well hello and welcome to HealthLine this Tuesday evening .

Thanks so much for joining us.

I'm Jennifer Blomquist.

I have the privilege of hosting tonight and I'm so glad you joined us because we have not done a program for quite a while about Parkinson's.

Are we going to be talking about that as well as something maybe you're familiar with essential tremor?

There are differences and we have a neurologist with us tonight who's been kind enough to come back.

He's been here before but I spent a long time so I bet there's somebody you know or care about maybe a coworker or a loved one who's dealt with this issue and so I encourage you to call in.

We are live in the studio and our guest will be more than happy to answer questions, maybe steer you in the right direction for some help or type types of treatment or therapy.

So please call in at any time.

We're going to be talking about the two issues but we welcome your questions any time and there are a couple of ways you can do that.

I know for all you faithful viewers who come every week you know this so I apologize if I'm boring you but just want to make sure everybody knows about this calling is the easiest way.

866- (969) 27 two zero it's a toll free call.

You'll talk to a call screener and you can either ask the question why they won't just throw you on the air so you'll they'll kind of talk you through it and then you can ask it live.

I really like that way because then you can talk to our guest.

Maybe he would need to ask you some questions to be able to give you a better answer.

So if you feel up to it that's a great option or you can just relay your question to the call screener and we'll get it answered for you that way.

Also we started a texting option a few months ago so that's a really easy way to get your question answered.

Just shoot us a text I promise your phone number will remain secret.

We we don't show it.

We keep it private.

If you feel up to it though, maybe you want to tell us your first name and where you're calling from and then your question.

So couple of options there.

Let's go ahead and meet our guests tonight again, it's been quite a few years.

>> I know I've never had the privilege of hosting with him but others have.

This is Dr.

Jodi near and you are a neurologist.

>> Yeah.

Jennifer, thanks for having me.

I appreciate it has been a number of years since I've been on set to present and I like the live live offering at least as a neurologist I've been working for it's hard to believe twenty five years and so a lot has changed over the course of your career has changed?

Yeah, we'll talk about some of that in the area of trauma tonight.

>> All right.

Well you know, for most of us who don't deal with this special medicine, you know if we see somebody shaky or trembling, you know we we just probably assume they have Parkinson's disease.

But there are differences between its Parkinson's and essential tremor.

Yeah.

Why is it important to differentiate?

Are there totally different treatments?

>> Absolutely.

OK, I think, you know, the the clinical course is much different between the two conditions I try to think of .

The tremor is mostly an internal eitel like your heart rate is for your your heart the brain idle.

You don't normally feel that but there are some people that kind of spill over and start to have tremors all the time or they're brought on by certain things and so we are often presented a patient who is concerned that they have a tremor and it's affecting their quality of life and they don't know whether it represents something more serious that's going to progressively get worse like Parkinson's disease or if it is something more annoying we'd call life affecting called essential tremor.

>> You know, does essential tremor ever become Parkinson's in advanced stages?

>> Yeah.

So the classic teaching was now, you know, over time though I do think there's a slightly higher risk it may be from us closely following patients over time but in general people shouldn't be worried if they have a tremor that they automatically have Parkinson's disease.

You know that number is almost eight to one meaning essential tremor is that much more common than tremor of Parkinson's.

And again, tremor of Parkinson's is just one of many symptoms on that list.

>> I want you were kind enough to put together some graphics for us and I want to make sure we take advantage of that because there's a lot of there's a lot more to it than you realize.

So can we bring up the the first graphic which deals with just the different vocabulary about tremor so there are different kinds of tremors which I didn't I didn't know that.

>> Yeah.

So we kind of think about what position the tremor is occurring and right.

So the so-called when your hands are doing nothing resting tremor you're not using a muscle, they're just resting your lap or along your side.

That is a more indicative tremor of Parkinson's disease and I'm sure we've all seen that in the community.

Someone's hand is shaking as they walk down the hallway, that kind of thing.

It's more of an out of sight out of mind.

A lot of those patients don't even realize it that it's happening.

And so that resting component is an important thing that we look for .

The second thing is when our hands are put out in front of us in posture we're holding that position for a period of time and we will start to see an oscillation usually it's very fast and it's very fine.

It's not a slow kind of flopping tremor.

And then the third thing most important is the action component.

So as someone is grabbing something or bringing it to their mouth for example or writing, I think we have some examples or many examples of interesting that is more indicative of a central tremor.

So postural tremor hands in front and then finger to nose or eating drinking is more typical of a central tremor.

>> Can can we bring up if you guys don't mind at that graphic number two does yeah.

There it is with the handwriting examples.

So on the left that's essential tremor correct.

