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Dr. Vinayak Vijayakumar

Psychiatrist, Chennai

Dr. Vinayak Vijayakumar Psychiatrist, Chennai
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My experience is coupled with genuine concern for my patients. All of my staff is dedicated to your comfort and prompt attention as well....more
My experience is coupled with genuine concern for my patients. All of my staff is dedicated to your comfort and prompt attention as well.
More about Dr. Vinayak Vijayakumar
Dr. Vinayak Vijayakumar is an experienced Psychiatrist in Mylapore, Chennai. You can visit him at Dr.Vijayakumar's Clinic in Mylapore, Chennai. You can book an instant appointment online with Dr. Vinayak Vijayakumar on Lybrate.com.

Lybrate.com has an excellent community of Psychiatrists in India. You will find Psychiatrists with more than 31 years of experience on Lybrate.com. You can find Psychiatrists online in Chennai and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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No.7, Lalitha Nagar, Papanasam Sivam Road 1st Street, Mylapore. Landmark: Near Rosary Matriculation, ChennaiChennai Get Directions
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Uncanny fear grips me at best of times, some occasional sleeplessness exists, Parents left longing for a united family life, before I could settle myself I'm 70 yrs+, had led a reasonably stable professional life of a middle class british educated engineer. Two PhD holder sons are on their way to their professional tracks. Wife's devoted to stability of my health and everybody else but talks (nags mostly) unnecessarily. Am presently working with a MNC on a serious national (make in India) project. Usual work stresses are there but increasingly getting the better of my fears of failures. How do I stabilise myself for my growing family and may be for the benefits my project may bring to the nation.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
Well, you are reasonably healthy for your age with nothing serious affecting someone at your age! In the light of your age, and a nagging wife, I suspect that the magnitude of the project you have undertaken may have its pressures, unbeknown to you. One thing is for sure, as you age, your defense mechanisms will wane in strength and some of them may even fail you, then the enormity of common pressures may be high and seem unduly so too. These may be things that you handled in your hey days with pomp but suddenly find yourself fearing the job at hand because of lowered defense mechanisms. If you objectively examine yourself, you will most likely find that these fears are unjustified, and that your knowledge-base is very sound. Knowledge is power, but not so effective, if your previous coping skills are suspect. I don?t know if you have additionally taken a break from work life and returned after a long sabbatical. This can take a toll too. What can be done is really of import right now. I know you are healthy but you may not be adequately fit! I suggest that you do regular exercise, as age and medical advice permits. Do some Yoga and meditation, regularly. Spend some time dealing with your emotions with a counselor. Eat well, sleep is definitely recommended on a priority basis, and share a lot of your work responsibility with some colleagues. You could, in fact, indent for extra hands to facilitate proper outcomes. It is not a sign of weakness but a very sensible thing to do, especially when someone with your knowhow is there but needs the vitality of a young generation to do the actual execution. I figure the management will understand that, if they are of the right caliber. One thing that definitely will help is to focus less on yourself and more on the nation at large and thus broaden your perspective.
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My friend has been using cigarettes for 2 years and now he is suffering pain in his entire face. What is happening to him?

Psychologist, Pune
Hi lybrate-user you need to show him to a doctor urgently. There may be side effects possibility. At the same time he has to quit smoking with immediate effect. Even if the diagnosis say it is not due to smoking he has to quit the habbit coz it is very harmful. Health is wealth.
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Hi sir! I am 17 year old I forget things many times anywhere please tell me why this happen with me. And how can I build up my memory power strong.

BHMS
Homeopath, Faridabad
Hello, take anacardium 30, 5 drops once daily for 10 days. Bacopa monnn. Q, 10 drops with water twice daily. Do meditation for half an hour in the morning daily. Revert me after 10 days.
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Sleep issues. The brain keeps thinking a lot. Stress issues too. What should I do?

