Constipation

Prodromal Symptoms Trace Parkinson’s Bottom-to-Top Progression

BARCELONA – Early neuronal death may spark symptoms that can precede the classic motor dysfunction of Parkinson’s disease by up to 20 years.

Rather than beginning in the substantia nigra and moving into the cerebellar regions, nerve damage may begin in the dorsal motor nucleus of the vagal nerve and progress upward into the midbrain, killing neurons all along its path. Constipation, cardiac denervation, and rapid eye movement sleep disorder are some of the conditions that may appear as the march of cell death continues, Dr. Yoshikuni Mizuno said at the International Conference on Alzheimer’s and Parkinson’s Diseases.

"Parkinson’s probably starts in the peripheral portions of the vagal nerve," said Dr. Mizuno, director of the Research Institute for Diseases of Old Age at Juntendo University, Tokyo. "When the neurons die, their content is expelled into the extraneural space in the medulla oblongata." Other nerve terminals pick up this intracellular debris and die as well, expelling their own contents as damage progresses. "Eventually, this reaches the substantia nigra and the higher cerebellar neurons. This, I believe, is the model for the spread of Parkinson’s."

Constipation can be one of the first symptoms, occurring when Lewy body lesions first appear on the vagal nerve’s dorsal motor nucleus. This is generally 15-20 years before the onset of motor symptoms, Dr. Mizuno said.

The Honolulu Heart Program study clearly showed the association between Parkinson’s disease and constipation. The study followed almost 7,000 men. Over an average of 12 years, 96 developed Parkinson’s disease. In a multivariate analysis, men who had fewer than one bowel movement per day were four times more likely to develop the disease than were men with two or more bowel movements per day (Neurology 2001;57:456-62).

"I think most of these patients already had Parkinson’s before the onset of motor symptoms," he said.

As cell death proceeds along the nerve, it can affect cardiac innervation. Cardiac scintigraphy with the imaging agent iodine-123 metaiodobenzylguanidine (MIBG) highlights norepinephrine transport cells in the normal heart. "In patients with Parkinson’s and dementia with Lewy bodies, you don’t see this, because of the loss of postganglionic parasympathetic nerve fibers," Dr. Mizuno said. "In Alzheimer’s, as well as in progressive supranuclear palsy and multisystem atrophy, you do have nice visualization of these fibers, and this is a very useful test for differentiating Lewy body disorders from these other diseases."

His own studies suggest that MIBG cardiac uptake may parallel the progression of Parkinson’s disease. About half of patients with stage 1 disease show reduced uptake, but "there is much more markedly diminished cardiac MIBG uptake in those with stage 2 disease or higher," Dr. Mizuno said.

Disordered sleep can occur when cell damage advances to the pons – about 10 years before motor symptoms are apparent. "Half of the patients with idiopathic REM sleep disorder will go on to develop Parkinson’s disease," he said.

As nerve damage progresses further, the olfactory bulb may be affected. Hyposmia affects most (80%) Parkinson’s patients, but about 40% report a decline in olfactory function before the onset of motor symptoms. "The interval between hyposmia and motor symptom onset is about 5 years," Dr. Mizuno said.

The characteristic motor symptoms appear only when most of the dopaminergic neurons in the substantia nigra have died. If the damage progresses further, the cortex may be affected, leading to dementia.

"If you compare clinical and lab findings in Parkinson’s disease dementia and dementia with Lewy bodies, you will notice a lot of similarities: constipation, loss of smell, executive dysfunction, fluctuating cognition, and visuospatial dysfunction," Dr. Mizuno said. "The only difference between the two is the presentation of initial symptoms. If motor symptoms appear first, we call it Parkinson’s disease, while if dementia is the initial symptom, we call it dementia with Lewy bodies."

Dr. Mizuno declared no potential financial conflicts of interest.

http://www.internalmedicinenews.com/news/neurology/single-article/prodromal-symptoms-trace-parkinson-8217s-bottom-to-top-progression/054c4c304d.html


Constipated Patients' Beds Blocked

A report commissioned by the Centre For Physical Health has revealed that thousands of patients suffering from constipation are spending too long in hospital.

The report advises that the blockage is due to a lack of basic support for sufferers after their symptoms have eased.

Dr Phyllis Clitheroe, the widely acknowledged leading expert in the field, stated :

"There is a genuine problem with patients who have been admitted to NHS hospitals suffering from constipation but who have subsequently recovered.

Very often the successful treatment leads to the sufferers experiencing symptoms at the very opposite end of the spectrum and it is then that they need advice and support to cope with their new problems.

But there is absolutely no availability of such facilities".

The report concludes that as a result these patients are kept in hospital for weeks on end when the issuing of a simple advice leaflet would enable them to be discharged and thus free up much needed bed spaces.

Secretary of State for Health Andrew Lansley has promised an urgent investigation into the blockage problem.

http://www.thespoof.com/news/spoof.cfm?headline=s1i94013

Nasal rinsing with Sea Salt Water for Sinus Allergies

People who have sinus disease highly vulnerable to relapse if there are triggers or allergens. But by way of rinsing the nose with salt water sea, the sinuses due to allergies can be mitigated.

Sea salt is commonly used to treat allergic reactions that affect the sinuses. Reported by LIVESTRONG on Wednesday (09/02/2011), sea salt can be used for washing or rinsing the nose or a nasal spray bottle.

Sea salt is believed to be healthier than table salt because it can be efficacious as a therapeutic treatment. Sea salts are hydrates and softens skin to enhance the protective barrier function of skin.

Unlike sea salt and table salt is the source and the way its processing. Processed sea salt from sea water evaporation while table salt is processed underground reserves of salt. Table salt is usually marketed after the added iodine.

Rinsing the nasal cavity with sea salt water to clean the congestion (blocked nose), reducing excess mucus and reduce the symptoms associated with sinusitis and retronasal.

Currently experiencing an allergic reaction, the body can not recognize the actual substance is safe. Substance is regarded as the cause of allergies that can trigger a chain of chemical reactions in the body that can cause various symptoms, like nasal congestion.

Besides causing nasal congestion, allergic reactions mostly cause complications such as sinuses, sneezing, runny nose, runny nose and even a fever. Well, sea salt to cleanse and moisturize the sinuses caused by allergies.

How to do is enter the sea water into one nostril in a state of the head is tilted. Take a few moments and gravity will pull the mucus in the nasal cavity, remove and dispose of air gently. Repeat for the next nose.

According to the University of Maryland Medical Center, rinsing the nose with sea salt water to remove excess mucus, irritants and allergens are trapped inside the sinuses.

If you suffer from allergy sinus, previously discussed with your physician before using sea salt to treat your condition.

However, the American Academy of Allergy, Asthma and Immunology states that the most effective treatment for any allergy is to identify the allergens and avoid exposure to these allergens.

Allergens (allergens) commonly are pollen, dust, pet hair, mold, food, medicines and insect bites.