How describe to me like the thing the key a component you look for and I think this example is a little bit too smooth as far as the undulations do I kind of refer to this is Halloween handwriting.

Yeah well you can see the jagged someone may be writing a check at the grocery store or at the bank and the nerves of that really maybe people are nervous subconsciously they are and so the tremor will pick up a bit.

So with every aspect of that turn that we see there, the shaking is part of it as opposed to what we have to the right side there with Parkinson's disease.

The handwriting is really not tremulous but it's small.

>> Yeah.

And someone can take a very long time to draw in one little tiny spot.

So just an example in some people will bring these things into us and say, you know, here's my writing, here's my checks.

>> The bank will cash them anymore.

Oh yeah.

So you know and that's interesting you say that when you think about somebody writing with both hands tremble you have the tremor at the same time or is there do you ever run across somebody who maybe they're right handed left hand doesn't tremor as much so maybe they can kind of guide the yeah.

>> Hand I don't know if that's feasible.

>> Excellent point.

You know I forgot to touch on that earlier but Parkinson's disease is often unilateral with that resting tremor whereas the central term is usually Bilad and so you will see patients trying to hold a clipboard and trying to write at the same time is very difficult.

But yeah, one side may be more prominent than the other and I think that that is because of their dominant hand they notice it more.

Yeah.

Oftentimes we refer to that essential tremor is kind of a piece on the fork soup spoon you are drinking from a glass putting a screwdriver the screw had can be very difficult.

>> Oh, I would imagine it would be frustrating to especially because neurologically they may be functioning just fine and able to cognitively function but just you know, to have that you know that deal with that.

Yeah.

Do they ever feel exhaustion from it?

I you know I don't I've never asked anybody do you feel tired from your hands or body trembling?

>> Absolutely.

You know they are often fatigued from the rhythmic movement sometimes this is a very large tremor of the head, the voice in the extremities.

So it's it's just overwhelming, you know, and annoying.

>> People will often avoid going out to restaurants.

>> I can understand that.

You know, oftentimes I think of this like a salad bar.

You know, having a soup in a salad or whatnot not going to happen.

>> You're not going to make it back to the table and you we were talking before the show and you've been in this profession for more than two decades.

I think there's greater awareness of it.

I was telling him, you know, all right, I'm really revealing a lot about my age.

But I had a major crush on Michael J. Fox when I was in middle school and high school and I never missed any of his movies or weekly television programs and I just thought he was the coolest guy and then I think he brought a lot of attention to this issue.

I was blessed there was nobody in my family who had that at the time so I never really gave it much thought.

But when he was diagnosed with it and I remember seeing him testifying before members of Congress in Washington just trying to to draw attention to it and for programs to be created to help people.

And so, you know, whether you love Hollywood or don't I you know, you got to at least give him credit for bringing light to it and everybody in America knows who he is.

>> You know, I think I think he's had a huge impact on Michael J. Fox Foundation is a not for profit has been amazing to bring forward research also awareness and fitness, you know, is a big movement right now that helps patients with Parkinson's disease.

You know, just the point I want to stress is that Parkinson's is not just a tremor.

In fact, the tremor may be the most obvious symptom to the public but it's not the most disabling symptom.

You know, it really is slow movements eventually balance difficulty and then muscle stiffness.

>> All right.

Well, we have a lot more that we want to talk about some more slides to share with everybody.

But we welcome your questions at any time.

We would love that.

So please feel free to interrupt at any moment again.

That's why we keep the phone number and the texting number up at the bottom of the screen.

So it's (969) 27 two zero that's the phone number to call put an six in front of the air in case you're outside of Fort Wayne it will still be a free call for you and then texting I'm surprised we usually get a lot of people texting for the programs because it's so easy.

That's a little different.

No (969) 27 three zero and again we only have doctor near here until a little before 8:00 so take advantage of the time sooner rather than later.

What what can person expect?

You know, if they're starting to have issues and they're concerned, you know, is this an essential tremor or is it Parkinson's?

>> What should they do is they're kind of a standard test that that they can go through for a diagnosis.

>> Yeah, yeah.

I think a lot of people will start mentioning it to their primary care provider.

I think that's a good good place to start.

Yeah.

Most providers are very familiar with tremor and at least how to kind of guide people and so I think that that's very helpful.

A lot of times they will even start a treatment.

You know that may in anticipation of sending a patient to neurology for further evaluation.

But I'll be honest, you know, the primary care in our region is very good and a lot of times patients have tried one or two medications without much benefit or side effects and they're ready to come in and hear about, you know, what else could be done when you say medications and I know the approach across the board in all specialties is start conservatively.

So I talk about maybe just like an oral medication and is it to help control the movement or is it more like neurological functioning or.