C.S.C, D.C.H, M.B.B.S
General Physician,
Sleep issues. The brain keeps thinking a lot. Stress issues too. What should I do?
Think about all the factors that can interfere with a good night's sleep ? from pressure at work and family responsibilities to unexpected challenges, such as layoffs, relationship issues or illnesses. It's no wonder that quality sleep is sometimes elusive. Although you might not be able to control all of the factors that interfere with your sleep, you can adopt habits that encourage better sleep. Start with these simple sleep tips. 1. Stick to a sleep schedule Go to bed and get up at the same time every day, even on weekends, holidays and days off. Being consistent reinforces your body's sleep-wake cycle and helps promote better sleep at night. There's a caveat, though. If you don't fall asleep within about 15 minutes, get up and do something relaxing. Go back to bed when you're tired. If you agonize over falling asleep, you might find it even tougher to nod off. 2. Pay attention to what you eat and drink Don't go to bed either hungry or stuffed. Your discomfort might keep you up. Also limit how much you drink before bed, to prevent disruptive middle-of-the-night trips to the toilet. Nicotine, caffeine and alcohol deserve caution, too. The stimulating effects of nicotine and caffeine take hours to wear off and can wreak havoc on quality sleep. And even though alcohol might make you feel sleepy at first, it can disrupt sleep later in the night. 3. Create a bedtime ritual Do the same things each night to tell your body it's time to wind down. This might include taking a warm bath or shower, reading a book, or listening to soothing music ? preferably with the lights dimmed. Relaxing activities can promote better sleep by easing the transition between wakefulness and drowsiness. Be wary of using the TV or other electronic devices as part of your bedtime ritual. Some research suggests that screen time or other media use before bedtime interferes with sleep. 4. Get comfortable Create a room that's ideal for sleeping. Often, this means cool, dark and quiet. Consider using room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs. Your mattress and pillow can contribute to better sleep, too. Since the features of good bedding are subjective, choose what feels most comfortable to you. If you share your bed, make sure there's enough room for two. If you have children or pets, try to set limits on how often they sleep with you ? or insist on separate sleeping quarters.
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Hello Sir/Mam I have problem of body ache from last 1 week. what should id o ? please advice

MBBS, cc USG
General Physician, Gurgaon
Hello Sir/Mam
I have problem of body ache from last 1 week. what should id o ? please advice
Hi, This problem may be due to Any medical disease like Anaemia/ Hypoproteinemia/ Thyroid problem/Vit D deficiency Multi mineral and vitamin Deficiency Stress/ anxiety Over exertion (physical and mental) kindly follow advises given below: 1. Take adequate rest 2. Proper diet 3. I recommend you to take Tablet Daily(Nutrilite) after personal consultation this supplement has shown wonderful result Consult me for further management
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I am 28 old marriage female and I am quick out in 5 min bed so my husband is angry so please suggestion?

DHMS (Hons.)
Homeopath, Patna
I am 28 old marriage female and I am quick out in 5 min bed so my husband is angry so please suggestion?
Hi, you r under wt. It seems you r not interested to cooperate in sexual coition with your partner as you don't desire to go for sexual enter course due to certain reasons or circumstances. You need to go for the under norms * tk, plenty of water to eliminate toxins and to regulate metabolism to abserve neutritions, vitamins, to feel energetic. * go for meditation for 30 mnts to reduce stress, anxiety if any and to nourish your brain to calm down your nerve to r release the mental blocks, you possess regarding sexual enter course. Your diet b easily digestible on time. Tk, apples, carrots, cheese, pumpkins, spinach, milk, almonds, walnuts. Tk, homoeo medicines: sepia 200-6 pills at bed time. Alfalfaq-10 drops, thrice with little water. Avoid, caffeine, junk food, dust, scorching sun, polluted atmosphere, conteminated water intake. Tk, care.
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I want to quit smoking and drinking but itz too hard for me it is lyk day today activity for me. Give some advice or suggestions how I quite. Thanks.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), Masters in psychology counselling
Psychologist, Hyderabad
Dear Lybrate-user, it is good that you wants to stop smoking, we are destroying our health by smoking normal human takes oxygen into lungs 12 -15 times per minute (12 - 15 breaths) Lungs mixes oxygen in our blood and it purifies our blood, by smoking we are mixing not only oxygen adding and mixing bad elements like Nicotine etc. In Oxygen, that spoils our blood and our body organs like Lungs, Heart, kidney etc… How to quit: By willingness and willpower" where there is a will there is a way" Reduce one by one day by day.
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I am 18 years old and I am suffering from sex addiction. I think most of adulteration suffered from this addiction and I can't even control more than one day. My body is going weak day by day, I am feeling anxiety, guily, shame and I can't even think with open mind. Most of the days in weak I feel depressed and If this addiction toward masturbation wouldn't stop then my whole future will be vanish. And I promise you if you help to this problem and my addiction is gone forever. I will be a better person and for this I will try harder and abdicate everything. So plss help me.

B.Sc(Hons) Mumbai Univ., ND, MD - Alternate Medicine, Aroma Therap., Bach Flower Rem, Mental Health Cert.
Alternative Medicine Specialist, Mumbai
I am 18 years old and I am suffering from sex addiction. I think most of adulteration suffered from this addiction an...
Hi I will prescribe some harmless but effective flower remedy available in homoeopathy shops. Try to buy original medicines. Mix 3 drops of Olive + 3 drops of Hornbeam + 3 drops of Honeysuckle + 2 drops of Mimulus. Mix these with 100 ml water and drink it every night. If any problems consult me online.
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Hi i am a 37 yrs old lady working as a accountant in a pvt. Firm i have lot of work pressure at home and in office, sometimes i feel broken. Thr is not co-operation with my partner and colleagues. Sometimes i cry a lot when iam alone. Iam going through a bad time. Please help me.

BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
Psychiatrist, Bangalore
Please contact me regarding the same for a discussion over phone / 09845033734/ Please contact Lybrate and Pay Rs 500,service fee.
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My understanding power is very low please give me a solution that will done at home.

MBBS
General Physician, Mumbai
Eat well and sleep well. Be a strict vegetarian, drink cow's milk in night about three hours after dinner on alternate days (about thrice a week ). For sleep, Everyone knows that sleep is very important for maintaining a good physical and mental health. However, the duration of your sleep is just as important as the way in which you sleep. Your sleep position can influence your health, help in keeping your skin look young, and improve your digestive health. Furthermore, sleeping on the left side of your body can even save your life. If you are currently sleeping in another position, keep reading to find out why you should start sleeping on your left side right now. There are several sleeping positions – your front, your back, your left side, and your right side – and they all affect your health. Sleeping on the back can be particularly dangerous for people with sleep apnea or asthma, because it can cause breathing difficulties. Sleeping on the right side is likely to worsen digestion problems, whereas sleeping on the left side may improve digestive symptoms.
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Some times my headache problem killed my enjoyness whenever my headache occurred my mind becomes very disturb and I can not focus in my study.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
Some times my headache problem killed my enjoyness whenever my headache occurred my mind becomes very disturb and I c...
Dear Sanu. Headache is just a symptom and it is not a disease. There could be some underlying problems regarding your headache. Most common problem is stress. Engage in physical activities and be always creative and entertained. Please consult a psychologist online for counseling, advice and therapy. Take care,
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All About Parkison's Disease

MBBS, Master In Health Science
Neurologist, Mumbai
All About Parkison's Disease

* Should I be afraid of talking to the doctor?
No. Every doctor wants his/her patient to recover as soon as possible. If patients have the right knowledge, they are able to interpret and report their symptoms better. Having this knowledge prevents unnecessary anxiety and greatly facilitates diagnosis and treatment.

It is the duty of every doctor to provide the right information to the patient, and every doctor tries to do this to the best of his/ her ability. Sometimes it is not possible to provide thorough information and answer all questions of a particular patient, because then the doctor will not be able to give adequate time to the next patient. Th is is the main reason behind writing this book. In many cases, patients do not want to talk to their doctor because they are afraid of knowing more about their illness. This is the wrong approach. Knowledge is power. I assure you that having the right knowledge will decrease your anxiety and help you get better.

I do have one suggestion: before going to the doctor, write down all your questions on a piece of paper. Almost all doctors will be very happy to answer your questions if you ask them efficiently.

* Why should I pay attention to my symptoms? just run some tests and you will know what disease I have...
Tests can be helpful, but they cannot diagnose all diseases. Often, no test can detect the small short-circuits in the brain that are responsible for causing seizures. Until very recently, there was absolutely no test that could diagnose parkinson's disease. Tests cannot tell the doctor how you are responding to the medication. For example, in parkinson's the doctor may ask you how you feel in the morning, how long the eff ect of medication lasts, do your arms or shoulders jerk after you take medication, and so on. Each symptom is important for the correct diagnosis and treatment of your condition. You and your immediate family members can provide the doctor with this essential information. If you have difficulty remembering your symptoms, you should note them in a notebook. If you have difficulty describing some of your symptoms, you should make a video recording for 3-5 minutes using a smartphone or digital camera (android, Iphone etc). Such recordings are tremendously helpful for diagnosis and treatment.


* What are the common tests used to diagnose brain diseases?
The three tests most commonly used are:
Mri, ct scan and eeg. Other specific tests have been described in the relevant chapters.
(i) Mri (magnetic resonance imaging) scan:
An mri scan is probably the most important test for diagnosis. It can diagnose many diseases such as a stroke, tumor and inflammation. Mri scanning is done in a big tube shaped machine which is attached to a bed. Th e patient sleeps on the bed for 30-45 minutes. Th e bed slowly moves back and forth through the machine. During this time the machine clicks very detailed pictures of the patient's brain.

Please note that during the scan you may hear some loud whooshing and clicking sounds. Th ese are just the sounds of

Magnets and motors inside the machine, and there is no need to be concerned by these noises. Some people may feel anxious because of the small space within the scanner, and a few people may need medications to decrease this anxiety. Mri scanning is extremely safe; there is usually no health risk. Before the scan, please inform the doctor about any metal inserts or implants (e. G. Heart defi brillator) In your body.

Mri test machines are of various strengths such as 1.5 tesla, 3 tesla and so on. Mri machines with a higher number (for example 3 tesla) take better pictures. This book was written in 2015, at this time the highest resolution mri available in india was 3 tesla.

