Education

12 Medication Management Tips That May Save Your Life

December 1, 2017 Awareness, Education, Life

What can be done to help older adults take medications safely? Take care to avoid some of the more common medication mistakes, such as taking drugs incorrectly or taking more than is prescribed. Pill dispensers, organizers and even reminder services can also be useful tools for some.

That being said, nothing substitutes for responsible caregiver advocacy and being proactive about the drugs we and our loved ones are taking.

Here are some other tips to keep in mind:

1. Ask your provider if the dosage is age-appropriate.

Because of the way our bodies metabolize various drugs as we get older, seniors can be more sensitive to some drugs and less sensitive to others. They are also more likely to experience adverse effects. Double-check with your doctor or pharmacist to ensure that the dosage on the prescription is age-appropriate, and ask if it’s advisable to start with a lower dose and taper upwards.

2. Be aware of medications deemed unsafe for seniors.

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, put together by the American Geriatric Society, is a list of medications that older adults should avoid or use with caution. Some pose a higher risk of side effects or interactions, while others are simply less effective.  For instance, commonly prescribed sedatives in the benzodiazepine category, like diazepam (Valium), are on the “avoid for certain conditions” list because older adults may be more sensitive to these drugs. Ask your pharmacist if any of your loved one’s medications are on the caution list, and whether you should be concerned.

3. Bring a medications list — or the medications themselves — to the doctor with you.

Take your list of prescription medications —  a list of over-the-counter drugs and any herbal supplements you might be taking — and bring it to the doctor’s office with you, or to a pharmacist. The more information your provider has, the more accurately they can pinpoint any potential adverse effects or drug interactions.

4. Check on prescriber behavior in Prescriber Checkup.

Rather alarmingly, Medicare may not monitor prescription safety as effectively or as closely as we might like, as noted in a ProPublica report. “In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug [carisoprodol] to patients 65 and older,” says the report — a drug that was pulled from the European market in 2007 and is on the Beers caution list. If you have concerns about a provider, or if you simply want more information about the drugs prescribed in your area, check ProPublica’s online Prescriber Checkup tool.

5. Closely monitor medication compliance in the cognitively impaired.

If your loved one shows signs of confusion about their medications, or has been diagnosed with cognitive impairment, Alzheimer’s disease, or another form of dementia,  do not allow them to manage or take their own medications. If they are simply having trouble tracking their medications, a reminder system may be helpful, but the situation is more serious if your loved one is cognitively impaired. Taking medications incorrectly can be harmful or fatal.

6. Create and maintain an up-to-date medication list.

American Nurse Today says, “keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency and reason for taking the drug.” This can help reduce the risk of polypharmacy.

7. Get a second opinion if you are uncertain.

Not all providers are alike, and there are, unfortunately, some doctors who prescribe medications inappropriately, in excess, or for unapproved uses. If you are concerned about a prescription or a diagnosis, don’t be afraid to seek out a second opinion.

8. Know the side effect profile of your medications.

Knowing the potential side effects and interactions can help you stay alert to any health changes that may occur in response to a new medication or combination of medications. If you do notice health changes, contact a physician right away. Some side effects can mimic other health conditions, including dementia, so make sure to bring a list of your medications to every doctor visit. This will help the provider properly diagnose the problem — and help the patient avoid unnecessary or dangerous medications.

9. Make sure the pharmacy label says why you are taking the prescription.

This is particularly important for older adults who are taking multiple medications, to ensure that they know what each medication is for and how to take it properly. It can also help caregivers police whether their loved one is being given too many medications to treat the same issue, or whether a less scrupulous provider has prescribed a drug for a purpose it wasn’t intended to treat.

10. Minimize the number of providers and pharmacists you use.

Keeping the number of doctors and pharmacies to a minimum is better for you and better for the providers who must coordinate care. “The primary-care provider and specialists must maintain good communication with each other to prevent or minimize problems,” says American Nurse Today. They also advise people to “use only one pharmacy to obtain medications; this adds another level of review to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions.”

11. Talk to the pharmacist and ask questions.

If you have any concerns at all about the combination of medications you or your loved one is taking, or how a new medication will affect you, ask your doctor or pharmacist. Learn about the potential dosage, proper storage, side effects and anything else that will help you take medications correctly. You should also talk to your provider if you are thinking of stopping a medication.

12. Tell your provider about any previous adverse drug effects.

This one might go without saying, but if you or your loved one has had a bad reaction to any medication in the past, let your doctor and pharmacist know.

 

Article from A Place for Mom.

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Gifting Appreciated Stock to WPA

December 1, 2017 Education, Exercise

A gift of stock to Wisconsin Parkinson Association may make sense for you. It’s a simple process that can have a big impact on WPA.

Why gift stock?
You can gift appreciated stock held over one year and receive a charitable deduction for tax purposes.

What is the procedure to gift stock?
You need to transfer your stock in writing. The date the stock is transferred is the date used for the calculation of your charitable contribution. For stocks, the average of the High and the Low Trading Price for the day is used.

The brokerage account WPA uses for appreciated stock is at the investment firm RBC Wealth Management. Please contact RBC (information below) to inform them that you will be transferring stock to Wisconsin Parkinson Association.

Then, contact your broker about transferring your stock to the Wisconsin Parkinson Association. Your broker will advise what documentation they require.

It is RBC’s policy to sell all securities when they are received. They will prepare a letter for you and WPA that shows the value of your charitable contribution for tax purposes.

Thank you for your generosity!

DTC #0235 Capital Markets
Account # 315-66414
Account Name: Wisconsin Parkinson Association

RBC Wealth Management
Bob Chernow – 414-347-7089
Linda Cowan – 414-347-7088
Jeanne Watson – 414-347-7087
Fax – 414-347-7670

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Sleuth-ebrating the Holidays

December 1, 2017 Caregivers, Change, Education, Life

This holiday season can also be a time to be a loving (but slightly nosey) detective. If you are traveling to visit your loved ones who may be in need of care, the holidays afford an ideal time to assess any changes in their health and well-being.

As any good detective knows, the first step is to follow the clues.

