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Dr. Nitin Manoj Sapru

Psychiatrist, Mumbai

Dr. Nitin Manoj Sapru Psychiatrist, Mumbai
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I'm a caring, skilled professional, dedicated to simplifying what is often a very complicated and confusing area of health care....more
I'm a caring, skilled professional, dedicated to simplifying what is often a very complicated and confusing area of health care.
More about Dr. Nitin Manoj Sapru
Dr. Nitin Manoj Sapru is one of the best Psychiatrists in Bandra, Mumbai. You can consult Dr. Nitin Manoj Sapru at Jyoti Poly Clinic in Bandra, Mumbai. Save your time and book an appointment online with Dr. Nitin Manoj Sapru on Lybrate.com.

Lybrate.com has a number of highly qualified Psychiatrists in India. You will find Psychiatrists with more than 42 years of experience on Lybrate.com. Find the best Psychiatrists online in Mumbai. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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I lost somebody close last year and since then feel very depressed and prefer keeping to my self all the time please help me.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
I lost somebody close last year and since then feel very depressed and prefer keeping to my self all the time please ...
The dead are no more but memories will longer. It is no use wallowing in the past. You will tend to do so if you have not learned some lessons. In this case, you must treasure the good moments and move on. The living are really important i. E. You and your life. If you have weak ego boundaries, you will tend to stay stuck with this person for a long time. You must learn to detach and enjoy the life ahead with the other people around. You will and can make new friends but you will do so only if you socialize. If this person you lost knows how you are wasting your life, s/he will not be pleased at all. You must also work with a counselor to deal with your grief and that will help you tremendously to move on. Please reach out soon for your own sake. If there is some unfinished business that you needed to complete that can be done too in gestalt therapy.
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I am 52 years old suffering from depression for the last 22 years. Now I am losing my memory power. I am suffering from behavior problem. Please suggest me.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
I am 52 years old suffering from depression for the last 22 years. Now I am losing my memory power. I am suffering fr...
You must go and meet with a counselor immediately and if that person advises that you meet with a doctor you must do so and cooperate to your utmost. Please visit these professionals along with your parents. In the meantime please do the following sincerely because you could resolve the problem better with good cooperation: Have a good night’s sleep, have a good breakfast of more proteins, meditate often, remain free of stress, eat a lot of fiber, nuts, avocado, exercise regularly, eat dark chocolate, do Yoga meditation exercises, etc. I suggest you do the opposite of what this depression makes you feel like doing (actually, not doing): you will need to fight this condition. You must become active; stay upright during the daylight time; meet people; never sleep during the day, wake up by 6 am every day, play some active games, especially contact games, do physical exercises, talk to people and join some social clubs, attend Yoga classes etc. Watch sitcoms on TV or comedies and cheer yourself up. Go for excursions in groups, for outings, camps, conferences, and religious conventions. Get a pet dog and spend time training it, exercising it and relating to it. Expose yourself to some sunlight every day, at least, 30 minutes but not in the scorching heat. Whatever happens, please incorporate these three important adaptations in your life: always be responsible, be respectful, and be functional. If you did these three, lots of things will go well in life. Please pray and have faith in God to alleviate your sufferings. Don’t wait for others to help. Use your own motivation, which might be at its lowest, but persevere and win this battle. Above all to be really happy, you need to live in love and for love. Learn all about emotions and how to handle them and that will get you out of the depression rather easily and quickly. A counselor is there only to facilitate you, all the hard word must come from you, and your cooperation with that person is very critical for your success. Be positive every day and learn to be contented with what you have. Do some left brain exercises: it is the happy brain. Here are a few suggestions: shut your left nostril and breathe, move your eyes from right to left and vice versa for at least half a minute at a time, and do callisthenic exercises with some form of counting, regularly. Whatever happens please cooperate with the therapy and do not discontinue until the condition is completely resolved.
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Creative Arts can boost Mental Health

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
Creative Arts can boost Mental Health
A team of australian researchers have found that participating in the arts for just two hours a day for about a week can improve mental health and well being

Since a year I have been suffering from anxiety, have a bad phobia of cancer and aids, of course due to traumatic events in the past, the anxiety caused by the phobia has been uncontrollable, should I go to a psychologist or a psychiatrist?