(ii) Ct (computerized tomography) scan:
The CT Scan machine looks just like the mri machine. It has a bed that moves back and forth slowly while the machine takes a picture of your brain.

CT scan has a few advantages over mri:
(i) It is less expensive. An mri may cost around 5000-7000 rupees, while a ct scan usually costs around 1000 inr (indian rupees).
(ii) It can be done very quickly. An mri may take 1 hour or more, but a ct scan can be completed in 10-15 minutes.

Unfortunately, CT scanning has some significant disadvantages:
- The picture obtained by a ct scan is not as clear as that obtained by an mri. The difference in quality is striking: it is like the diff erence between a black-and-white tv from the 70s and the new lcd televisions available today.

- CT-Scan exposes your body to radiation.
Radiation is bad for your body, and especially a baby's body. Therefore, pregnant women should never have a ct scan. Ct scan is commonly used during emergencies. When a patient comes to the emergency room, a rapid ct scan may be done to look for emergencies which may need immediate surgery such as bleeding inside the brain. An mri is usually done the next day, when the patient is more stable.

If you have already had an mri, then usually you do not need a ct scan. Th ere are a few rare conditions (e. G. Calcification in brain) which are seen better on a ct, but these are very uncommon.

(iii) Eeg (electro-encephalo-graphy):
Our brain functions because of electric currents traveling from one place in the brain to another. An eeg measures this electric current.

To do this test, small pieces of wire are stuck to the head using glue. These wires are then connected to an amplifi er and the electrical activity in the brain is recorded. The machine itself does not send any current to the brain. It only records current. Therefore, there is no pain or discomfort, and this is an extremely safe test. Anyone can have this test, including pregnant women, babies and very sick patients. Th is test is most often used for evaluating seizures. An eeg is also used in cases where the patient is unconscious for a long time, without a clear reason.


1. Doctor, my hand keeps shaking. It stops shaking only at night. Why is this happening?
The shaking of your hands is called a tremor. There are many causes of hand tremor. Th e most common causes are essential tremor and parkinson's disease. If you have essential tremor, your hands will shake more when you try to do something. For example, writing may become very diffi cult or water may fall down when you try to drink form a glass.

If you have parkinson's disease, the tremor is maximum when your hands are resting and doing nothing. For example, when you are sitting on a chair and watching tv comfortably, the hand starts shaking. Besides these common causes, there are other causes. For example, shaking of the hand (s) can begin after a small stroke near an important part of the brain called the red nucleus or in a condition called dystonia which causes contraction of the hand muscles without any clear reason some medications (see list), severe anxiety and very excessive tea/coff ee can cause hand shaking. Finally, there are diseases that have symptoms exactly like parkinson's disease.

Therefore, I need to examine you carefully. Based on observing you so far, I think there is a possibility that you may have parkinson's disease.


2. Parkinson's! I have heard this is an extremely serious illness! is this disease fatal?
No. Parkinson's disease is not fatal. Yes, but it is important to treat parkinson's disease promptly. Th e diagnosis of parkinson's disease is often missed. If not treated on time, patients with parkinson's disease are significantly restricted in their day-to-day activities, practically becoming disabled if treatment is delayed for a long time.

Secondly, if left untreated, patients with parkinson's disease can have frequent falls causing serious injuries including fractures and head injuries. Hence the diagnosis and treatment of parkinson's disease should be done as soon as possible.


3. What causes parkinson's disease?
Our brain runs on electricity and chemicals. If there is too much or too little of a particular chemical in your brain, it causes a disease. Parkinson's disease is caused by the reduction of a chemical called dopamine in our brain.

Dopamine is produced in the back of our brain, in a part called the mid-brain. It is then transported forwards and is widely distributed throughout the entire brain. It fi res up the movement centers of our brain, and helps them communicate better with one another. In parkinson's disease the cells in the midbrain producing dopamine gradually

Die. No one quite understands why this happens. Then effect is that the movement centers of the brain don't Communicate well with one another, and this produces the various symptoms of parkinson's disease.


4. Ok so what are other symptoms of parkinson's?
You already know one symptom shaking of the hands while resting. There are many other symptoms in patients with parkinson's disease and recognizing them is often very easy:
- Their muscles are often stiff and become inflexible, but they often do not complain about it. Th ey may complain that they are not able to do some things such as comb their hair.
- They are very slow in doing everything. They walk very slowly. They often bend forward while walking.
- They have difficulty turning around when they are walking.
- Sometimes they can get stuck in one position. Often this happens while walking, but may happen while doing something else.
- In later stages, they can fall frequently.
- Their friends may notice that their face has become expressionless and they just appear to stare off without blinking into distant space.