Clue One – Your loved one’s home:

  • What condition is it in? Is it a clean, clutter free and safe environment?
  • The kitchen is where you can find a lot of telling clues. Look for signs of spoiled food, or an excess of junk/convenience foods compared to the last visit. This may be a sign they have stopped cooking.
  • Is the bathroom safe, with grab bars (if necessary) and slip proof mats? Are cords dangling dangerously near running water?

Clue Two – Your loved one’s behavior:

  • How do they handle their medication regimen? Are they using expired medications?
  • Is your loved one acting withdrawn, or making excuses not to participate?
  • Are there noticeable changes to hearing, sight or speech?
  • What is their balance like? Are stairs becoming an issue?
  • Observe memory capabilities. A good way to check this is to see if a loved one is remembering to pay bills, or keep appointments.
  • What are your loved one’s grooming habits like?

Once your detectiving is done and you have a clear picture of your loved one’s living situation, it is time to assess if you need to take further next steps in providing additional care for them.

  • What services (appointments, shopping, banking, etc.) do they need access to on a regular basis?
  • Is your loved one still able to drive? Don’t just take their word for it.
  • What socialization opportunities exist in the community to help prevent isolation and depression?
  • Is another family member or close friend living nearby and able to help?
  • What local help is available?

Before making any big changes, it’s essential to talk (respectfully) with your loved one about what they see as their greatest needs. Discuss solutions, and then bring some options forward that may work for all involved.

While the holidays may be overwhelmed by gifts and gatherings, it’s also a great time for a long-distance caregiver to take the extra time to observe a loved one’s living situation and address any new needs. The gifts of love can be shared in many ways, even if not wrapped in a box and ribbon.

 

Article from Today’s Caregiver.

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Parkinson’s on the ROPES: Exercise programs incorporating boxing skills

November 1, 2017 Education, Exercise

When Preston Moon was diagnosed with Parkinson’s disease at age 53 in 2008, he never dreamed he’d be bobbing and weaving in a boxing gym or pounding punching bags one year later. After learning that the condition would progressively impair his motor function due to a loss of brain cells that produce the chemical messenger dopamine, he thought he had little to look forward to but a steady decline. Then, in 2009, his next-door neighbor in Indianapolis mentioned Rock Steady Boxing, a local nonprofit program she’d attended that used boxing to manage the symptoms of Parkinson’s disease.

Moon was skeptical. “I’m a retired Army sergeant first class, and physical training was something I did but didn’t necessarily enjoy,” he says. “The last thing I wanted to do was work out again.” But with little to lose, he decided to check out the program. What he saw at the gym was surprising: People were punching small speed bags and large heavy bags, doing footwork and balance exercises, and performing calisthenics. “It was people of all ages, male and female, and they were—excuse my French—going balls to the wall,” Moon says. “I thought, ‘These guys have Parkinson’s?’ It changed my attitude immediately.”

He’s been boxing three or four times a week ever since. Eight years later, he feels strong, does push-ups, can run, and rides a motorcycle. His disease has affected him cognitively, slowing his thinking and making it difficult to come up with timely assessments and solutions in his work as a systems analyst, which is why he recently took long-term disability from his job. “But physically,” Moon says, “I don’t look or feel like I have Parkinson’s.”

GROWING STRONG

Moon was an early convert to an exercise regimen that’s expanding nationwide. The earliest proponent was Rock Steady, founded in 2006 in Indianapolis by Scott C. Newman, a community leader who was diagnosed with Parkinson’s disease and found that boxing helped with some of his symptoms. Together with Kristy Rose Follmar, a former professional boxer with world and Indiana state titles, he developed a program using a variety of training exercises—pummeling a speed bag, for example—to address symptoms such as loss of hand-eye coordination. Variety, fun, camaraderie, and intensity—but no actual fighting—are core elements of the program, with exercises designed for people of different abilities and in different stages of the disease.

Rock Steady now has affiliates around the country, and other programs have cropped up, too. These are often led by former professional fighters, such as Paul Delgado of Livramento Delgado Boxing Foundation (LDBF) and PD Gladiators in Atlanta, Mark Royce and Tate Wheeler of Knock Out Parkinson’s in four locations in Minneapolis-St. Paul, MN, and Paulie Ayala of Punching Out Parkinson’s in Fort Worth, TX.

TRAINING COACHES

The programs share many characteristics. For instance, the prospective instructors often have had experience working with people who have Parkinson’s disease, says S. Elizabeth Zauber, MD, associate professor of clinical neurology at Indiana University School of Medicine and an early member of Rock Steady’s board of directors. Further training for prospective coaches usually involves learning more about boxing and Parkinson’s, as well as how to structure a class.

MAKING ASSESSMENTS

All participants are assessed based on observations from coaches, as well as tests that measure abilities such as balance, gait, and grip strength. Boxers are then placed in classes appropriate for their level of function or follow customized workouts. “The assessment helps us get to know the people,” says Rock Steady executive director Joyce Johnson, whose mother had the disease. Coaches also factor in age, fitness level, other health problems, and cognitive abilities, says Dr. Zauber. “If someone can’t do something, instructors need to be able to adapt exercises and levels to that person’s needs.”

Patients may also undergo more thorough testing at their neurologists’ offices and/or with a physical therapist. Once they start, participants are assessed regularly. Knock Out Parkinson’s, for instance, performs assessments monthly, tracks the progress of each patient, and reviews the results with them. “Several of the patients in our program have neurologists who tell them they should keep doing what they’re doing with the boxing ‘because it’s working,’” Royce says.

TAILORING WORKOUTS

Creating customized workouts is key, says Adolfo Ramirez-Zamora, MD, associate professor of neurology at the University of Florida Center for Movement Disorders and Neurorestoration in Gainesville. Being in a wheelchair, for example, doesn’t have to be prohibitive. “Even if your balance isn’t good,” he says, “there’s still a lot you can achieve.”

If needed, coaches or volunteers provide one-on-one assistance. Participants who are at the lowest-functioning level are required to have a “corner man”—a trainer, volunteer, or care partner—to assist with the workout.

