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I told myself Parkinsons was not going to hold me back, said Chesnut, who perseveres with his family Mindy and children Karley and Nolan in his corner. My doctors play a pivotal role helping make my life better.
Despite his disease, Chesnut said he makes plenty of time for hobbies and coaching sports activities for his kids.
He has continued to stay active, playing golf and using his workout room with a boxing bag in his home.
The co-owner of Design 4, a local printer and design firm, with Mindy, Chesnut said he keeps busy working because every day is different and fun.
I have a great staff at Design 4 whom I rely on to keep the company moving forward with me, he said. I can do everything despite this debilitating disease. I chalk it up to one day and one moment at a time.
While he admits to experiencing fatigue and sometimes has difficulty walking, as well as new symptoms as a result of COVID-19, Chesnut deals with his disease with medication and various procedures.
He started taking dopamine medication and now has a regimen of medication and procedures that help him cope with the symptoms of the disease.
He recently underwent the first of two stages of Deep Brain Stimulation surgery where leads are placed into his brain. The third step will be to place a computer battery in his chest.
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How Does The Levodopa Drug Help In Managing The Symptoms Of Parkinsons Disease
In levodopa drug therapy the patient is given the drug which gets synthesized into dopamine in brain. Levodopa is considered to be the most important drug for the management of Parkinsons disease. This drug is generally given in combination with carbidopa in order to prevent nausea, caused by levodopa. It also enhances the effect of levodopa.
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Symptoms Of Parkinsons Disease
Parkinsons has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Muscle stiffness, where muscle remains contracted for a long time
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include:
The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.
What Causes On/off Episodes In Parkinsons Disease
On/off episodes, also known as off time, typically happen more often as Parkinsons disease progresses, and levodopa becomes less effective.
Carbidopa/levodopa is considered the gold standard in Parkinsons disease treatment, meaning its the most effective for treating motor symptoms, such as tremor, rigidity, and bradykinesia . Levodopa works by crossing the blood-brain barrier and converting into dopamine, low levels of which are believed to be the cause of Parkinsons symptoms. Adding carbidopa to levodopa helps prevent levodopa from breaking down before it crosses into the brain, which helps reduce side effects like nausea and vomiting.
Some people who have Parkinsons start taking levodopa at around three doses per day. If you start experiencing off episodes, your doctor may increase your dose to four or more times per day.
Off time is common: According to patient surveys, around half of patients who take levodopa report experiencing wearing off periods. Of those patients, 25% experience it 3 to 6 hours per day, and 52% have symptoms for 1 to 3 hours a day.
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The Onset Of My Symptoms
The symptoms started while I was traveling as a passenger in a car. My anxiety started to increase, followed by a panic attack. My body became shaky and my movements became slower. In addition, my gait was becoming more like a shuffling pattern.
Balance difficulties added to this change of condition. I felt as if my body was becoming encased in a concrete outer shell. Extreme stiffness quickly came over my entire body. Every inch of my body severely ached right down to the bone! Nonetheless, when the car went over even a small speed bump, I cringed. I hurt.
Admittedly, it was difficult for me to get up from the car seat and open the door. Meanwhile, apathy and fatigue were adding to the situation. My irritability and despair became heightened due to extreme restlessness. I was unable to find a comfortable position for my body. During this time, my thinking ability became impaired.
Finally, we arrived home. My wife assisted me inside to my recliner chair where I rested until the “off time” passed. When it was over, I felt relieved and much better.
Characteristics Of Patients With Wo
According to clinician assessments, patients were divided into the WO group and Non-WO group. Compared with the Non-WO group, the WO group showed younger age at onset , lower weight , longer disease duration , higher H& Y staging , higher daily levodopa dose and daily levodopa equivalent dose , and longer duration of antiparkinsonian medical treatment and levodopa treatment . In terms of the medication types, the WO group used levodopa/benserazide , levodopa/cabidopa , pramipexole , and amantadine more frequently than the Non-WO group. In addition, the WO group was much frequently treated with polytherapy of levodopa and other medications compared to the Non-WO group . No difference was found in the gender ratio or age between the two groups. In order to identify the WO-associated factors, we included all factors that showed significant differences into the multivariate logistic regression model. It showed that disease duration , H& Y staging , and the LED were associated with the occurrence of WO.
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Medicines For Parkinsons Disease
Medicines can help treat the symptoms of Parkinsons by:
- Increasing the level of dopamine in the brain
- Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
- Helping control non-movement symptoms
The main therapy for Parkinsons is levodopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy such as nausea, vomiting, low blood pressure, and restlessness and reduces the amount of levodopa needed to improve symptoms.
People living with Parkinsons disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.
The doctor may prescribe other medicines to treat Parkinsons symptoms, including:
- Dopamine agonists to stimulate the production of dopamine in the brain
- Enzyme inhibitors to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
- Amantadine to help reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
Many Dont Manage Off Time Well
In the Parkinsons Disease in America 2017 survey, 80% of people with PD reported they currently use a carbidopa/levodopa therapy to treat their symptoms. Carbidopa/levodopa treatment is the most effective treatment available for the management of motor symptoms of PD.
However, half of the survey respondents who use carbidopa/levodopa therapy are experiencing off times. Twenty-five percent of those experiencing off times notice their symptoms for 3 to 6 hours a day.
Another 52% report 1 to 3 hours a day when their symptoms are noticeable and affecting their daily activities. Yet 43% of those experiencing an off time report that they dont take any action to manage these episodes.