All patients do not have all of these symptoms. Some patients experience just the shaking of hands; other people experience just the muscle stiffness and so on. Often as people get older, more and more of the dopamine producing cells are destroyed and patients start developing more symptoms. But it takes years for this to happen and it may not happen in all people. In some patients, parkinson's disease remains restricted to just a few symptoms.


5. Ok doctor, thankfully I seem to be having just the hand shaking at this time. But other than the symptoms you just described, I am having other symptoms. I am always constipated, I cannot sleep well, and my saliva keeps dribbling from my mouth. Is it possible that these symptoms are also related to parkinson's disease?
Yes. It is not just possible but very likely that all these symptoms are due to parkinson's disease. Parkinson's disease is recognized by all doctors as a disease affecting movement. But in addition to movement problems, patients can have many other problems.

These are frequently not recognized, even by physicians, and therefore left untreated. If recognized and treated (and simple treatments are available for many of these symptoms), their resolution can significantly improve the patient's quality of life. It is important that your doctor should think about other diseases too. For example

If you have back pain, it is important that the doctor should think about arthritis of the back, if you have impotence your doctor should think about diabetes etc. But in many cases, no other cause can be found - these problems are due to parkinson's disease. About 10-20 years ago, even doctors did not know about these complications of parkinson's disease. It is a matter of great pride for me that I had the opportunity to receive training from the world-famous indian professor who is at the forefront of research regarding these symptoms: Dr. Kallol ray chaudhuri at king's college hospital in london.


6. How can you be sure that I have parkinson's disease?
A better patient history and examination will help me to confirm my diagnosis. We need to rule out other problems which look like parkinson's disease. Certain drugs may produce symptoms that are very similar to parkinson's disease (see list). Make sure you are not taking these medications, and avoid these medications in the future.

There are a few other diseases which have almost the same symptoms at parkinson's disease. Their names are complicated! these include diseases such as progressive supranuclear palsy (psp), multiple systems atrophy (msa) and cortico- basal degeneration (cbd)! th names are not very important the important thing is that there are other diseases that look just like parkinson's disease. Some of these diseases are identified by your doctor by looking for small clues on your exam: such as your blood pressure and the way your eyes move. Now let me tell you something very frankly even after a very detailed history and meticulous examination, the diagnosis may not be clear in some patients, even to the best of doctors in the best of institutions.


7. So isn't there a test for parkinson's disease?
Unfortunately, there is no test for parkinson's disease which can prove it with 100% accuracy. An mri (see information for everyone section) can be helpful to rule out some other diseases e. G. Multiple strokes, and 
Therefore many doctors get an mri in patients with parkinson's disease. There is one test that can be helpful. It

Is called the dat scan. The dat scan is abnormal in parkinson's disease, but it is also abnormal in some other diseases that look like parkinson's disease! therefore it is helpful only in certain cases. There are a few other tests like a cardiac scan (mibg scan), but these are only available at a few research centers, and again, do not help to completely rule out other diseases.


8. But. That is very concerning. What you are saying is that in some patients the diagnosis remains unclear?
You are correct. In most cases, the diagnosis of parkinson's disease can be made with certainty. But about 10% of patients have an uncommon mixture of symptoms so that no doctor, no blood test, no investigation can confidently determine if the patient has parkinson's disease or if he/she has another, similar disease. In such cases, most doctors explain the situation to the patients, and give them anti- parkinson's medications such as levodopa. Usually, a dramatic improvement is seen if the patient has parkinson's disease. If a patient takes an adequate quantity of Levodopa for 4-6 weeks and there is no clinical improvement, it is very unlikely that he has parkinson's disease.

These medications cause clinical improvement in about 1/3rd of all patients with the other diseases such as msa, psp etc. However, this improvement is not as dramatic as the improvement seen in parkinson's disease and frequently does not last as long. As the years go by, other symptoms develop (such as urinary problems, eye movement problems and falling) and a more definite diagnosis can be made on the basis of repeat examination.

9. Hmm. Doctor, there must be several medicines for parkinson's. If the parkinson's is caused by a lack of dopamine, shouldn't consuming dopamine help to reduce the symptoms of the parkinson's?
Yes, there are many medications and yes you are correct providing extra dopamine to the brain is one of the best ways to make the symptoms better. I have provided a list of these medications, but it is worth highlighting two of them: levodopa is the oral form of dopamine. It is converted into dopamine when it goes inside the brain. Th is is usually the fi rst medication that is started. It is available in standard, dispersible and extended-release

Preparations. Young patients with very mild symptoms of parkinson's disease are given a diff erent kind of medication initially. These medications are called dopamine agonists. Th ere are 3 dopamine agonist medications: pramipexole, ropirinole, and rotigotine. Th ey are available in standard and extended release preparations.