SPECIFIC MOVES FOR SPECIFIC SYMPTOMS

Boxing classes typically last 75 to 90 minutes and are designed to tackle symptoms in multiple ways. For example, warm-up exercises stretch muscles and relieve stiffness. Hitting heavy bags builds power and strength. Punching speed bags improves hand-eye coordination and posture. To stimulate cognitive processing, a trainer may hold “focus mitts” as targets and bark out varied instructions—“right, left, uppercut!” Shouting exercises and loud counting work on soft-voice disorders common in people with Parkinson’s disease. Calisthenics and isometric exercises build extremity and core strength critical for posture and gait. Footwork and drills such as moving sideways, jumping rope, or walking on a two-by-four improve balance and agility. Group games that involve tossing footballs, medicine balls, beach balls, or Frisbees encourage socialization and improve reaction time.

At LDBF-PD Gladiators, trainers call out punches using a number system that Delgado and his coach used when he was a pro fighter. “When I call out ‘one, two, three!’ that’s an intentional sequence—jab, right cross, left hook,” Delgado says. “Participants need to make these moves correctly.” Translating numbers to punches makes the workout mental as well as physical. Delgado recently switched the right-handed sequence to a left-handed version. “I’m making them southpaws,” he says. “That way they’re boxing from their weak side as well as their strong side, and the numbers apply to mirrored moves so they have to be cognitively sharper to throw those punches.”

PUSHING LIMITS

Rock Steady leaders say that “forced exercise”—demanding more effort than people would exert on their own at whatever level of function or fitness—is key to success. “We tell coaches-in-training that these guys can be pushed and don’t want to be treated like sick people,” Follmar says. “We’re respecting them by encouraging them with tough love, and that gives them confidence.”

FIGHTING A DISEASE

Anyone dealing with Parkinson’s disease is in some sense fighting it, but boxers feel like they’re fighting it literally and physically. “That idea is important,” Follmar says. “There’s a toughness about Rock Steady that makes people feel empowered.”

At Knock Out Parkinson’s, coaches sometimes keep the foe—Parkinson’s—front and center. “They’ll give us a series of drills while we recite ‘Knock! Out! Parkinson’s!’ and “I! Hate! Parkinson’s!’—punch, punch, punch—and scream as loud as we can,” says Lee Goderstad, who joined Knock Out Parkinson’s in March 2016. The drills also help participants work their vocal cords to strengthen them and combat loss of voice.

For Moon, boxing is an alternative form of therapy. “I was never one to go to support groups,” he says. “I was taught to adapt and overcome. We [boxers] don’t get in a group and moan about how rough we have it. Sure, we have challenges. So what do we do to get over them? I wanted to be part of something that would help me get over them, and I found that through boxing.”

WHAT THE SCIENCE SAYS

An early news story on Rock Steady motivated Stephanie Combs-Miller, PT, PhD, associate professor at the University of Indianapolis’ Krannert School of Physical Therapy, to investigate the benefits of boxing. In a preliminary case study of six participants published in Physical Therapy in 2011, she found that every participant improved on at least five of 12 measures, including balance, gait, walking speed, stride length, step width, get-up-and-go time, and ability to reach forward, over three months. “Some people improved on all of them,” Dr. Combs-Miller says. “It was a pretty strong indication that something positive was going on.”

VARIETY AND INTENSITY ARE KEY

That “something” may not precisely translate to boxing. “The regimen is a mix of aerobics, resistance training, balance exercises, and, for part of it, boxing-related activities,” says Ergun Uc, MD, professor of neurology at the University of Iowa Hospitals and Clinics in Iowa City, who has researched exercise and Parkinson’s disease. “While you can’t say boxing improves Parkinson’s, you perhaps could say that the training regimens boxers use might improve symptoms of the disease.”

In a follow-up clinical trial in 2013 published in the journal NeuroRehabilitation, Dr. Combs-Miller and colleagues recruited 31 people and assigned half to a boxing group and half to a control group that did more traditional resistance, aerobic, and balance exercises. Both groups showed significant improvements in balance, mobility, and quality of life, with variations on certain measures over three months. “My hunch is that it doesn’t matter if people box, play basketball, cycle, or dance, as long as they exercise at a high-intensity level,” Dr. Combs-Miller says. For example, traditional exercisers actually reported slightly more confidence in their balance than boxers.

That hunch is supported by earlier research published in Neurorehabilitation and Neural Repair in 2009. Cleveland Clinic investigators found that when people with Parkinson’s disease rode a tandem bike that forced them to pedal faster than they would normally, their motor scores on a measure called the Unified Parkinson’s Disease Rating Scale improved by 35 percent. Motor scores in a control group that pedaled at their preferred speed didn’t improve, even though aerobic fitness gains for the two groups were similar. The research seems to suggest that intense exercise has benefits beyond activity-specific fitness.

PROGRESSIVE CHALLENGES ARE IMPORTANT

What is considered intense depends on what kind of shape people are in. “Most people are so deconditioned that even lower-intensity exercise can push their boundaries,” says Lisa M. Shulman, MD, FAAN, professor of neurology and director of the University of Maryland Parkinson’s Disease and Movement Disorders Center in Baltimore. In a 2013 study published in JAMA Neurology, she and her colleagues showed that lower-intensity exercise like walking on a treadmill at a normal, comfortable speed was more effective than higher-intensity treadmill or resistance exercise in improving gait speed.

Yet the benefits tend to be specific to the form of exercise. Walking improves gait but not strength. Strength training makes you stronger but not more aerobically fit. “There is good reason to believe that because boxing combines multiple types of activities, it has special benefits,” Dr. Shulman says.

These boxing programs also encourage participants to progress as their skills improve. “It’s well known in training research that you need to be adaptive and progressive,” Dr. Uc says. “You try to increase performance and not stay at one level. But boxing isn’t the only exercise that does that. Generally, anything that motivates patients and safely increases the level of physical activity improves a variety of symptoms.” Yet boxing may still be special, Dr. Uc allows. “There’s a coolness factor,” he says. “Perhaps it’s more interesting and motivating.”