>> Yeah, a great question.

I think just maybe take a step back in regards to adaptive techniques you mentioned holding the hand down many people will change the way they write or holding that hand tight or changing the way that they grip a pen they make weighted hands or weighted utensils.

They have a kind of a fancy gyroscope you can hold so that the fork doesn't move.

So you know, humans are innovative.

You know they come up with ways of making this livable and so there are those conservative ways and then oftentimes we do kind of build over into medication options.

>> All right.

Well, I I want to talk more about that but somebody did call in Fred called in and wanted me to ask the question for him.

So thank you, Fred.

So he wanted to know if elevated levels of iron can cause tremors.

>> That's interesting.

Yeah, that's a great question, Fred.

I'm not sure that we would typically consider elevated iron levels as a cause of tremor necessarily.

There are many different types of tremors beyond what we're talking about tonight that can be induced by chemical right.

At least other medications.

Right.

And so even use caffeine is an example, right.

Caffeine is sometimes a little bit of a stimulant effect with tremors.

So but I'm not aware that ion itself would be something you could we would test for to see if it's elevated.

>> Yeah.

Do they do blood work?

I know you've got a whole clinical effect.

We've got we've got a slight I think is it no.

Three or no I think it might be further down or further up excuse me where you talk about different ways to diagnose it is there what does blood work give you any clues?

>> I wasn't sure yeah.

When it when it comes to kind laboratory studies they're really just a couple of things that we think about thyroid right?

Oh sure.

Hypothyroid overactive thyroid kind of like a thermostat.

We turn it up, we get tremulous, we get Texican, we lose weight you know so we check thyroid and vitamin B 12 level is a common task that's done.

So pretty simple when it comes to genetic evaluations there's really not a lot in the essential tremor group.

There are some things in the Parkinson's territory with regards to genetic testing.

>> All right.

Yeah, I mean think about that that you could have that hereditary component.

What about environmental factors to those do you think ever play a role or is there are researchers even considering that?

>> Yeah, clearly I think the I always kind of the VA has done a very good job of collecting data on the veterans where they've served and what they may have been exposed to and owning up to that.

And so even some of the Agent Orange or the Camp June water or things like that, they've tried to make links and a lot of those conditions are neurologic Tramer being a common one, Parkinson's being another.

And so clearly there's an environmental trigger from a Parkinson's standpoint but essential tremor tends to be 50 percent genetic or 50 percent random.

>> OK, all right.

Yeah, that is I mean it's great that there's research which I know we want to talk about that toward the end of the program as well but we did get a text message so thank you so much.

Rita called or texted from Fort Wayne .

Her question was if Parkinson's disease eventually results in death, can it can it shorten your lifespan?

>> Yeah, you know, I spent a lot of time with patients in the clinic trying to provide guidance on this and clearly it's hard to predict the future but typically for I call it garden variety Parkinson's disease that behaves well.

It shouldn't necessarily shorten someone's life .

It will make it more difficult.

Yeah, by far the risk of falling you know, the risk of choking and aspirating those are real risks.

But if I was still them if we do our job right and you do your job right by exercising, I think we can take this a long way.

>> And I'm just wondering if a lot of people can live independently with this.

I mean especially with somebody older, maybe their spouse is no longer living or they just live by themselves.

>> Is that safe or only up to it at a certain point?

>> Yeah, I think speaking of Parkinson's specifically the progression that really we think of five stages you know stage one and two are mostly tremor in imbalance that can take years seven to ten years maybe to move through a stage.

Stage three is having a little bit of balance issues, maybe needing some help every now and then four and five really lean heavily on a walker in someone being there.

So it really comes down to following these patients over time and trying to predict where they're where they're heading.

In the meantime, they're exercising every day.

>> Yeah.

If they if they do it then hopefully they're exercising in groups.

Right.

Which is hugely helpful.

Really good.

And so I think that's been some some of the major movement has been the patients initiative to take it on and we do have we are blessed to have a wonderful medical community and a lot of amazing nonprofit organizations and there is a nonprofit in town that we've done programs with them before Turnstone and they have a great exercise program for Parkinson's patients and I've learned a little bit about it over the years.

And so it not only helps them physically but as you were talking a doctor near the importance of socializing because these people will go to this exercise class together and they all are dealing with similar issues which I think would be very helpful and avoid isolation.

>> Absolutely.

You know, I think that the spouse is encouraged to come to that.

>> Yeah, the patients are working out and it's not easy.

You know, it's tough actually if you see video of them doing some of these exercises and as you were saying we were talking before the show it's kind of symbolic because it's it's kind of like kickboxing.

>> Absolutely.

Yeah.