MD - Psychiatry
Psychiatrist, Chennai
Since a year I have been suffering from anxiety, have a bad phobia of cancer and aids, of course due to traumatic eve...
Rather than worrying who is apt to treat anxiety neurosis. It is ideal for you to get the severity of anxiety disorder evaluated, if the symptoms are mild, you can be treated by CBT (Cognitive Behavior Therapy) alone or medications. If the symptoms are moderate a combination of CBT and medicines, if severe medications first and after improvement CBT can be planned. Medications are given only by a psychiatrist as well as diagnosis ruling our medical causes for anxiety is done by a psychiatrist. CBT can be given by psychiatrist or clinical psychologist, who are trained in the procedure. Hope this helps you to decide.
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Sometimes my left knee and sometimes right pains for a little time and also I feel tired always moreover I forget things just in a minute I cannot memorize things faster now what could it possibly be.

Diploma in Anesthesia
Pain Management Specialist, Ahmedabad
Sometimes my left knee and sometimes right pains for a little time and also I feel tired always moreover I forget thi...
Hi, how did the pain start and when does it pain also what activity cause increase or decrease in pain. These are few questions that can help to know what exactly is your problem, also the forgetfulness may be due to stressful lifestyle or micro nutrient deficiencies.
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I was depressed for 1 year then I took medicine for almost 3 year under doctor prescription so how long I have to take the medicine because now I completely feel ok.

M.S. Counselling and Psychotherapy
Psychologist, Bangalore
I was depressed for 1 year then I took medicine for almost 3 year under doctor prescription so how long I have to tak...
You are feeling ok because of the medicines. To get rid of these medicine, try counselling. Your doctor and counsellor together will help you in tapering down and stopping these medicines. But please don't stop medicines on your own.
1 person found this helpful
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I am having pain in my throat for last few days I can't able to speak clearly my words are getting cracked in middle I don't know why it is happening my voice was gone there is any reason for that? Please advise.

MD(EH)/AM/Accupressure
Acupressurist, Chandigarh
I am having pain in my throat for last few days I can't able to speak clearly my words are getting cracked in middle ...
As you r telling the problem, there may be hoarseness of your throat. Avoid cold drink and curd etc. Do gargles of hot water with salt three times a day. Also at night hot milk adding turmeric, sugar ghee you may take 3 days.
1 person found this helpful
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Sir I consult a doc for my daughter for depression they suggest olanzapine fluoxetine combination 25 mg at night during this time can I send to school .she is saying I am unable to concentrate wat is going around me not understand unable to do wat to do next. She is very intelligent in studies bt not she is struggling to read 4 lines and forget what she studied after that .my question is she better after taking tis tablet and how long she has to take. Can we give cbt for her .pls suggest.

M.S. Counselling and Psychotherapy
Psychologist, Bangalore
Sir
I consult a doc for my daughter for depression they suggest olanzapine fluoxetine combination 25 mg at night duri...
Dear lybrate user, it is better for your daughter to continue the medicines prescribed by the doctor, for the time being. But along with this she certainly needs counselling. She might have a number of issues at this age, which she may not be able to share with anyone. The counselling process will give her an outlet to express herself and understand her own mind. Cbt will work for her, but don't insist on it. Let the counsellor decide which therapy will suit your daughter. Most counsellors would use" integrative therapy" which might be more useful. Once she is able to modify her thought processes and behaviour, her depression might go away, only then after consulting the counsellor and your doctor, you can stop the medication. Take care.
1 person found this helpful
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Significance of Sexual Health and Mental Health

MS sexuality, M.Phil Clinical Psychology, PhD (behaviour modification), Certified in Treatment of Resistant Depression
Sexologist, Hyderabad
Significance of Sexual Health and Mental Health

Does a struggle with mental illness mean losing one’s cherished sexuality? No, it certainly doesn’t. But many people struggle far more than necessary because they don’t have the information and support they need to address the challenges that can arise around sex and mental well-being.