It’s too early to say definitively that boxing or other forms of exercise slow the progression of Parkinson’s disease, says Dr. Shulman. And Dr. Uc says that more research is needed in larger samples of patients before boxing regimens become a recommendation for Parkinson’s patients. “But substantial evidence from animal studies suggests that exercise benefits brain pathways involved with the disease,” Dr. Shulman says.

EMOTIONAL EMPOWERMENT IS A BONUS

Camaraderie is another special ingredient of these programs, according to participants, coaches, caregivers, and researchers. A 2016 study published in the Journal of Applied Sport Psychology found that training with a group carried a variety of emotional benefits. It helped relieve anxiety by allowing participants to talk and joke about Parkinson’s with others who understood the disease. Participants also reported that they were inspired by their peers, felt like athletes, and found a sense of mutual support.

Researchers haven’t yet studied the impact of boxing’s social component in people with Parkinson’s disease. “But I think there’s something about the feeling of empowerment patients get from it,” Dr. Shulman says. “Boxing sounds strong, and they are proud to be involved.”

 

Article from Neurology Now.

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Be a Savvy Science News Consumer

November 1, 2017 Awareness, Education

News is everywhere, all the time. It overtakes Facebook pages, overflows email inboxes and blasts from the television. We’re inundated with information and, unfortunately, often misinformation as well. But separating the two doesn’t have to be daunting or time consuming. Start with a small but healthy dose of skepticism: Don’t believe everything you read or hear. If it sounds too good to be true, it probably is.

Then, consider these five tips:

  • Go to the original source.
    Find out where the information was published. Was it a well-respected, peer-reviewed journal, such as Nature, Science or Movement Disorders? Or was it in a newer journal that is not widely recognized by the scientific community? “Peer review” is a form of quality control, and means experts assess and approve the research.
  • Compare news coverage.
    See if and how other sites are reporting the information. Are they communicating similarly across the board or are there competing views?
  • Dig deeper.
    Don’t take everything at face value. Figure out who is reporting and why. Is there an underlying motivation, such as profit seeking (if a product is being sold, for example), a political agenda or desire for sensationalism?
  • Put news in context.
    Look to trusted sources, such as your physician or credible organizations, for the facts. Many sites, including The Michael J. Fox Foundation, blog about breaking news. Some, such as healthnewsreview.org, rate news reports on how comprehensively they inform the reader.
  • Develop a checklist to evaluate news.
    Create a set of criteria or questions you can use to gauge the accuracy of news stories. Make a list of red flags, such as words like “miracle cure,” that give you reason to pause.

Stay on top of the news by reading regularly and asking questions. Follow sites you trust or sign up for email alerts. Last, but perhaps not least, think twice before you forward an email or share a Facebook post. Make sure the information you pass on is credible — word can spread like wildfire on social media.

 

Article from Michael J. Fox Foundation for Parkinson’s Research.

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What is Tremor?

October 1, 2017 Education, Life

Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is a common movement disorder that most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. It can occur sporadically (on its own) or happen as a result of another disorder.

Tremor is most common among middle-aged and older adults, although it can occur at any age. The disorder generally affects men and women equally. Tremor is not life threatening. However, it can be embarrassing and even disabling, making it difficult or even impossible to perform work and daily life tasks.

WHAT CAUSES TREMOR?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. Most types of tremor have no known cause, although there are some forms that appear to be inherited and run in families.

Tremor can occur on its own or be a symptom associated with a number of neurological disorders, including:

  • multiple sclerosis
  • stroke
  • traumatic brain injury
  • neurodegenerative diseases that affect parts of the brain (e.g., Parkinson’s disease).

Some other known causes can include:

  • the use of certain medicines (particular asthma medication, amphetamines, caffeine, corticosteroids, and drugs used for certain psychiatric and neurological disorders)
  • alcohol abuse or withdrawal
  • mercury poisoning
  • overactive thyroid
  • liver or kidney failure
  • anxiety or panic.

HOW IS TREMOR CLASSIFIED

Tremor can be classified into two main categories:

Resting tremor occurs when the muscle is relaxed, such as when the hands are resting on the lap. With this disorder, a person’s hands, arms, or legs may shake even when they are at rest. Often, the tremor only affects the hand or fingers. This type of tremor is often seen in people with Parkinson’s disease and is called a “pillrolling” tremor because the circular finger and hand movements resemble rolling of small objects or pills in the hand.

Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are considered action tremor. There are several sub-classifications of action tremor, many of which overlap.

  • Postural tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched.
  • Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.
  • Intention tremor is produced with purposeful movement toward a target, such as lifting a finger to touch the nose. Typically the tremor will become worse as an individual gets closer to their target.
  • Task-specific tremor only appears when performing highly-skilled, goal-oriented tasks such as handwriting or speaking.
  • Isometric tremor occurs during a voluntary muscle contraction that is not accompanied by any movement such as holding a heavy book or a dumbbell in the same position.

WHAT ARE THE DIFFERENT CATEGORIES OF TREMOR?

Tremor is most commonly classified by its appearance and cause or origin. There are more than 20 types of tremor. Some of the most common forms of tremor include:

Essential tremor

Essential tremor (previously also called benign essential tremor or familial tremor) is one of the most common movement disorders. The exact cause of essential tremor is unknown. For some people this tremor is mild and remains stable for many years. The tremor usually appears on both sides of the body, but is often noticed more in the dominant hand because it is an action tremor.

The key feature of essential tremor is a tremor in both hands and arms, which is present during action and when standing still. Additional symptoms may include head tremor (e.g., a “yes” or “no” motion) without abnormal posturing of the head and a shaking or quivering sound to the voice if the tremor affects the voice box. The action tremor in both hands in essential tremor can lead to problems with writing, drawing, drinking from a cup, or using tools or a computer.

Tremor frequency (how “fast” the tremor shakes) may decrease as the person ages, but the severity may increase, affecting the person’s ability to perform certain tasks or activities of daily living. Heightened emotion, stress, fever, physical exhaustion, or low blood sugar may trigger tremor and/or increase its severity. Though the tremor can start at any age, it most often appears for the first time during adolescence or in middle age (between ages 40 and 50). Small amounts of alcohol may help decrease essential tremor, but the mechanism behind this is unknown.

