What Does A Neurologist Do
The neurologist will want to know why you came, your medical history, your family history , and what, if anything, in your social and work history may have contributed to your symptoms. Bring a summary of your medical history, including serious and chronic illness, hospitalizations, surgeries, allergies, medications taken, family and personal background, occupational risks, and lifestyle risks. If what you have to talk about is difficult to discuss, practice how to bring it up. If you expect bad news, bring someone supportive with you.
The doctor or his assistant may ask you about your activities of daily living. These include questions about your speech, salivation, swallowing, handwriting, cutting food and handling utensils, dressing, hygiene, turning in bed, falling, freezing, walking, tremor, and sensory symptoms. This review of your daily activities is not a laundry list. Careful and imaginative questioning is very helpful.
It’s helpful for the doctor to obtain specimens of your handwriting and compare them with past samples. This may show when your disease actually began. In some people it’s reassuring to know they had PD for several years before they were aware of their symptoms. This implies their PD is progressing more slowly than they thought.
What Other Specialists Can Help Manage My Care
The physical, psychological, and quality-of-life effects of PD are often best managed using a team approach. Your medical team will likely include a neurologist, primary care provider, and an internal medicine specialist. To help you handle specific symptoms and better manage your day-to-day life, it can also be useful to work with occupational and physical therapists, mental health counselors, and a registered dietician.
Newly Diagnosed With Parkinsons: Blakes Story
I went to my doctor and I was shaking. He said, you need to see a neurologist. So, I got an appointment with a neurologist and he told me I had Parkinsons disease.
At first, I thought that cant happen to me. It happens to other people. Thats how I spent the first few years, in denial.
Then, I started living a more active lifestyle and exercising. I also started reaching out to others. Sharing and talking with other people that were going through what I was helped. I reached out to Parkinson Canada and registered for Parkinson Canada SuperWalk. I posted on my Facebook asking for donations and told people about my diagnosis. Participating, and sharing, became part of my healing.
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Look For A Parkinsons Specialist
Both general neurologists and movement disorders specialists care for people living with Parkinsons. It takes about 12 years in the U.S. to become a general neurologist a doctor who works with brain and central nervous system conditions. This includes a four-year undergraduate college degree, four years in medical school and three to four more years of specialized training in a neurology residency. General neurologists typically work in a hospital, or private or group practice. Some neurologists treat many people with Parkinsons and are knowledgeable about the disease. However, most neurologists have diverse practices, of which PD represents only a small percent.
Most movement disorders specialists are neurologists who have completed another one or two years of movement disorders training, a neurology sub-specialty. Movement disorders specialists may see patients in a private practice or at university medical centers. They often perform clinical or basic science research in addition to caring for patients. They may also teach doctors who are becoming specialists.People with Parkinsons may constitute 50 percent or more of a specialists practice. With this level of experience, a movement disorders specialist will be more familiar with the range of available Parkinsons medications, how they work and possible side effects. A movement disorders specialist is also more likely to discuss the role of clinical trials.
Working With Your Care Team
Once you have chosen members of your care team how can you best interact with them? You and your team want the same thing: They want to give you the best possible care they can and you want to receive the best care available. Why then do so many persons with PD not get the best possible care available? One reason is that communication between patient and care team breaks down.
How can you keep the communication lines between you and your healthcare team open? Here are a few tips.
For every visit to a health professional try to have the following information written down so that you can hand it over to the secretary instead of having to repeat it ad infinitum:
- Your name
- Insurance information and member number
- Date of birth social security number
- Current medications, including over the counter medications and any nutritional supplements you use, the dose you take, and the purpose of the medication
- Known allergies or adverse reactions to medications or common medical equipment
- Current health problems and dates of onset
Don’t forget that medication errors are all too common. You should learn a few ideas to reduce the chance of a medication error.
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How Is Parkinsons Disease Treated At Orthoneuro
Parkinsons Disease is generally managed with medications as well as lifestyle changes. For instance, your OrthoNeuro Neurologist may recommend a consistent exercise routine.
There are a variety of medications used to treat the symptoms of Parkinsons Disease that your OrthoNeuro Neurologist will discuss with you. Your OrthoNeuro Neurologist will monitor your reaction to these medications and adjust dosages as needed until your symptoms are controlled.
Peripheral Neuropathy And Parkinsons Disease
A number of studies have tried to determine if PN is more common among people with PD as opposed to people without PD. PN is a relatively common condition in the general population, which makes it difficult to ascertain whether or not it is even more common among people with PD.