Sex is a matter of mind

We often think of sex as something our bodies are doing, but a lot of our sex life takes place in our brains. It’s important to realize that, for all genders, our thoughts and feelings play a vital role in getting us turned on and keeping us that way.

Anxiety or depression can strongly affect arousal and can definitely ruin the mood sometimes. Anxiety and other related mental health struggles can make it hard to be relaxed enough to have or enjoy sex, overshadowing it with a host of worries or intrusive distractions. When we are very unwell and struggling just to function, sex is rarely at the top of our mind.

The struggle with mental illness in a variety of forms can hurt a person’s self-esteem and make them feel unworthy of sexual attention. For example, a person may have an unrealistic view of their own body and may actively seek to deny or discipline the body as a way of coping. In these cases, it’s important to be critical of the beauty norms we are shown by the media, step away from the practice of measuring or defining ourselves, and to seek to rediscover our love and appreciation for our bodies and our sexual selves.

Substance use may put limitations or restrictions upon one’s sexual interest. Some drugs can affect your brain in ways that make you less able to feel pleasure from sex for periods of time after their use.

Substance use can be a problem when it leads to sexual behaviours one may not feel proud of. Under the influence of drugs, you may do things that you regret, such as having sex with someone you wouldn’t have while sober, or doing things you normally might be uncomfortable with; such as being filmed or photographed during sex, or having sex in public spaces. These personal-boundary transgressions can lead to shame and loss of self-esteem and cause conflict in relationships.

Additionally, addiction or mental health problems like mania may be associated with intentionally seeking risky situations such as having unprotected sex with strangers or seeking ever escalating levels of violence, humiliation, and bodily harm (both in real life and in the pornography one is consuming). This can impact a person’s ability to find interest in having sex with their steady partner, because the sought-after thrill or risk is no longer present.

When you become an ally to your partner and deepen your communication, your sex life is certain to benefit. Great sex is often based on great connection, and by working on your communication you are nurturing that connection.

we are all entitled to knowledge about our sexuality and that good scientific knowledge about sex is necessary for us to be able to make informed sexual choices. By educating ourselves, whether we are young or old, we can make sex better for everyone.

We all have a right to enjoy and appreciate our sexuality. Do your best to not let mental illness steal that away from you and the ones you love!

6 people found this helpful

I am elder son in my family, I have to face all the responsibility / works etc. Due to this circumstances I am getting tension frequently, so please advise me how to reduce my tension. I am bellow the normal height I have belly due to chair work please advice me how to reduce my belly.

M.D,Psychiatry
Psychiatrist, Amritsar
U must stop sugar intake, cold drinks and fast food to decrease belly. Do yogic exercises also. Go for early morning brisk walk. Take tab zosert50 mg daily to lessen tension. Report after 7 days.
11 people found this helpful
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Dear sir, my brother suffering from parkinson's decease from past 7 years, we tried hard for treatment but no treatment in english medicine. His hand is continuously shaking. Is there any treatment. Please provide details. How and where it can be treated.

DNB in Psychiatry, completed course from Asha Hospital, Hyderbad
Psychiatrist, Salem
I feel the dosage has to be adjusted. If you mention the medicines he is taking, one can suggest the remedy..
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I love someone. That person also loves me or loved me. We were together for 7 yrs. Now i feel like he s changed. Words say something and feeling say something else. Doesn't give importance like before. Because of the behaviour i am hurt i get mood swings. I want to overcome this. But i don't know what i can do. I tried avoidin but i am not able to. Please help?

Reparenting Technique, BA, BEd
Psychologist, Bangalore
Do not avoid this situation. If you perceive this development, talk to him openly and find out as to what is happening with him. These seven years should have been spent in building the union. Since that is not what is happening, may be you have done everything that was meant for marriage and the relationship has become stale and not so exciting. Relationships must be worked on always and little interesting things must be introduced to spice it up. Staleness will creep in easily, and one or the other will get bored. If there is nothing more to explore in this relationship, then that could be the end and the signs are showing. You should not force a relationship to work ? there must be things in the relationship that excite each of you. Women are very intuitive but your interpretation may be all wrong. The disconnect between what is said and the feeling is a good pickup and must be discussed. Instead of speculating any more talk to him and find out the truth and then act accordingly. Remember, both of you must want this relationship, only then there is scope and hope.
1 person found this helpful
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I am feeling very stressed and feel sick also always with headaches n feel sleepy . I do house wrk and also I am a working person. I am too much stressed at my in laws place as a result lack mental peace also which is affecting my health. I am not free to do the things I want. What is the solution.