10. So, what you are saying is that the dose of parkinson's medications does not stay constant throughout life?
You are correct. Parkinson's disease often progresses as patients grow older. Some symptoms change and become less prominent but on the whole the symptoms become more severe. Th is progression is probably caused by gradual death of more and more cells producing dopamine. Very few people have side eff ects due to these based on the symptoms that develop, the medications. Often, parkinson's disease dose of parkinson's medication may need progresses as patients grow older and new to be changed, or new medications may be given. For example, if you have trouble sleeping at night, then the doctor can ask you to take an extra levodopa pill at night or an extended release ropnirole pill. If the benefi cial effect of levodopa is not lasting for as long as it used to, the doctor may ask you to take entacapone with the levodopa. If you have constipation the doctor will prescribe a laxative and so on. Sometimes it may take a few trials of different medications over 1-2 weeks to find the right combination that works for you. Parkinson's is not a deadly disease. Th ere are many medications for parkinson's. Th e doctor needs to have precise information about the patient's symptoms in order to prescribe the right medications. In parkinson's disease, the doctor needs help from his/her patient. It is essential to record your symptoms accurately and visit your doctor regularly, every 3 to 6 months.


11. Doctor, you are saying that frequently the dose of levodopa needs to be increased. But what happens if too much levodopa gets into the person's brain?
Yes, this can happen but it is not life-threatening. When there is excessive dopamine in the brain, the body starts moving too much. Often there are small jerks in the neck, shoulders and sometimes in the leg. If you are a fan of michael jackson, you have seen break-dancing. Th ese excessive movements look like break-dancing. Th e medical term

For these excessive movements is dys-kinesias. It is very important for you to be aware of them and remember the word: dys-kinesias. Often, dys-kinesias are at their maximum 1-2 hours after you take levodopa. If you have trouble recognizing these movements, you should take a video of any suspicious movements on your smartphone and show it to your doctor. In the early stages of parkinson's disease, dys-kinesias are only seen when the

Levodopa dose is very high. But in more advanced stages, they may be seen at lower doses and giving the patient an adequate dose of levodopa without producing dyskinesias may become diffi cult. At this stage, some dyskinesias may need to be tolerated. If you are suff ering from dyskinesias, you can reduce the dose of levodopa that you are

Taking. But this may result in some of the symptoms of parkinson's disease (slowness, rigidity, freezing etc) to reappear. Another way in which dyskinesias may be reduced is by giving you amantadine.


12. I am getting it now, doctor. This is like a weighing scale isn't it? too little levodopa causes the parkinson's disease symptoms to come back, and too much levodopa action causes dyskinesias.
Yes! th at is absolutely right. In the initial stages, balancing this weighing scale is very easy. But after 10, 15 or in some cases 20 years, balancing this scale becomes diffi cult. After taking levodopa, many patients improve but also get dyskinesias. It becomes impossible to fi nd a levodopa dose that causes improvement without producing dyskinesias. Th erefore, at this stage, some dyskinesias may need to be tolerated as long as you are able to function satisfactorily.


13. So doctor, you told me what happens when there is too much dopamine action in the brain. What if the there is too little dopamine action in the brain? What if levodopa just stops working?
Levodopa never stops working. But it may become less effective, and its effect may become short-lived. Th ere could be many reasons for levodopa to become less eff ective. These are listed separately the most important reason is that the patient may not be taking the levodopa on an empty stomach. As parkinson's disease advances, the eff ect of levodopa lasts for a shorter duration of time. Here is a somewhat typical story from such a patient. Remember, this happens only in few cases:
Taking the tablet helps me only for a short time. When I wake up in the morning, my feet contract, twist and become painful.


14. I understand. It must be difficult at that stage to find the right combination of medications. What if the situation worsens further?
Yes. And I think it is vital for patients to understand this. Frequently, with the right combination of medications the patient can get better. But it can take some time to find the right combination; sometimes even 3-4 trials of diff erent combinations may be required. If a patient gives up hope and gives up in the middle of these trials, the only possible outcome is progressive deterioration of the patient's health.

Sometimes, inspite of repeated adjustments, a good combination of medications cannot be found. But remember this situation arises 10-20 years after the parkinson's symptoms have been detected. Many parkinson's

Patients do not have to face this situation. If the right combination of medicines could not be found even after many trials, then still there is one solution. Brain surgery. Th en I take my morning dose of levodopa

And feel good. Sometimes I get some dyskinesias, but I don't complain about them because I am feeling good. But only an hour or 1.5 hours later, the symptoms of parkinson's disease start coming back. I become slower and slower, and then freeze. I get better again when I take levodopa, but I can't keep taking levodopa every hour!

I understand. It must be difficult at that stage to fi nd the right combination of medications. What if the situation worsens further?

