[Music Playing] >>Lori Banks: Coming up on this edition of Being Well our topic is Parkinson's disease.

Dr. Manishkumar Gorasiya from Paris Community Hospital Family Medical Center will be our guest.

He'll explain the nature of the disease and how doctors diagnose and manage it.

We'll learn about the early symptoms and the 3 types of treatment options.

That's all coming up next so stay right here Being Well starts now.

[Music Playing] >>Female Speaker: Production of Being Well is made possible in part by Sarah Bush Lincoln Health System.

Supporting healthy life styles, eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health Systems.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online or at 347-2255.

>>Chorus: Rediscover Paris.

>>Female Speaker: Our patient care and investments in medical technology show our on going commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

>>Lori Banks: Welcome back to this edition of Being Well.

I'm your host Lori Banks and Dr. Gorasiya has joined us today from Paris Community Hospital Family Medical Center.

Thanks so much for coming by.

>>Dr.

Manishkumar Gorasiya: Thank you.

>>Lori Banks: You're new to the area and to this show so tell our viewers a little bit about yourself and your practice.

>>Dr.

Manishkumar Gorasiya: Well my name, as you mentioned, is Dr. Gorasiya.

My first name is Manishkumar.

Basically I am from India.

I finished my med school back in India.

I moved to the state in 2007 and I did my Masters in public health from Florida International University, which is in Miami, Florida.

After that I moved to Chicago, worked for home health and a home physician group for a couple of years and then I got into residency in family medicine in Montgomery, Alabama.

I just finished my residency and I moved to Paris.

Currently I am [both] a certified family physician.

My [element of interest] is [specially] [unclear dialogue] population and chronic medical problems in elder populations.

However, I see patients from all different ages.

>>Lori Banks: Alright, so we're talking about Parkinson's and I was telling you that I had gentleman come up to me in a local store and said "I watch Being Well.

Have you thought about having a show on Parkinson's?"

Because he has it and we thought "We've never covered that before."

So we've brought you here today to talk about the disease.

Give us a little background on the nature of Parkinson's and where does the name come first of all.

>>Dr.

Manishkumar Gorasiya: Ok.

So let me tell you first of all about its history.

There was a person named James Parkinson he wrote an article in 1817.

He has published this article named Shaking Palsy and at the time everyone knew about the symptoms of Parkinson's.

But 450 years ago back in [India] ancient medical systems known as [I-radar] they mentioned a diseased called Kampavata.

If you break down this word Kampavata, kamp is tremor, which is shaking, and vata is slow movement, which is of course a symptom of Parkinson's disease.

And they used to treat with plants and the plant name is Mucuna Pruriens.

And then scientists have worked on this plant, why this is helping with this disease.

And they found it to have L-dopa which is a [unclear dialogue] or Parkinson's disease in [the current world].

>>Lori Banks: Really?

That is interesting.

So is this a chronic disease, is it a generative disease?

How do you categorize Parkinson's?

>>Dr.

Manishkumar Gorasiya: In medical terminology we can say Parkinson's disease, which is also known as paralysis agitans, is a neurodegenerative progressive disorder.

Parkinson's Disease is the most common cause of Parkinsonism.

Parkinsonism is a syndrome manifested by symptoms of shaking, which is tremor, slow movement, which is parakinesia, postural instability, which is poor balance, and stiffness, which is rigidity.

So this constellation of symptoms is Parkinsonism.

And Parkinson's disease is one of the most common causes of the symptoms.

If we break it down for our viewers we can say it is a brain disorder which mainly effects the movements, which over a period of time it can get worse.

>>Lori Banks: Ok. >>Dr.

Manishkumar Gorasiya: And as it gets worse it can also make a person to have a dysfunction of other brain functions, which is learning, memory, and behavior.

>>Lori Banks: So it starts with something like a tremor, you know, something muscular, is that how it typically presents itself?

>>Dr.

Manishkumar Gorasiya: Yes.

>>Lori Banks: And then over time gets worse?

So it is degenerative?

>>Dr.

Manishkumar Gorasiya: Yes.

>>Lori Banks: Ok. >>Dr.

Manishkumar Gorasiya: You can see, like most of the people are aware of what is arthritis, which is again, a degenerative disease.

The same way, Parkinson's disease is a degenerative disease only it starts affecting your brain, certain parts of your brain and it grows worse and worse.

>>Lori Banks: So is it a message in the brain that's not getting to the right places?

Or what's kind of going on in a Parkinson's person's brain?

>>Dr.