The available studies have varying results and are difficult to compare with each other as they:
- Include different types of populations of people with PD
- Assess peripheral neuropathy differently
- Assess for causes of peripheral neuropathy differently
A recent review looked at all the available data and determined that large fiber neuropathy was present in 16% of patients with PD, about double the prevalence of this condition in the general population. Skin biopsy-proven small fiber neuropathy was present in over 50% of people with PD, although this result was based on a small sample of patients.
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Health Care Utilization And Outcomes
In a subgroup of 124,173 Medicare beneficiaries with a claims diagnosis of PD but without incident stroke/TIA, those cared for by a neurologist had the lowest 1-year SNF placement rates compared with patients cared for by all types of primary care physicians . The highest SNF rate was among those seen by geriatricians , followed by internists and then family practice physicians . In a logistic regression model that adjusted for age, race, sex, comorbidity index, and socioeconomic deprivation, patients with PD who received neurologist care were less likely to be placed in a SNF . In an analysis of all incident cases of PD, treatment by a neurologist was associated with a lower likelihood of hip fracture .
Multidisciplinary Movement Disorders Clinic
Patients who come to the Movement Disorders Clinic are seen by a movement disorders specialist, a neurologist who has extra training in evaluating and treating a person with Parkinsons disease. There are no blood or imaging tests that can confirm Parkinsons disease, so diagnosis is based on visible signs and symptoms, which are reviewed during a medical history and neurologic examination.
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Parkinsons Foundation Center Of Excellence
Mount Sinai Beth Israel is designated as a Center of Excellence by the Parkinsons Foundation, specialized team of neurologists, movement disorder specialists, physical and occupational therapists, mental health professionals and others who are up-to-date on the latest Parkinson’s disease medications, therapies, and research to provide the best care.
Hip Fractures And Survival
To investigate whether treatment by a neurologist was associated with differences in clinical outcomes among patients with PD, we compared 1-year risk of hip fracture between neurologist-treated and primary care physiciantreated patients with PD. Because race and sex also have been shown to affect baseline hip fracture risk, our logistic regression model for this analysis consisted of hip/pelvic fracture as the main effect variable, with race, sex, socioeconomic deprivation, and modified comorbidity index and age as covariates.
For survival analyses, we extracted vital status information for each patient from 2002 to 2008. Cox proportional hazards models were used to compare survival between neurologist- and primary care physiciantreated patients with PD, controlling for age at diagnosis, race, socioeconomic deprivation score, and modified comorbidity index. The time-to-event variable was from the beginning of the study period to the date of death . The surviving patients were censored at the end of the calendar year 2008.
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Communicating With Your Doctor
One of the most important parts of getting good medical care is communicating with your doctor and health care team, so you can make smart, informed decisions about your health. That includes getting detailed information about your condition, how it can be treated, what the possible side effects of different treatment options are, and what you can do to improve your quality of life. It also includes information about coping with your diagnosis and treatment, both emotionally and physically.
Physician Encounter And Referral Patterns
Medicare provider specialty codes identified the physician specialty for each patient encounter. We restricted analysis to patients with PD who had claims generated by physicians specializing in neurology, internal medicine, family practice, or geriatric medicine . We calculated neurologist encounter rates over a 48-month period by examining carrier files for the cohort from January 1, 2002, to December 31, 2005 . Logistic regression with incident cases for the primary analysis was used to determine the odds of receiving neurologist treatment. In a second model, we assessed the effect of racesex combinations on the likelihood of receiving neurologist care. Both models included the following covariates: modified comorbidity index and socioeconomic deprivation.
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Treating Parkinsons Disease And Other Movement Disorders
Patients suffering from Parkinsons disease and other types of movement disorders face a daily struggle to interact with the world around them like they used to. Our neurologists and neurosurgeons understand the struggles that our patients face, and work directly with those in their care to craft an individualized treatment plan that will help them manage their symptoms and improve the quality of their life.
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Much more can be found inourEvery Victory Counts®manual.Its packed with up-to-date information about everything Parkinsons, plus an expanded worksheets and resources section to help you put what youve learned into action.Request your free copy of theEvery Victory Countsmanual by clicking the button below.