L L. B..,, M.Sc psychy,, N L P, P.G.D.G.C, M.S psychotherapy,, M.A child care, M A, clinical psy, M.A,social psychiatry,, M.Phil., psychology., Ph.D .,psychology
Psychologist, Vijayawada
I am feeling very stressed and feel sick also always with headaches n feel sleepy . I do house wrk and also I am a wo...
Because of work stress and irritation in home. May cause for your headache. Do not stress in office. Better to develop cordial relations with your colleagues. Be to feel very flexible in work. Do not feel to burden in work. Feel always in a positive manner. When you come to home please talk in a pleasing manner when they are in a good mood. Tell the situation to your husband take the help of him. If he is not helpful. Then do not care to them. Do not priority to their voice. Listen and leave it. Do not put any words in your mind. Better to prepare your mind like that. Feel flexible. Be happy always. Take personal rest. Spend some more time for yourself. Better to talk in phone when your mood disturbed in home. Professional life is different. And personal is different. Behave according to the situation. Do not feel stress. Be friendly and be happy. Ok all the best.
1 person found this helpful
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Hello! is their any tips to concentrate more on studies, nd to be more serious in my life.

MBBS
General Physician, Mumbai
I will suggest you to do suryanamaskar pranayam daily as per your capacity for a minimum of six months.
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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

How can I increase my concentration level at the time of study I am not able to start my study.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
Although concentration is different to memory, they can affect each other. You have not mentioned your age but I assume you are close to 20 years, in which case there may be hormonal changes going on in your system. You may therefore have hormonal imbalances which may impact your memory because of the chemical but also the distractions that come with it. But you may work on the following even if the hormones kick in: Daily exercise of at least half an hour is a must. Even if you go to a gym, ask for aerobic and/or callisthenic exercises with whatever else you are doing. A healthy body harbors a healthy mind. With regard to memory, it is very important that your brain and body is ideally rested to be able to recall whatever is required, rather comfortably. Puzzles pose problems to the brain that help it to use new pathways and neurons, which give the brain considerable exercise. It taxes the left brain to use logic to solve the myriad possibilities which other activities do not stimulate. Crosswords are excellent for vocabulary learning and use. Jigsaws and Rubik cube stimulate different permutations to finally settle on the most likely one. Picture completion and anagrams help approach problem solving from several angles. Do Sudoku, and memory co-relation activities and skills. Have a good night’s sleep, have a good breakfast of more proteins, meditate often, remain free of stress, eat a lot of fiber (whole grains, fruits and vegetables), nuts, avocado, eat dark chocolate, do Yoga meditation exercises, etc. You need to check out if you are stronger visual or auditory. The visual is a better mode than the auditory. However, if you combine the two modes, you will get the best concentration. Have a special place of learning, which should be well lit, with soft painted walls, well-ventilated, with no distractions. When you get bored, study by writing. If you repeat learning at least five to seven times, you will apparently remember for a longer time. Sit comfortably but do not slouch. The reading material should be of a fairly large print. Study at small intervals of about 40 minutes and then take a break or change the subject. Short-term memory is a faculty of the left brain, and long-term memory is a feature of the right brain. When people are stressed, they tend to favor the right brain and abandon the left brain, where short-term memory resides. So, it is really very simple: deal with the stress and activate left brain functions. Here are a few suggestions to activate left brain function: shut your left nostril and breathe, move your eyes from right to left and vice versa for at least half a minute at a time, and do callisthenic exercises with some form of counting, regularly. There are some memory enhancing techniques and study methods that your teacher will be able to guide you with. If your home life is full of distractions and stress, it is likely to affect your memory, adversely. In that case, I suggest that the family goes for counseling. If it is only starting trouble, then I suggest that you do group study or study with another friend but both need to be really serious.
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How much alcohol can someone over 50 safely drinks, and does our tolerance change with aging?