Manishkumar Gorasiya: Ok so our brain has certain areas we call substantia nigra and the surrounding area [thalamus].

That particular area is responsible to manage the function of one of the chemicals in the brain we call dopamine.

And once after certain areas, for unknown reasons, if that area stops making that particular chemical, dopamine, it can cause all of these symptoms.

>>Lori Banks: Ok.

So, in your practice, do you have any Parkinson's patients that you're treating right now?

>>Dr.

Manishkumar Gorasiya: Yes, I started seeing nursing home patients and they do have Parkinson's disease and most of them are managed by me and some of them are also seeing specialists.

>>Lori Banks: Ok, so we're going to get into the treatment in just a little bit, but what is a typical age of onset?

Who is more at risk for getting Parkinson's in our population?

>>Dr.

Manishkumar Gorasiya: Ok. Let me discuss about how common it is in our world and especially North America.

The prevalence is the number of cases at a particular point in time.

The worldwide prevalence is 0.3% for gender population, aging people more than 40 years of age, which is approximately 7 million.

It increases with the age.

If we assume that [longitivity] will be increasing from this point in time, by 2030 it will be 9 million.

And this is again, worldwide.

For North America the prevalence is 100-200 per 100 K people of gender population aging more than 40 years of age.

>>Lori Banks: So the earliest it starts is people in their 40s or later in life?

>>Dr.

Manishkumar Gorasiya: It can start at the age of 40.

There are some of the cases who have Parkinson's Disease before age of 40 which is rare and in that case genetic factor is the reason, most likely.

The mean age of diagnosis of having Parkinson's disease is 70.5 years.

>>Lori Banks: Alright, that was one of my questions, is it hereditary or is it genetic in nature?

>>Dr.

Manishkumar Gorasiya: Genetics plays a key role.

It's 10-15% of the time if you ask the person with Parkinson's Disease, "In your family anyone have a Parkinson's Disease?

", they will say 10-15% of the time that one of the first [unclear dialogue] they have Parkinson's Disease.

>>Lori Banks: Ok, so that plays a role but it's not a major role.

>>Dr.

Manishkumar Gorasiya: Yes, one of the biggest risk factors is aging.

>>Lori Banks: Ok. >>Dr.

Manishkumar Gorasiya: And then family history, then there are other factors which are not clearly shown in studies that they are the risk factor.

What is associated with risk factors are infection, and some of the medication, which can give the symptoms of secondary Parkinsonism.

>>Lori Banks: So really it's unlike a lot of other diseases we have like heart disease and diabetes their kind of maybe not a lot that we can do to prevent this.

We can't change our genetics and we can't change getting older.

So let's talk about some of the early symptoms that people may see if they may by diagnosed with Parkinson's.

>>Dr.

Manishkumar Gorasiya: At first the person with Parkinson's disease can have shaking.

70% of the time when a person comes to the doctor or a person by themselves realize they notice they have shaking is 70% of the time.

Other thing that Parkinson'’’s disease can make patients do is move slowly.

>>Lori Banks: Like walking slowly?

>>Dr.

Manishkumar Gorasiya: Walking, performing daily activities like buttoning their shirts or doing computer work or using a mouse click.

All of these movements get slower.

If they walk they probably can be dragging their legs and sometimes follow steps very slow and kind of shuffling.

>>Lori Banks: So when should someone see their doctor if they're suspecting that "gosh I may have this"?

>>Dr.

Manishkumar Gorasiya: Ok, now as I mentioned that patients can have shaking and slow movement, but before that sometimes patients may notice, or not notice, feel that internal shaking of the limb.

>>Lori Banks: Ok. >>Dr.

Manishkumar Gorasiya: But it's not noticeable.

Patients cannot see, other people cannot notice, but the patient may feel that.

>>Lori Banks: They may feel it inside.

>>Dr.

Manishkumar Gorasiya: Inside.

>>Lori Banks: Ok. >>Dr.

Manishkumar Gorasiya: That it's shaking.

One other thing that comes before this is inability to sense or smell.

That smell can get diminished before all these symptoms appear, but it's difficult for a person to realize.

Once a patient starts having these symptoms or they have any concerns they need to discuss with their doctor that they are having these symptoms that might be Parkinson's disease or something else.

And they also need to think "Ok, one of my family members has Parkinson's Disease, so I'll be having an increased chance of having Parkinson's disease."

So once they realize "Ok, something is going wrong" they need to come to their doctor then the doctor can do thorough general and neurological examinations, goes through history, and goes from there.

>>Lori Banks: So they may see a family care physician, do they often see some kind of specialist as well?