About 50 percent of the cases of essential tremor are thought to be caused by a genetic risk factor (referred to as familial tremor). Children of a parent who has familial tremor have greater risk of inheriting the condition. Familial forms of essential tremor often appear early in life.

For many years essential tremor was not associated with any known disease. However, some scientists think essential tremor is accompanied by a mild degeneration of certain areas of the brain that control movement. This is an ongoing debate in the research field.

Dystonic tremor

Dystonic tremor occurs in people who are affected by dystonia—a movement disorder where incorrect messages from the brain cause muscles to be overactive, resulting in abnormal postures or sustained, unwanted movements. Dystonic tremor usually appears in young or middle-aged adults and can affect any muscle in the body. Symptoms may sometimes be relieved by complete relaxation.

Although some of the symptoms are similar, dystonic tremor differs from essential tremor in some ways. The dystonic tremor:

  • is associated with abnormal body postures due to forceful muscle spasms or cramps
  • can affect the same parts of the body as essential tremor, but also—and more often than essential tremor—the head, without any other movement in the hands or arms
  • can also mimic resting tremor, such as the one seen in Parkinson’s disease.
  • Also, the severity of dystonic tremor may be reduced by touching the affected body part or muscle, and tremor movements are “jerky” or irregular instead of rhythmic.

Cerebellar tremor

Cerebellar tremor is typically a slow, high-amplitude (easily visible) tremor of the extremities (e.g., arm, leg) that occurs at the end of a purposeful movement such as trying to press a button. It is caused by damage to the cerebellum and its pathways to other brain regions resulting from a stroke or tumor. Damage also may be caused by disease such as multiple sclerosis or an inherited degenerative disorder such as ataxia (in which people lose muscle control in the arms and legs) and Fragile X syndrome (a disorder marked by a range of intellectual and developmental problems). It can also result from chronic damage to the cerebellum due to alcoholism.

Psychogenic tremor

Psychogenic tremor (also called functional tremor) can appear as any form of tremor. It symptoms may vary but often start abruptly and may affect all body parts. The tremor increases in times of stress and decreases or disappears when distracted. Many individuals with psychogenic tremor have an underlying psychiatric disorder such as depression or post-traumatic stress disorder (PTSD).

Physiologic tremor

Physiologic tremor occurs in all healthy individuals. It is rarely visible to the eye and typically involves a fine shaking of both of the hands and also the fingers. It is not considered a disease but is a normal human phenomenon that is the result of physical properties in the body (for example, rhythmical activities such as heart beat and muscle activation).

Enhanced physiologic tremor

Enhanced physiological tremor is a more noticeable case of physiologic tremor that can be easily seen. It is generally not caused by a neurological disease but by reaction to certain drugs, alcohol withdrawal, or medical conditions including an overactive thyroid and hypoglycemia. It is usually reversible once the cause is corrected.

Parkinsonian tremor

Parkinsonian tremor is a common symptom of Parkinson’s disease, although not all people with Parkinson’s disease have tremor. Generally, symptoms include shaking in one or both hands at rest. It may also affect the chin, lips, face, and legs. The tremor may initially appear in only one limb or on just one side of the body. As the disease progresses, it may spread to both sides of the body. The tremor is often made worse by stress or strong emotions. More than 25 percent of people with Parkinson’s disease also have an associated action tremor.

Orthostatic tremor

Orthostatic tremor is a rare disorder characterized by rapid muscle contractions in the legs that occur when standing. People typically experience feelings of unsteadiness or imbalance, causing them to immediately attempt to sit or walk. Because the tremor has such a high frequency (very fast shaking) it may not visible to the naked eye but can be felt by touching the thighs or calves or can be detected by a doctor examining the muscles with a stethoscope. In some cases the tremor can become more severe over time. The cause of orthostatic tremor is unknown.

HOW IS TREMOR DIAGNOSED

Tremor is diagnosed based on a physical and neurological examination and an individual’s medical history. During the physical evaluation, a doctor will assess the tremor based on:

  • whether the tremor occurs when the muscles are at rest or in action
  • the location of the tremor on the body (and if it occurs on one or both sides of the body)
  • the appearance of the tremor (tremor frequency and amplitude).

The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness. Blood or urine tests can rule out metabolic causes such as thyroid malfunction and certain medications that can cause tremor. These tests may also help to identify contributing causes such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging may help determine if the tremor is the result of damage in the brain.

Additional tests may be administered to determine functional limitations such as difficulty with handwriting or the ability to hold a fork or cup. Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral.

The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation.

HOW IS TREMOR TREATED?

Although there is no cure for most forms of tremor, treatment options are available to help manage symptoms. In some cases, a person’s symptoms may be mild enough that they do not require treatment.

Finding an appropriate treatment depends on an accurate diagnosis of the cause. Tremor caused by underlying health problems can sometimes be improved or eliminated entirely with treatment. For example, tremor due to thyroid hyperactivity will improve or even resolve (return to the normal state) with treatment of thyroid malfunction. Also, if tremor is caused by medication, discontinuing the tremor-causing drug may reduce or eliminate this tremor.

If there is no underlying cause for tremor that can be modified, available treatment options include:

MEDICATION

Beta-blocking drugs such as propranolol are normally used to treat high blood pressure but they also help treat essential tremor. Propranolol can also be used in some people with other types of action tremor. Other beta-blockers that may be used include atenolol, metoprolol, nadolol, and sotalol.

Anti-seizure medications such as primidone can be effective in people with essential tremor who do not respond to beta-blockers. Other medications that may be prescribed include gabapentin and topiramate. However, it is important to note that some anti-seizure medications can cause tremor.

Tranquilizers (also known as benzodiazepines) such as alprazolam and clonazepam may temporarily help some people with tremor. However, their use is limited due to unwanted side effects that include sleepiness, poor concentration, and poor coordination. This can affect the ability of people to perform daily activities such as driving, school, and work. Also, when taken regularly, tranquilizers can cause physical dependence and when stopped abruptly can cause several withdrawal symptoms.

