, my Movement Disorder Specialist sent me for spinal MRIs - which showed some demyelination (loss of the "insulation" on nerves).  And more MRIs, including more current MRIs of the brain.  But no lesions in the brain; just the spinal cord.  While I waited to see even more of a specialist my balance continued to get worse.  I fell again, and started using a rollator outside the house, then another rollator inside the house.

So, lupus myelitis.  Myelitis is already rare, but caused by lupus is even more rare. Also myelitis, often called transverse myelitis, usually presents as sudden partial paralysis.  I had the initiating event - the lupus flare which damaged my spinal cord - without the paralysis (long may that continue).  So the treatments for the initial damage aren't available or appropriate.  What is available now is often used - a chemotherapy drug (rituximab) that suppresses the part of my immune system that has attacked my nervous system.

I've had the first two half-treatments and now wait for the next full treatment in six months. Treatment involves infusions (IV) that take 5-6 hours; I sleep through a lot of these hours.  The chair is a comfy recliner and they give me a blanket and some benadryl; how could I not sleep?

My balance does not seem to be worsening, which is good.  I'm not as stiff, and urinary retention is slowly improving (retention means it's hard to completely empty my bladder when I pee).  Baby steps, but I won't be satisfied until my balance improves and my fine-motor coordination improves, which might take months or years - or never.

                                                             ***

One problem with myelitis (very similar to MS, but in the spine, not the brain) is that vigorous exercise is out and heat/sweating can be a problem.  I had been having a tough time with exercise and with heat.  Either (exercise or heat) was starting to leave me so stiff that I could barely walk, and I was exhausted for the next 24-48 hours.

Cutting back on what has become a habit has been hard.  But if I don't overdo, I'm not as stiff and exhausted.  I'm back at Rock Steady, which is both exercise and support group, but doing the warm ups. balance work, and stretches; when the rest turn to boxing, I continue stretching.  I've tried but punching is out - too vigorous.

I still respond to L-dopa so do I officially have Parkinson's or not?  Which symptoms are from PD and which from TM?  And will I ever know?  Discussing with my Movement Disorder Specialist when I next see her.

Images from Pixabay.

Monday, December 30, 2019

Looking up research on the European version of PubMed, called EuropePMC

Sample of EuropePMC search bar


A friend recommended using EuropePMC, https://europepmc.org/  as an alternative to PubMed (thank you, Chris).  This repository describes themselves as:
  • Europe PMC is an open science platform that enables access to a worldwide collection of life science publications and preprints from trusted sources around the globe.
  • Europe PMC is developed by EMBL-EBI. It is a partner of PubMed Central and a repository of choice for many international science funders.
  • Free, transparent, and community-driven, Europe PMC is your gateway to life science research.
Doing a search on EuropePMC is similar to doing a search on PubMed (which works much like a Google search; see this recent blog post), but the search results can be quite different.  Hmm.  Why?

Many things are the same with PubMed and EuropePMC. There are Basic (like a Google search) and Advanced search available in both (for searches by journal, for example).  You can also sort the results by date or by "relevance"/"best match."  Further, you can limit results for a particular date range and whether there is a free article available for both, and you can search by article type, but each repository does it differently (advanced search in EuropePMC, filters in PubMed).  The way the two identify free articles (full articles available to all) is a bit different, but both seem to have the same access.  In addition, both have ways to tell about other research that cites this article (a real-world measure of influence), show links to similar articles, and highlight keywords.  Here is an excerpt from a sample EuropePMC search:

The more restrictive your keywords are, the more similarities you find between the two tools.  When I used the keywords (example: Parkinson's dementia rivastigmine) and sorted by recent date, the first article is the same - but many of the rest of the citations/abstracts are not.

But what causes the differences?   Partly different journals are available (there are more in EuropePMC), but partly, I suspect, because of different indexing (selection of keywords for each article).  Here's a recording of a webinar about how to do search on EuropePMC:

Another difference is that PubMed will let you email a search to yourself, which is handy if you use multiple computers;  you can email just the citations in EuropePMC, but since EuropePMC saves your previous searches - and you can sign in to the system - the email may not be as important.  Also, some features in filters on both platforms don't seem to work, but I can't tell if this is a limitation based on indexing that just hasn't been done.

I happen to prefer PubMed, probably because I'm used to it.  But I use both repositories to search research.  When I don't find results in one, I often can find results in the other (one of the reasons I suspect the indexing is different).

See which one you prefer.

Monday, December 23, 2019

Suppose you want a complete research paper but you only have the abstract

Sometimes the abstract is so brief that you want to know more.  Sometimes it doesn't summarize anything including the conclusions (grrr).  Or maybe people are talking about it and you want to know what they are talking about.