>>Dr.

Manishkumar Gorasiya: It depends on the severity of the Parkinson's disease at the time of presentation.

Some patients will be waiting until it progresses a lot.

At that time, primary care physicians always start on medication, but if the patient and family insist and the doctor thinks they need a second opinion then they can send it to a neurologist or a movement disorder specialist.

I have one patient who is managed by a neurologist.

>>Lori Banks: Ok, so is the prognosis better if it diagnosed early and the treatment starts?

Because it is a degenerative disease, but can you slow it down a little bit?

>>Dr.

Manishkumar Gorasiya: Unfortunately there is no medication available which helps to slow it down.

>>Lori Banks: Ok. >>Dr.

Manishkumar Gorasiya: We do have a treatment option available just to control the symptoms.

>>Lori Banks: Ok, alright.

So what kinds of medications do people take if they have Parkinson's?

>>Dr.

Manishkumar Gorasiya: Treatment wise there are 3 choices available at this point.

Number 1 I would say non-pharmacological measure.

Number 2, pharmacological measure, and number 3, surgical intervention.

Non-pharmacological measure contains, once the patient has been diagnosed and patient and family education.

So once the patient is diagnosed and he knows he has Parkinson's disease that will be frightening for any one of us.

>>Lori Banks: Oh absolutely.

>>Dr.

Manishkumar Gorasiya: So knowing about the disease and treatment choice availability that would make the patient calm and that would be always beneficial.

Second thing is a support group.

The support group will provide for the family and patient to interact with other patients and their family with how they are doing, what they have done, what things need to be taken care of.

Third thing is physical exercise that will be a preventive factor as well.

As we discussed about risk factors I forgot to mention about prevention factors.

One of the preventive factors is regular physical exercise can decrease the risk of having Parkinson's disease.

Again, once you're diagnosed with Parkinson's disease and if you do regular physical exercise like swimming or brisk walking that will decrease your symptoms of ridigty and poor balance.

Nutrition can help.

Later in stage, Parkinson's can have a patient constipated.

So if you eat high fiber diets that can help with constipation.

Also, they have slow response, they have a decrease in judging of the distance so they are not safe drivers, so that needs to be [reevaluated].

The home environment needs to be [reevaluated] like the rugs or cluttered furniture.

>>Lori Banks: Nothing in the way.

>>Dr.

Manishkumar Gorasiya: Yeah, like a hood light and a grab bar in the shower.

So all of these factors are considered all part of a non-pharmacological measure.

If you consider pharmacological measure there are a couple of medications, mainly L-dopa and dopamine agonist which is Pramipexole, Requip which is a brand name for another medication.

It's in other medications as well, epimorhpine which is available IV.

So it's available in pill form, like oral form, topic form, and IV form.

So mainly we start with L-dopa and dopamine agonists.

There are other medications as well [unclear dialogue], [unclear dialogue].

So it depends at the time of presentation and diagnosis depends on age, severity, and how [active] the patient is.

The doctor and patient can discuss about medication and side effects.

We can start on one medication and we add another as well if the patient needs it.

>>Lori Banks: And then the third option is surgery.

>>Dr.

Manishkumar Gorasiya: Surgery.

Currently, the surgery, we call it [deep] brain stimulation.

How they perform it, the patient must have one surgery to put the wires in some part of the brain, which controls the movement.

So once that wiring has been done they will connect those wires to one device, which usually they put beneath the collarbone.

And then that device can control the access of [unclear dialogue] movements.

>>Lori Banks: So it's not curing it, it's subsiding the symptoms.

Ok. What is kind of the progression?

So if you're diagnosed, in some people does it progress really fast and other people, slower?

What have you seen?

>>Dr.

Manishkumar Gorasiya: The progression varies from one person to another person.

For example, as the patient is diagnosed with Parkinson's disease it's in mild form.

As it gets worse, the patient's daily activity will be compromised.

At that point we can say the patient's functional state is impaired.

As it further progresses it will be worse at a point that a patient needs assistance from other people for the daily activities.

And we can call at that stage, a disability.

From [impairment] stage to disability stage it varies from 3-7 years.

And mean survival is from the diagnosis of Parkinson's Disease is 6-22 years.

>>Lori Banks: Alright.

That's a big range.

>>Dr.

Manishkumar Gorasiya: Yes, so it varies from one person to another person.

>>Lori Banks: What eventually, it's not a disease that can be cured; do people succumb to the disease eventually?

Or what happens in its later stages?

>>Dr.