Parkinson’s disease medications (levodopa, carbidopa) are used to treat tremor associated with Parkinson’s disease.

Botulinum toxin injections can treat almost all types of tremor. It is especially useful for head tremor, which generally does not respond to medications. Botulinum toxin is widely used to control dystonic tremor. Although botulinum toxin injections can improve tremor for roughly three months at a time, they can also cause muscle weakness. While this treatment is effective and usually well tolerated for head tremor, botulinum toxin treatment in the hands can cause weakness in the fingers. It can cause a hoarse voice and difficulty swallowing when used to treat voice tremor.

FOCUSED ULTRASOUND

A new treatment for essential tremor uses magnetic resonance images to deliver focused ultrasound to create a lesion in tiny areas of the brain’s thalamus thought to be responsible for causing the tremors. The treatment is approved only for those individuals with essential tremor who do not respond well to anticonvulsant or beta-blocking drugs.

Surgery

When people do not respond to drug therapies or have a severe tremor that significantly impacts their daily life, a doctor may recommend surgical interventions such as deep brain stimulation (DBS) or very rarely, thalamotomy. While DBS is usually well tolerated, the most common side effects of tremor surgery include dysarthria (trouble speaking) and balance problems.

Deep brain stimulation (DBS) is the most common form of surgical treatment of tremor. This method is preferred because it is effective, has low risk, and treats a broader range of symptoms than thalamotomy. The treatment uses surgically implanted electrodes to send high-frequency electrical signals to the thalamus, the deep structure of the brain that coordinates and controls some involuntary movements. A small pulse generating device placed under the skin in the upper chest (similar to a pacemaker) sends electrical stimuli to the brain and temporarily disables the tremor. DBS is currently used to treat parkinsonian tremor, essential tremor, and dystonia.

Thalamotomy is a surgical procedure that involves the precise, permanent destruction of a tiny area in the thalamus. Currently, surgery is replaced by radiofrequency ablation to treat severe tremor when deep brain surgery is contraindicated—meaning it is unwise as a treatment option or has undesirable side effects. Radiofrequency ablation uses a radio wave to generate an electric current that heats up a nerve and disrupts its signaling ability for typically six or more months. It is usually performed on only one side of the brain to improve tremor on the opposite side of the body. Surgery on both sides is not recommended as it can cause problems with speech.

LIFESTYLE CHANGES

Physical therapy may help to control tremor. A physical therapist can help people improve their muscle control, functioning, and strength through coordination, balancing, and other exercises. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.

Eliminating or reducing tremor-inducing substances such as caffeine and other medication (such as stimulants) can help improve tremor. Though small amounts of alcohol can improve tremor for some people, tremor can become worse once the effects of the alcohol wear off.

What is the prognosis?

Tremor is not considered a life-threating condition. Although many cases of tremor are mild, tremor can be very disabling for other people. It can be difficult for individuals with tremor to perform normal daily activities such as working, bathing, dressing, and eating. Tremor can also cause “social disability.” People may limit their physical activity, travel, and social engagements to avoid embarrassment or other consequences.

The symptoms of essential tremor usually worsen with age. Additionally, there is some evidence that people with essential tremor are more likely than average to develop other neurodegenerative conditions such as Parkinson’s disease or Alzheimer’s disease, especially in individuals whose tremor first appears after age 65.

Unlike essential tremor, the symptoms of physiologic and drug-induced tremor do not generally worsen over time and can often be improved or eliminated once the underlying causes are treated.

WHAT RESEARCH IS BEING DONE?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

Researchers are working to better understand the underlying brain functions that cause tremor, identify the genetic factors that make individuals more susceptible to the disorder, and develop new and better treatment options.

Brain Functioning

It can be difficult to distinguish between movement disorders such as Parkinson’s disease and essential tremor. These debilitating movement disorders have different prognoses and can respond very differently to available therapies. NINDS researchers are working to identify structural and functional changes in the brain using non-invasive neuroimaging techniques to develop sensitive and specific markers for each of these diseases and then track how they change as each disease progresses.

Other researchers are using functional magnetic resonance imaging technology to better understand normal and diseased brain circuit functions and associated motor behaviors. Scientists hope to design therapies that can restore normal brain circuit function in diseases such as Parkinson’s disease and tremor.

Genetics

Research has shown that essential tremor may have a strong genetic component affecting multiple generations of families. NINDS researchers are building on previous genetics work to identify susceptibility genes for familial early-onset (before age 40) essential tremor. Researchers are focusing on multigenerational, early onset families to better detect linkages.

Additionally, NINDS scientists are researching the impact of genetic abnormalities on the development of essential tremor. Previous research that has shown a link between essential tremor and possible genetic variants on chromosome 6 and 11; ongoing research is targeting the impact of other genetic variations in families.

Medications and other treatment methods

While drugs can be effective for some people, approximately 50 percent of individuals do not respond to medication. In order to develop assistive and rehabilitative tremor-suppressing devices for people with essential tremor, researchers are exploring where and how to minimize or suppress tremor while still allowing for voluntary movements.

Many people with essential tremor respond to ethanol (alcohol); however, it is not clear why or how. NINDS researchers are studying the impact of ethanol on tremor to determine the correct dosage amount and its physiological impact on the brain and whether other medications without the side effects of ethanol can be effective.

Other NIH researchers hope to identify the source of essential tremor, study the effects of currently available tremor-suppressant drugs on the brain, and develop more targeted and effective therapies.

Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact BRAIN at 800-352-9424.
Information on tremor also is available from the following organizations:

International Essential Tremor Foundation
HopeNET
National Ataxia Foundation
Tremor Action Network

 

Article from Caregiver.com.

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Brain Rewiring in PD May Contribute to Abnormal Movement

October 1, 2017 Education, Research

The brain’s own mechanisms for dealing with the loss of dopamine neurons in Parkinson’s disease may be a source of the disorder’s abnormal movement, according to a Northwestern Medicine study published in Neuron.