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How Was The Study Performed
Willis et al. reviewed Medicare data to explore 2 questions. First, what characteristics determine whether a patient with Parkinson disease sees a neurologist? Second, are patients who see a neurologist likely to live longer than patients who do not see a neurologist? The Medicare data for this study data came from insurance claims. When a doctor sees a patient, he or she provides some basic information on forms sent to Medicare as reasons for payment, such as the diagnosis being treated. This type of data is powerful due to the large number of patients with these data. However, insurance claim-based data sources lack detailed information, so reaching definite conclusions is difficult. For example, an insurance claim just records that a patient has a diagnosis of PD, but does not record symptoms, how long he or she has had the disease, or how severe the symptoms are.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
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Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
Doctors Who Treat Parkinsons Disease
Primary care physicians are often the first to see patients with symptoms of Parkinsons disease. Symptoms of Parkinsons disease mimic those of other conditions, and Parkinsons disease is widely misdiagnosed. Since early and expert intervention can ensure proper diagnosis and effective treatment, it is important to be evaluated at an advanced brain center as soon as possible.
The multidisciplinary team at the Weill Cornell Medicine Brain and Spine Centers Movement Disorders service expert neurosurgeons along with their team of physicians, nurse practitioners, physician assistants, nurses, physical therapists, and pain management specialists provide comprehensive, integrated care for patients with Parkinsons disease and many other conditions of the brain. Patients receive a complete continuum of care, from diagnosis to treatment and recovery.
We generally begin with nonsurgical, non-invasive options to treat Parkinsons disease, usually managed by one of our expert movement disorders neurologists . For patients who do need surgery, we offer the latest in minimally invasive and non-invasive surgical techniques using state-of-the-art equipment. Patients respond faster, have less pain, and get back to their normal daily activities sooner than they could with older surgical methods.
At the Weill Cornell Medicine Brain and Spine Center, patients with Parkinsons disease may also be seen by:
- Associate Professor of Clinical Neurological Surgery 718-780-5176
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Members Of The Healthcare Team
Who should make up your care team? At a minimum you will need:
- A primary care healthcare provider who looks after your day-to-day medical needs. This may be someone who you have seen for many years and knows you well, or you may need to find a primary care healthcare provider.
- A neurologist who specializes in movement disorders. This is most important as a neurologist in movement disorders will likely be able to help you find others who are experienced in Parkinson’s disease to fill out your healthcare team.
- A counselor or psychiatrist or psychologist who can help you manage potential emotional and mental health problems is they arise
- Allied health professionals like physical therapists, occupational therapists, sleep medicine specialists and so forth. Your neurologist should be able to help you find the allied health professionals right for you.
- Yourself – Part of being an empowered patient is playing an active role in your care.
- Your partner – Parkinson’s disease can have a tremendous impact on relationships, and including your partner or other family members can be very helpful in managing the disease.
All of these people will, of course, need to communicate with one another, but the key figure for management of your Parkinson’s symptoms will be your neurologist. So how do you find a neurologist who is right for you?
Don’t overlook your own role as a very important member of your healthcare team, as well as that of your family.
In Addition To Getting Treatment From A Neurologist Are There Other Support Groups I Can Tap Into
Many people find it helpful to join a support group to help manage the physical and psychological effects of the day-to-day realities of Parkinsons disease. It is not hard to find a support group in your area. They are organized all over the country by many different organizations.
Support groups vary in size and format, so dont feel discouraged if it takes more than one try to find a suitable group. If you arent interested or cant leave your home, there are also online groups and forums that can help reduce the isolation that can come with Parkinsons disease. Ask your doctor or health care provider, if you need help finding groups in your area.
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Parkinson’s Patients Do Best If Treated By Neurologist
Study Shows Parkinson’s Patients Cared for by Neurologists Are Less Likely to Be Put in Nursing Homes
Aug. 10, 2011 — People with Parkinson’s disease may live longer if treated by a neurologist, a new study suggests.
The study also found that Parkinson’s patients who see a neurologist are less likely to be placed in a nursing home and less likely to break a hip.
The study is published in Neurology.
“This is a very interesting and unique investigation,” Washington University researcher Allison Wright Willis, MD, tells WebMD. “There are ways that we can help improve the lives of people with Parkinson’s disease beyond discovering a cure and beyond discovering the cause.”
Researchers analyzed the records of nearly 138,000 newly diagnosed Parkinson’s disease patients receiving Medicare seen in outpatient clinics during 2002. Between 2002 and 2005, 58% of them were treated by neurologists.
The fact that more than half of Parkinson’s patients are already seeing a neurologist for treatment is reassuring to James C. Beck, PhD, director of research programs at the Parkinson’s Disease Foundation.
“But that still leaves a large number, over 40%, who are not seeing a neurologist for their care,” Beck tells WebMD. Beck was not involved in the study.
The study revealed that women are 22% less likely than men to see a neurologist, and minorities are 17% less likely than whites to see a neurologist.