Manishkumar Gorasiya: Unfortunately at this point we don't have any medication, which can cure, or slow the progress, but researchers and scientists, they are working on it.

So I hope they will find something.

But as this is progressed the patient can have no motor symptoms which is not related to movement, like anxiety, depression, psychosis, which can be because of Parkinson's Disease or long term medication side effects.

They have sleep problems.

They have a walking problem.

They'll be bed bound, wheelchair bound.

And the cause of death with patients of Parkinson's disease is when this disease will hit the muscle of the lungs, which is slow movement.

If the lungs are not functioning well the patient cannot get a breath in and out and that can be a dreadful event.

Another complication can be that over a period of time as the disease is progressed the patient has difficulty swallowing, an increase is salivation.

So if the patient has difficulty swallowing sometimes they [unclear dialogue] some of the food particles, they have pneumonia and it's the sequence of complications.

>>Lori Banks: So you mean that the Parkinson's can cause other things to happen?

>>Dr.

Manishkumar Gorasiya: Yes.

>>Lori Banks: Ok. You had mentioned, I should have asked this earlier, does it happen more in men or women?

>>Dr.

Manishkumar Gorasiya: Yes.

The study says that men have a higher risk of getting Parkinson's disease than women.

>>Lori Banks: Ok. >>Dr.

Manishkumar Gorasiya: And smoking exposer, researchers mentioned that is associated with a decreased chance of having Parkinson's disease.

Same as coffee and caffeine intake, it decreases the chance of having it.

So smoking, coffee, caffeine, and regular physical exercise those are [projective] factors, but I still say do not smoke.

>>Lori Banks: Well yeah there are many reasons as we've done many of these shows, smoking and caffeine and physical activity and all of those things they can, if you don't do those, they can help stave off other diseases as well.

Is Parkinson's sometimes misdiagnosed or maybe the symptoms can maybe mimic maybe something else?

>>Dr.

Manishkumar Gorasiya: Yes.

As I mentioned earlier, that is most common cause of Parkinsonism.

And there are so many other factors or reasons, which can give you Parkinsonism.

The most common reason after Parkinson's disease is drugs, like metoclopramide, which is nausea, vomiting medication, [antipsychotic] medication.

A person who has bipolar disorder who takes antipsychotic medication they can have the same symptoms.

Then infection, HIV AIDS, neurosyphilis, [anencephalitus], all of these factors can cause secondary Parkinsonism.

Even heavy metal exposure like lead, copper, manganese.

Liver failure, that can give you some symptoms of Parkinson's disease.

>>Lori Banks: But that's not Parkinson's.

>>Dr.

Manishkumar Gorasiya: That's not Parkinson's disease.

Symptoms of Parkinsonism are similar to Parkinson's disease.

This patient does not get benefitted from medication, sometimes they do, and sometimes they don't.

It depends on why they have those symptoms.

It's always been difficult to diagnose this.

That's why it is a clinical diagnosis, it's based on a patient'’’s history, sign and symptoms, and physician'’’s evaluation based on general examination and thorough neural examination.

After that, the physician can give a trail of medication.

If the patient gets better, the patient has Parkinson's disease.

Still they do MRIs of the brain to rule out the other causes of the disease, but the MRI does not help to confirm the diagnosis of Parkinson's disease.

>>Lori Banks: In this last, we've got about 30 second left, if someone's watching and maybe they have a parent or maybe they themselves think "Oh boy, I may have some of these symptoms" what should they, when they make their appointment to see their primary care doctor, what kinds of things should they be asking and bringing up so that can help you as the doctor move the process along and help them find out if they have it or not.

>>Dr.

Manishkumar Gorasiya: First of all, once they are concerned about having Parkinson's Disease go see your primary care doctor, discuss what's bothering you, and then go from there.

Also, ask questions about once you are diagnosed, the medication options, when to start medication, and if you need to see a specialist or not.

>>Lori Banks: Ok, alright.

But early diagnosis and make sure you ask those questions to your primary care doctor.

>>Dr.

Manishkumar Gorasiya: Absoutely.

>>Lori Banks: Alright, Dr. Gorasiya thank you so much for being on our show and welcome to Central Illinois.

>>Dr.

Manishkumar Gorasiya: Thank you.

It was my pleasure.

>>Lori Banks: Thank you.

>>Female Speaker: Production of Being Well is made possible in part by Sarah Bush Lincoln Health System.

Supporting healthy life styles, eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health Systems.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online or at 347-2255.

>>Chorus: Rediscover Paris.

>>Female Speaker: Our patient care and investments in medical technology show our on going commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

[Music Playing]