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Facilitators Of Discussing Off Periods
Physician ratings of facilitators to the discussion of OFF periods are shown in . The facilitator most commonly identified by both general neurologists and movement disorders specialists was the presence of a care partner at the clinical visit . A high percentage of general neurologists and movement disorders specialists also already used this strategy for communication . Free-flowing dialogue was the next most commonly reported facilitator in both groups . Again, a high percentage of both physician groups reported already using this method for communication . Incorporating a teach-back technique in communication was identified as a facilitator by a high percentage , but was less commonly implemented as a method of communication . A multidisciplinary approach incorporating allied health personnel such as nurse educators was seen as a facilitator by both groups , but less used by general neurologists than movement disorders specialists .
What Causes Parkinsons Disease
Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.
People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.
Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.
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Living With Parkinsons: What Is Off
The terms ON and OFF have been used to describe responses to Levodopa therapy for over 40 years. However, to this day, theres still no universally agreed upon definition for the term OFF.
This poses a problem for the doctors who are expected to recognize it and the people living with Parkinsons who try to describe it.
When both sides interpret OFF in different ways, it often means that people with Parkinsons dont get the interventions or treatments they need to reduce their OFF periods and live well with Parkinsons.
In an attempt to help you become a better advocate for yourself, this article will highlight four different types of OFF and why they happen. We will also offer a list of questions and a working definition of OFF that you can take with you to your next doctors visit.
Parkinsons Disease Symptoms Everyone Should Know
Parkinsons disease symptoms can include tremor and trouble with movement, along with emotional and cognitive changes.
Parkinsons disease symptoms can vary significantly from person to person. Some people may have range of motor symptoms, like tremor, stiffness, and slow movements. Others may also experience the non-motor symptoms of Parkinsons disease, such as anxiety, cognitive changes, and loss of smell.
It has to do with a chemical messenger known as dopamine, which plays a role in the brains ability to control movement, coordination, and emotional responses. In Parkinsons disease, the brain cells that produce dopamine either stop doing their job or they die out, resulting in both motor and non-motor symptoms. Its not always easy to tell if someone you care about has Parkinsons disease. Lets take a closer look at the symptoms of the disease and signs that someone should make an appointment with their doctor.
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Omaha Business Owner Shares Battle With Parkinsons Disease To Raise Awareness
Nic Chesnut is co-owner of Omaha printer and design firm Design 4 with his wife, Mindy. First diagnosed with Parkinson’s disease in 2013, Nic has worked hard to maintain his normal life for as long as his body lets him.
Nic Chesnut has always taken pride in being in charge of his life.
Since he was diagnosed with Parkinsons disease in 2013, he has worked hard to maintain his normal life for as long as his body lets him.
Now, nearly 10 years later with the disease continuing to progress, hes taking charge of his life and his condition with surgery and a positive outlook that anything and everything is possible.
Change is always hard in your life everyone has change, Chesnut said. This is just a different type of change for me. Im always in charge of me. This surgery will allow me to stay in charge of myself.
Nics wife, Mindy, first noticed his early signs of Parkinsons when she saw his hand moving involuntarily while reading the paper.
This led them to start researching doctors, and Nic attended a Parkinsons disease conference in Omaha following his diagnosis to learn as much as he could.
How The Parkinsons On
Ideally, when you take doses of a medication like levodopa on a regular schedule, you shouldnt notice much of a difference in your symptoms between doses. In other words, your symptoms should remain relatively constant over time, regardless of when you last took your medication.
However, when the on-off phenomenon starts in Parkinsons disease, youll feel better as a new dose of your medication starts to take effect, and worse before youre due for another dose. Eventually, the duration of on states becomes shorter and the wearing off happens sooner .
Some experts have described the on period as akin to switching on a light, and the off period as the lights going off.
In an on state, the person with Parkinsons disease may feel energetic and able to move around more easily. However, in an off state, the person may become very stiff, slow, and may even be unable to move at all for a few minutes. A person may also have difficulty speaking, and you may notice him or her slurring their words. As you can imagine, the off state can be quite uncomfortable.
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Can An Off Episode Be Prevented
Eventually, most people with PD develop OFF episodes. Some people develop OFF episodes sooner than others.
Researchers have found evidence that taking high doses of levodopa may increase your risk of OFF episodes. It may cause greater fluctuations in your dopamine levels.
Its important for your doctor to prescribe the lowest dose of levodopa necessary to manage your symptoms. This may help limit fluctuations in dopamine and reduce your risk of OFF episodes.
If you think you might be experiencing OFF episodes, let your doctor know. They may adjust your prescribed dose or formulation of levodopa/carbidopa. They may also prescribe other treatments to manage OFF episodes.
If youre experiencing OFF episodes, your doctor may recommend one or more changes to your treatment plan.
They may:
In some cases, your doctor may recommend deep brain stimulation . In this procedure, a surgeon implants electrodes in the brain and a small internal pulse generator in the chest or abdomen. The internal pulse generator sends electrical signals to the brain to help control symptoms of DB.
Each treatment option carries a different risk of side effects. Ask your doctor about the potential benefits and risks of different treatment approaches.
What To Expect After Dbs
Surgery to implant the leads generally entails an overnight stay, while the IPG is usually implanted as same-day surgery. During recovery, your surgeon will talk to you about caring for your wounds, when you can shower, and any activity restrictions. Its usually recommended that any heavy lifting be avoided for a few weeks.
After another two to four weeks, youll return to have your device programmed. This process will continue for several weeks to ensure the stimulation settings are optimal to control your symptoms. During these visits, you will be shown how to turn the device on and off with the handheld device and check the battery level.
Once the programming has been completed, you will have regular follow-up visits to check and adjust the stimulation to maintain the most benefit for your symptoms.
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