The study suggests the loss of dopamine may cause the brain to rewire in a maladaptive manner, contributing to impaired movement in Parkinson’s disease. These findings also suggest that there are fundamental problems with scientists’ traditional model of Parkinson’s disease, said senior author Mark Bevan, PhD, professor of Physiology.

The prevailing consensus was that excessive patterning of the subthalamic nucleus (STN), a component of the basal ganglia, by the cerebral cortex was linked to the symptomatic expression of Parkinson’s disease, including muscle rigidity and slowness of movement, according to Bevan.

“When one saw a burst of activity in the cortex that was consistently followed by an abnormal burst of activity in the STN, scientists assumed that the direct connection between the two was responsible,” Bevan said.

Thus, Bevan and his colleagues, including lead author Hong-Yuan Chu, PhD, a post-doctoral fellow in the Bevan Lab, expected to see transmission in the cortex-to-STN pathway increase as dopamine levels dropped. Instead, they found the opposite: the strength of the pathway decreased massively.

“Like most scientists who come across something unexpected, we thought we’d done something wrong,” Bevan joked. “So, we used multiple, complementary approaches but everything pointed to the same conclusion.”

Further investigation suggested abnormal activity in a more indirect pathway from the cortex to the STN, involving the globus pallidus, was responsible. Abnormal activity in the indirect pathway leaves the STN vulnerable to excessive excitation, triggering compensatory plasticity that ultimately proved to be harmful, according to the study.

When the scientists prevented this maladaptive plasticity in late-stage Parkinson’s models, they found the symptoms improved, pointing to a link between compensation and motor dysfunction.

“According to the classic model, these adaptations should be homeostatic and preserve STN function,” Bevan said. “Preventing them should make the symptoms much worse — but it made them better instead.”

While the compensatory mechanisms may initially keep the brain operating normally under conditions of moderate dopamine neuron loss, as the disease progresses and more dopamine neurons die, the adaptations may become so extreme that they impair movement, according to the study.

These results suggest that there are fundamental flaws in our traditional understanding of brain dysfunction in Parkinson’s disease, Bevan said.

For Bevan, the unexpected results in this study served as a reminder that scientists must remain open-minded.

“It’s easy to be emotional and cling to your hypothesis,” Bevan said. “You have to be dispassionate, open-minded, and look at the data ­— if the data is not consistent with the hypothesis then you have to reject it and come up with a new one.”

This study was funded by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke grants 2R37 NS041280, P50 NS047085, 5T32 NS041234, and F31 NS090845. Confocal imaging work was performed at the Northwestern University Center for Advanced Microscopy, which was supported by National Cancer Institute Cancer Center Support grant P30 CA060553.

 

Article from Northwestern.edu.

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Scratch-and-Sniff Test Could Predict Parkinson’s Even Earlier

October 1, 2017 Education, Life, Research

A new study provides further evidence that a simple scratch-and-sniff test could predict Parkinson’s disease even earlier than previously thought.

According to Michigan State University researcher Honglei Chen, lead author and professor of epidemiology, the test could potentially identify certain people who are at an increased risk of developing the disease up to 10 years before they are actually diagnosed. Previous research has shown an association between sense of smell and disease progression of up to four to five years.

The federally funded study, now published online in Neurology, the official publication of the American Academy of Neurology, is also one of the first to follow black people.

“One of the key differences in our study was we followed older white and black participants for an average of about 10 years, much longer than any other previous study,” Chen said. “We found that there was a strong link between smell and disease risk for up to six years. After that, the link remained, but just wasn’t as strong.”

He added that the relationship between smell and Parkinson’s risk in black participants also appeared not as strong as in the white participant group.

“Previous studies have shown that black people are more likely to have a poor sense of smell than whites and yet may be less likely to develop Parkinson’s disease,” said Chen, who is part of MSU’s Global Impact Initiative, an effort to help accelerate research in key areas affecting the world such as health and energy.

“We found no statistical significance for a link between poor sense of smell and Parkinson’s disease in blacks, but that may have been due to the small sample size and more research is needed.”

The study also found that older men with a poor sense of smell were more likely to develop the disease compared to women.

The study included 1,510 white and 952 black participants with an average age of 75. The test asked people to smell 12 common odors including cinnamon, lemon, gasoline, soap and onion, and then select the correct answer from four choices.

Based on their scores, participants were divided into three groups – poor sense of smell, medium and good. Researchers then monitored participant health through clinical visits and phone interviews for more than a decade.

Overall, 42 people developed Parkinson’s during the study including 30 white people and 12 black people.

People with poor sense of smell were nearly five times more likely to develop the disease than people with a good sense of smell. Of the 764 people with a poor sense of smell, 26 people developed the disease, compared to just seven of the 835 people whose sense of smell was good and nine of the 863 people whose sense of smell was categorized as medium.

Researchers also discovered that the results stayed the same after adjusting for other factors that could affect risk including smoking, coffee intake and history of head injury.

“It’s important to note that not everyone with low scores on the smell test will develop Parkinson’s disease,” Chen said. “More research is needed before the smell test can be used as a screening tool for Parkinson’s, but we are definitely on to something and our goal now is to better characterize populations that are at higher risk for the disease and to identify other factors involved.”

The National Institute on Aging, National Institute of Nursing Research and National Institute of Environmental Health Sciences funded the study.

 

Article from Michigan State University.

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Legal Tools for Caregivers

August 1, 2017 Caregivers, Education, Life

If you are caring for a loved one, there are certain legal strategies and tools that you need to utilize to ensure that your loved one gets the best quality of care possible and has the highest quality of life. The tools and strategies come in two forms, the basics that everybody needs and then more advanced planning strategies.

There are certain basics that every caregiver needs to have in place for their loved one. Those basics include things like financial powers of attorney, medical powers of attorney, and personal care plans it is important to work with a certified elder law attorney to ensure that you have these documents in place, because these are the key tools that will allow you to provide and care for your loved one.

The first of the basic tools is a financial power of attorney. The financial power of attorney is a document that allows you to make financial decisions for your loved ones. For example, the financial power of attorney would allow you to pay the bills, work with the bank, move money around to protect against long-term care costs. The financial power of attorney is probably the most important document when it comes to caring for a loved one. It is not a document to be treated lightly or to skip over.