Yes. And I think it is vital for patients to understand this. Frequently, with the right combination of medications the patient can get better. But it can take some time to fi nd the right combination; sometimes

Even 3-4 trials of different combinations may be required. If a patient gives up hope and gives up in the middle of these trials, the only possible outcome is progressive deterioration of the patient's health. Sometimes, inspite of repeated adjustments, a good combination of medications cannot be found. But remember this situation arises 10-20 years after the parkinson's symptoms have been detected. Many parkinson's patients do not have to face this situation. If the right combination of medicines could not be found even after many trials, then still there is one solution. Brain surgery. A proper mixture of medications may help this situation as well. I had given you an
Example of this earlier: entacapone can prolong the eff ect of levodopa.


15. Doctor. Brain surgery? are you kidding me? this is a big deal. By the way, what is this surgery called?
I know brain surgery is a big deal. This surgery is called deep brain stimulation, or this is a brain surgery, but a relatively dbs

If your symptoms are well controlled with medications, no doctor in their right mind would recommend you to have surgery. But in a few patients, medications no longer produce adequate improvement. Either the improvement lasts for a very short time, or the medication produces such dramatic dyskinesias that giving an adequate dose is impossible.

Approximately, 70% of such patients benefit from this surgery. The improvement is very significant, but dbs does not make all symptoms of parkinson's disease magically disappear. It is very important to have realistic expectations from the surgery. The improvement seen after surgery is batteries last for about 5 years, and can be Replaced when required.


16. Well. How is this surgery done?
This is a brain surgery, but a relatively minor one. A metal frame is usually attached to the patient's head. A very small hole (approximately 1 cm in diameter) is made in the head, and a thin (1 to 1.5 mm thick) wire is inserted through it. The wire is pushed into a very particular part of the brain called the sub-thalamic nucleus. Th e same process is repeated on the other side and another small wire is inserted. These wires are then connected to a small battery (a square of approx. 3 inch) that is kept in the skin below the chest. No part of this device can be seen from the outside, and any scars on the head are usually covered by hair in a few weeks. Th e device is usually turned on 4 weeks after the surgery. On an average, most.


17. I see. Doctor, does DBS cure all symptoms of parkinson's disease?
No. DBS surgery improves only those symptoms which improve after levodopa.

- Dbs surgery prolongs the eff ect of levodopa, decreases dyskinesias, improves slowness of movement, hand shaking, muscle stiff ness and in general makes the patient much more functional. However, symptoms that do not get better after levodopa such as freezing and falling usually do not get better after dbs.

- Approximately 5% of patients can have serious complications such as stroke, seizure and infection. But most of these problems are cured with medications. Only 1% of these patients have permanent problems from these complications, such as permanent weakness of one side of the body. Other symptoms that we talked about e. G. Sleep problems may get better after dbs. I conducted an audit of sleep symptoms after dbs during my time in london at king's college hospital, and found that there is

Significant, but non-dramatic, improvement in many patients.

Two problems can become worse after DBS:
(i) Severe psychiatric problems such as severe depression and hallucinations and
(ii) Severe diffi culties of thinking and memory. If any of these problems are severe, dbs is usually not off ered to the patient. If a patient has severe psychiatric problems and is under treatment, dbs may be considered in the future if they completely resolve.


18. Okay doctor, what are the risks of this surgery?
Th ere is a small amount of risk involved in any surgery. Since dbs surgery is relatively minor, the risk is low but is not non- existent.
- The risk of death is less than 1%
- Approximately 5% of patients can have serious complications such as stroke, seizure and infection. But most of these problems are cured with medications. Only 1% of these patients have permanent problems from these complications, such as permanent weakness of one side of the body.
- A few patients have minor problems such as problems in wire connections or a non-functioning battery. Th ese are easily corrected. In short, about almost 90-95% of patient do not have any complications during or after the surgery, and the risk of death or permanent problems is very small (lts 2%).


19. Can the doctor guarantee a significant benefi t after DBS surgery?
No. No doctor in the world can guarantee Improvement after dbs. Th at being said, improvement happens in most patients as long as they are carefully selected. Before off ering you option of surgery, the doctor will give you a large dose of levodopa and make sure that your symptoms improve significantly. He/she will tell you that this is the maximum benefit that you may get after dbs, and try to set realistic expectations so that you are not disappointed after the surgery. Often the surgery is followed by a period of temporary improvement, even before the battery is switched on. This improvement Goes away in a few weeks. Th is is expected and you should not be disappointed - this is a good sign. After the battery is switched on, it may take between 3-6 months to achieve the optimal balance between your dbs and medications. During this time, your symptoms will improve gradually. But you should be patient if your symptoms

Have not improved within 1-2 months there is a good chance they will improve with further dbs adjustments. Most patients improve after dbs surgery, but a few people do not improve. Th e reason why these people do not benefit from dbs surgery is unknown, and this is being vigorously researched in the us, uk and other countries. Read more here

3 people found this helpful

I lost somebody close last year and since than feel very depressed and prefer keeping to myself all the time.