What are some ways to get the paper?

1.  The NIH requires that any study it funds must open their research results to all; some foundations do this, too.  (But not enough of them.)  Some journals only publish as "open access," so all their papers are available, too.  For these, you will see some variant of this, over on the PubMed abstract, upper right side:

2.  If you click on the DOI number on the PubMed abstract (right under the authors' names), sometimes that will give you a full version of the paper, even though the official link (see #1)  does not.
3.  If there is a corresponding author and email available on the abstract, you can email this person asking for the paper (give the precise title because they may be involved with a lot of papers and projects).  Most will give it to you.  Quickly, too.

4.  Google the exact title.  Some researchers have placed their paper on a university website.

5.  Ask a friend/family member who may have access to bio-medical journals on-line at work.  Know anybody who works for a college or university?  (Just don't wear out your welcome.)

6.  Rent the article (available for a fee from some publishers, but much less than the $35/article that many publishers charge for purchasing the article.)  Some publishers offer this.  Copy and paste the article into your word processor so that you have time to read it without worrying about the limited rental period.

7.  Then there is the illegal way.  A Russian maintains a website for access to full papers - sometimes an early version of the paper is available.  https://sci-hub.tw/   
Here's the rationale behind Sci Hub:
Donations are accepted in Bitcoin which means they're untraceable.  The Russian internet seems to be the Wild West, so Sci-Hub operates there without benefit of a government enforcing copyright law (that's the illegal part). There is probably some risk because this is Russia.

Sometimes on Sci-Hub instead of the paper, first there will be incomprehensible directions in Russian.  This is very like Captcha.  Type in the English letters that are shown and click the Russian word below.  Sometimes this works and sometimes it doesn't.

Lots of different ways to get the full paper if you really want to read the whole thing.  

I find that the particularly useful parts of the paper are:  # of patients who participated in the study, and # of participants by gender, if it's a clinical trial; Discussion; Conclusion.  

What do you want to find out?

Monday, December 16, 2019

Using the new PubMed


PubMed is a free database that has more than 30 million abstracts (summaries) of biological/medical and life sciences research, from MEDLINE, life science journals, and online books, and is located in NIH.  Sometimes there are links to the full-text research as well, not just the abstracts.


Why would you want to use PubMed instead of Google (or even Google Scholar)?  Because much of this research isn't available on Google/Google Scholar, and PubMed has terrific tools that make its use really easy and useful.
While you can search it just like you do Google, there are many additional filters that make PubMed more useful.  (And by the way, it says "Log In" but for looking up research, that's not required.)  Let's look at an example of search results to see some of PubMed's useful features:
The default sort is Best Match, that is the abstracts that best meet your search.  But if you prefer, you can change this to Most Recent, the abstracts in date order, with most recent first.  Any restrictions using the filters are highlighted in pink in the center of the page.  You can see that I've used the Article Type Review to limit abstracts to just Reviews, since Reviews are often evaluations of many related pieces of research.  Also notice that the search terms are shown in bold in the search results.

These are not all the possible filters, but seem to be frequently used - such as only "full text," or only published in the past "5 years."

If you look at an Abstract (PubMed calls these citations, but virtually all are abstracts), you can see information such as the authors - and if you click on Expand next to the authors' names, you can learn an email for correspondence, and what institutions the authors work for.
Also, you can see the full-text link, in the upper right (which will say "free" if anybody can see the article), and also the DOI number, under the authors' names - a clickable link that will occasionally take you to the full article, even if the full-text link will not.  (Each article has a unique DOI number - Digital Object Identifier - which can be handy.)

Also handy are "Similar articles," and "Citations" (other papers that cited this article).  Citations won't be that helpful for a just-published article because it is just too new to be cited yet;  but journals and others base quality measures on how often an author/ article/ journal is cited.

Now, why would the article not be available - this is called putting articles behind a paywall?  Well, publishers make money from subscriptions, and while universities and drug companies pay for subscriptions, private citizens usually don't.  But few of us want to pay $35.00 for each article we want to read in detail.  We'll talk about ways to get around this in another blog post.

Besides looking up abstracts, you can email the search results or abstracts to yourself (handy if you are working in more that one place), and even have the system send you Alerts whenever there are new articles that meet your criteria.  This requires you to Log In (see the first image).  Usually, you don't need to log in, but for Alerts you must.  One of the choices for logging in is your Google account, but this was not working when I tried it.

PubMed is added to daily, is indexed, and is free.  It's a tool I use every day.  You can, too.

PD Caregivers Survey

Make your voice heard! Help identify gaps in knowledge and support among Parkinson’s caregivers. Caregivers are often spouses, partners...