Not all financial powers of attorney are created equal. Many financial powers of attorney put limitations on what you can and cannot do as a POA. In fact, many of the financial powers of attorney actually put handcuffs on the agent, in fact not allowing them to do the things they may need to do when caring for a loved one. For example, many financial powers of attorney do not allow you to create an asset protection trust for a loved one. That is why it is important to work with a certified elder law attorney (CELA) when crafting a financial power of attorney.

The next key tool when caring for a loved one is a medical power of attorney. These may go by different names including patient advocate designation, advanced directive, or living will. What this document does is gives the ability to the person you’ve named to be able to make medical decisions for you, including the ability to remove you from life support. The defaulted in many states is that if you are in a vegetative state you are to remain that way unless there is some clear, written, evidence to the contrary. That is why having a medical power of attorney that includes the ability to be removed from life support is important. Typically, this is the document that doctors and hospitals will ask for.

Now one of the basic documents the many people do not have is a personal care plan. A personal care plan is a document that gives instructions to the financial and medical power of attorney on how best to care for you. The provides guidelines on what type of care do you want to receive, for example do on receive care at home or would you prefer to be in an assisted living. Another example would be what type of food do enjoy or what type of television programming would you want to watch. Now this document is not set things in stone, but it does provide a good guideline for your caregivers, whether those caregivers or family or professional caregivers.

Now that the basic documents are in place, now we need to talk about some advanced planning tools such as personal care contracts and asset protection trusts. But, before those are discussed, it is important to understand some governmental programs that are available to help pay for long-term care costs. There are two very important governmental programs. The first is Medicaid, which in many states can help pay for nursing home costs. However, Medicaid has a $2000 asset limit for single individual as well as a five-year look back period. The second governmental program is the VA benefit which can help pay for home care as well as assisted living. The VA benefit also has an asset test where, typically, if you have more than $30-$60,000 of countable assets you are not going to qualify. So, with these two governmental programs the next tools that will be discussed help us qualify for those governmental programs. They are not always necessary, but they can be helpful in qualification.

An asset protection trust is a great way to protect assets from the devastating cost of long-term care so the governmental benefits such as the VA benefit or Medicaid can help pay the cost of care and then the assets in the trust can be used to pay for additional services. Asset protection trusts will differ depending on the governmental program that they are set up to qualify for. For example, an asset protection trust set up to qualify for the VA benefit will have different rules and regulations around it then and asset protection trust set up specifically to qualify for Medicaid. That said typically a VA asset protection trust will also start the five-year look back. For Medicaid. So, a VA trust also will help you get qualified for Medicaid.

in addition to having an asset protection trust, it also may be important to have a personal care contract if you are providing care for a loved one because by you providing care to your loved one may be entitled to the VA benefit if they were veteran or surviving spouse. One of the qualifications for the VA benefit is long-term care costs. By setting up a personal care contract and having the veteran or surviving spouse pay a family member under the personal care contract, that could constitute long-term care costs for purposes of the VA benefit. In other words, if daughter was providing care for mom was a surviving spouse, mom could pay daughter under a personal care contract and now qualified for the VA benefit, which could pay mom an additional $1153 per month. Another important piece of the personal care contract is it if it’s set up properly the money that mom moves to daughter would not be a divestment under Medicaid’s five-year look back period.

Caring for a loved one can be confusing and frightening. It is important to use the right legal tools to make the process as easy as possible. Those legal tools include things like personal care plans, powers of attorney, asset protection trusts, and personal care contracts. It is important to work with a certified elder law attorney (CELA) to set up these documents and to make sure that you receive as much assistance from the governmental programs such as Medicaid and the VA benefit as possible.

 

Article from Caregiver.com

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People with Parkinson’s should be monitored for melanoma, study finds

August 1, 2017 Awareness, Education, Life, Research

People with the movement disorder Parkinson’s disease have a much higher risk of the skin cancer melanoma, and vice versa, a Mayo Clinic study finds. While further research is needed into the connection, physicians treating one disease should be vigilant for signs of the other and counsel those patients about risk, the authors say. The findings are published in Mayo Clinic Proceedings.

Overall, patients with Parkinson’s were roughly four times likelier to have had a history of melanoma than those without Parkinson’s, and people with melanoma had a fourfold higher risk of developing Parkinson’s, the research found.

Medical experts have speculated about the relationship between Parkinson’s and melanoma for decades, with varying conclusions, the Mayo researchers note. Several studies have suggested levodopa, a drug for Parkinson’s, may be implicated in malignant melanoma, but others have found an association between the two diseases regardless of levodopa treatment, they add.

“Future research should focus on identifying common genes, immune responses and environmental exposures that may link these two diseases,” says first author Lauren Dalvin, M.D., a Mayo Foundation Scholar in Ocular Oncology. “If we can pinpoint the cause of the association between Parkinson’s disease and melanoma, we will be better able to counsel patients and families about their risk of developing one disease in the setting of the other.”

The Mayo study used the Rochester Epidemiology Project medical records database to identify all neurologist-confirmed Parkinson’s cases from January 1976 through December 2013 among Olmsted County, Minn., residents. The study examined the prevalence of melanoma in those 974 patients compared with 2,922 residents without Parkinson’s. They also identified 1,544 cases of melanoma over that period and determined the 35-year risk of Parkinson’s in those patients compared with the risk in the same number of people without melanoma.

The results support an association between Parkinson’s disease and melanoma, but argue against levodopa as the cause, the researchers conclude. It is likelier that common environmental, genetic or immune system abnormalities underlie both conditions in patients who have both, but more research is needed to confirm that and refine screening recommendations, they say.

In the meantime, patients with one of the two diseases should be monitored for the other to help achieve early diagnosis and treatment, and they should be educated about the risk of developing the other illness, the researchers say.

The study’s senior author is Jose Pulido, M.D., an ophthalmologist at Mayo Clinic in Rochester, Minnesota, who treats eye melanoma.

 

Article from Science Daily.

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