B.A PSYCHOLOGY HONOURS, M.A PSYCHOLOGY, M.Phil - Psychology, PhD PSYCHOLOGY
Psychologist, Delhi
I lost somebody close last year and since than feel very depressed and prefer keeping to myself all the time.
Best tribute to departed person is to try your best to move above your personal loss and show it to the departed soul that you love and remember the guidance given and will now start pulling your life threads and become the person they had always wanted you to be when alive! put all energy at becoming a more stronger person and aim to be successful, just as your loved one had always wanted you to.
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I'm smoking since 30 years and now daily smoke of 20 cigarettes per day. How can I easily give up?

BHMS
Homeopath,
Dear Mr Jayakrishna......You can try Homeopathic Mother Tincture DAPHNE INDICA Q, 30 drops in water, thrice daily, after meals
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Hello sir, I am 29 years of old actually my problem is I am a very hardworking in my work so I was in love with a married lady and got breakup with her and lost my job too then I tried a lot to get back a good job buy couldn't get then I moved to Gulf their after I forgot myself somewhere in this world I was earning good but unable to get back to my social life and after coming back to home even today I am having everything but unable to get back to my social life always I am in my own world like something I have lost and I get frustrated very soon on anybody sometimes feel to giveup. Please let me know wat is my problem.

MBBS, MD - Psychiatry
Psychiatrist, Chennai
Hello sir, I am 29 years of old actually my problem is I am a very hardworking in my work so I was in love with a mar...
Mr. lybrate-user,my first advice to you is to follow Dr. Abdul kalam sirs words" Do your work, love your family and not the other way round" Well family, friends and other social relationships can help you during tough times. Hardworking and job are very essential but not at the cost of your family relationships. Finally it is just one life mate" just love it, enjoy it and live it" Regarding what is your problem "trying to be very sincere to your job and avoiding family is your problem" Live your life the other way. Be happy.
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Hello Sir / Madam, Good Afternoon. My Name is Litan Deb, age 32.5 months, I have suffering from body pain along 10 year above. In the year 2000 I got fiver.

BHMS
Homeopath, Raebareli
Hello Sir / Madam, Good Afternoon. My Name is Litan Deb, age 32.5 months, I have suffering from body pain along 10 ye...
Please check your hb% first and do test for crp and get back to me. In the mean time take rhus tox 200 - twice daily for next 7 days.
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I have been diagnosed as a case of Major Depression in 1983.Presently I am taking floxitine tabs,lithium tabs and some tabs for relaxation.I have never tried any other system of Medicine.I dont know whether it can be of any great help. Kindly advise.

MD - Psychiatry, MBBS
Psychiatrist, Delhi
Yes.Non pharmacological approach can also help u.You try progressive deep muscle relaxation technique for relaxation instead of taking antianxiety drugs. Also the duration and type of last episode information can make me answer about taper off ur fluoxetene.
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I am 50 years old. My memory power and brain is very weak. Is there any suitable medicine which can increase the efficiency of brain.

BHMS
Homeopath, Delhi
Hello, you can take homoeopathic medicine Kali Phos 6X ( 3 tabs) twice a day for 15 days and revert.
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My homeopathy doctor examined and told me that I'm having health anxiety through which I get difficulty in my breath. Can somebody please tell me is it actually anxiety which is causing shortness of breath or any order lung disorder? About a year ago I had all tests but everything was normal. I'm afraid if it's asthma what can I do during breathing problem without a inhaler? Your help would be greatly appreciated. Thank you :)

MA - Clinical Psychology, P.G. Diploma in Guidance and Counseling, BA In Psychology
Psychologist, Mumbai
My homeopathy doctor examined and told me that I'm having health anxiety through which I get difficulty in my breath....
Yes anxiety can cause breathlessness. Your way of speaking shows your high level of anxiousness. Please consult counsellor or psychologist and seek help.
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Sir I am suffer from stammering. My confidence level is very low when I stutter. Is there any remedy for it. Pliz suggest me.

MD - Psychiatry
Psychiatrist, Chennai
Stammering is typically recognised by a tense struggle to get words out. This makes it different from the normal non-fluency we all experience which includes hesitations and repetitions. Commonly it involves repeating or prolonging sounds or words, or getting stuck without any sound (silent blocking). Sometimes people put in extra sounds or words. Often people lose eye contact. Some people who stammer talk their way round difficult words so that you may not realise they stammer at all. This avoidance of words, and avoidance of speaking in some or many situations, is an important aspect of stammering. Stammering varies tremendously from person to person and is highly variable for the person who stammers who may be fluent one minute and struggling to speak the next. Get an mri brain and eeg with a psychiatrist evaluation.
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