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
Dear lybrate-user. Alcohol is poison. Your liver disintegrates alcohol, absorbs the poison part and releases good ingredients to the blood. That means, to save body, liver sacrifices itself. Even a drop of alcohol is not good for liver. Quit alcohol. Take care.
6 people found this helpful
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Suffering from cough and dust allergy sneezing and body pains esnophilia background using aerocort rotacaps, now body pains heavily pl prescription tablets thanks feverish thanks.

MD PULMONARY, DTCD
Pulmonologist, Faridabad
Suffering from cough and dust allergy sneezing and body pains esnophilia background using aerocort rotacaps, now body...
Aerocort rotacaps are for asthma and should be used in emergency only, as they are used as rescue medicine. For regular use, use asthma preventor medicine by inhalation with spacer.
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What are the uses of tramacip tablet? what will happen if a person uses it overdose? what are it's bad effects?

M.D,Psychiatry
Psychiatrist, Amritsar
Tramacip is Tramadol. Doctors use it for de addiction. Addicts use it for getting high. It can cause convulsions in overdose patient can become dependent on it if he uses without doctors help
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Hi doctor am severely addicted to smoking cigarettes and now I want to stop it but unable to do it please help me in this.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
You have to quit cold turkey because the body and mind will torture you endlessly while attempting a reduction in smoking. The tobacco tar in cigarette smoke lines your lung with huge patches that make that portion dysfunctional. Your oxygen carrying capacity is jeopardized, and breathing is impinged on. But don’t be discouraged because it is not too late even now to reverse all the ill-effects of smoking. I don’t know what other organs could be damaged but do go for a thorough medical check-up to assess the effects of your abuse. Regarding improving your lungs, do a lot of aerobic exercise breathing through your nostrils only. Then there are a lot of deep breathing exercises in Yoga which you can learn too. Deep breathing cleanses your system and lungs and restores it to good health. Deep breathing uses the 80% of the lungs which are not normally used in normal breathing and even when exerting yourself. The greatest effect is in the lungs because this substance is processed through the respiratory system directly through the lung surface. When quitting, you must take one day at a time; though you must give up all smoking at once, and promptly. If you look too far ahead you will get discouraged and will give up. If you sit and count the number of days you have given up, that will also focus too much on achievement. You must focus on the here and now, on that day to be precise. After all quitting is not that easy due to many factors. So even if you fail one day, you must try and try again. Very few people succeed in their first attempt. Your persistence will eventually pay off. The urge to discontinue is hampered by many factors but the worst of them is the conditioning. In fact, these conditions can exist all through the day, unlike other addictions. But your desire to want to stop is the most important factor. It is important to find out about the ill-effects of smoking to have a reason that alarms you about continuing the habit. The information is really scary but true and you must remind yourself about this every day. The nicotine in tobacco smoke stimulates the heartbeat to raise the blood pressure in no time at all. So you must avoid it like the plague: it is just very bad medicine for you. In fact, it is highly toxic too. You will need to stop smoking or consuming any tobacco related items with immediate effect. You should start vigorous exercises, gradually increasing it over a period of time. Do deep breathing exercises every time you feel like smoking (try Yoga), and replace the oral urge with some healthy food substitute to satiate the need. You may also take hard candy or chew gum. If the urge is too strong, then use nicotine gums and nicotine patches, for a little while until the smoking drive reduces, substantially. You may also join Smokers Anonymous in your city where the support is really extraordinary for like-minded people who are also in the same situation. Keep yourself occupied or engaged with interesting activities during the times when it is most tempting. Keep the company of non-smokers for some time i.e. at least for the first 21 days. Above all announce it to everyone that you have quit smoking. Here’s a piece of very good advice: even if you accidentally/willfully take a cigarette, it is not the end of the world – you can start the cessation all over again. You must persevere with the best support until you defeat this addiction. Counseling is very useful in the initial stages and when temptations are at their highest. You could also join twitter2quit program and enjoy its success to give up smoking.
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