So it works on balance and voice right.

And speed of movements.

You know some of the early trials of movement helping Parkinson's with cycling.

So peddling RPM's I think the more RPM's boxing the RPM's walking is good right.

It doesn't push every button that you need to work on persay but it's better than nothing now.

>> I mean any anything you can do to get out and about and just try and make your life a quality of life is such a big thing.

>> So they just held up the car not too long ago that we're getting down down to the last five minutes believe it or not.

So we could still take a few questions.

So we thank you to Fred.

Thank to Rita for for sending us some questions.

But if you're out there and you want something answered even if it's just to get a frame of reference, you know, if you think maybe somebody has an issue what to do, please just let us know and doctor and here would be happy to to address that for you.

>> So once the a person is diagnosed, what do you know what kinds of options do they they have?

>> Do you do any intervention necessarily for essential tremor?

Yeah.

Right off the bat right off the bat.

You know it's nice to review what medicines people may have taken, what testing if any they've had, how concerned they are about another condition at least and then it's really thinking about are there medication ways there's only one medication that's FDA approved to treat tremor.

OK, we try a lot of things and basically, you know, we think of kind of taking the edge off the nervous system a little bit.

People don't want to be confused.

They don't want to be tired.

Right.

They don't want to have other side effects.

So it's a real hard balance when we extinguish the medication options.

There are there are kind of some next level treatments that have been around for a while now.

Yeah, even you referred back to Michael J. Fox Parkinson's at least.

Yeah.

There's ways of kind of manipulating the brain if you will, injuring a small area of the brain that's in this complicated circuit.

Deep brain stimulation has been around for a very long time putting electrodes into the brain stimulating a little bit like a pacemaker.

>> And then over the last ten years already we've had noninvasive treatment with focused ultrasound.

And you know, another thing we were talking about earlier is I think people in what Wayne and hopefully this is you know, hopefully people are opening their eyes to see we have so much here medically available.

You know, there's a lot of stuff that you can have done here and not have to go to some of the bigger cities which is that's difficult especially if you're talking about an older person, you know, trying to travel, have somebody get them.

They're going a few hours away.

I know I hate having to do that with my children and so I can only imagine for somebody older that's a burden.

So you were saying they have a lot of options here.

>> I mean why not why not try it?

It can't hurt.

Absolutely.

And yeah, you know, having these offerings in the region is very nice because you know, all of these treatments were academic at one point just like a lot of medical advancements and then eventually they filter to the regional centers and eventually to even smaller communities sometimes.

>> Yeah, no, that's great.

Great to know.

So we want to talk about research too.

We just have a few minutes left.

But you know, we've talked about the issue coming to light nationally is is it a big topic of research?

>> Do you feel like there's a lot of advancement?

Yeah, I think in the in the essential tremor right.

Is the essential tremor is the most common movement disorder.

Yeah.

It affects people.

It's not life ending or life it's life changing though they have researched 30 plus medications most of which fail because of the side effects.

Right.

Trying to take the edge off of the nervous system is difficult and so the research is heavily weighted right now into procedural interventions.

You know, I think the circuit of this tremor control making our movement smooth.

There's multiple steps and I think eventually we may find that treating one aspect of the circuit helps someone more than another person.

>> Yeah, it definitely sounds like it's not a cookie cutter diagnosis for each person is is unique.

Yeah.

Yeah, very much so.

>> I don't want to put you under the gun.

We only have two minutes left but we did get a text from a man named Mark.

>> He wanted to know if there were any links between Parkinson's and Alzheimer's.

Great question.

>> I hear a lot about that now.

Absolutely.

So both of these conditions are neurodegenerative, right?

One is a movement disorder.

The other one is a cognitive disorder and we really don't know why these two areas well multiple areas of the brain decide to close up shop before we're ready at least.

And so patients with Parkinson's disease can develop dementia.

It's usually later in their course 10 years, 15 years, 20 years down the road.

Patients with Alzheimer's disease don't usually have movement problems early on as things advanced, their movement system may fail them but there really isn't a link.

I think sometimes we'll find patients that were diagnosed with both Alzheimer's and Parkinson's disease and the neurologists to me would say no, no, no.

That's probably something we call dementia with Lewy body disease which is the second most common dementia after Alzheimer's.

>> Most people haven't heard of it before.

Yeah, and these are all things that they continue to impact.

A lot of people are you know, growing up there was no if you had said memory care center I would have said well you know, we have memory care centers all over now.

I mean it's I've written some articles about them and they they they do them they design them.

I mean they work with the contractors and they're building based on the symptoms and you know, like one I remember one of them they said they like to walk in circles so they just had this this whole thing was based around like a hallway where they could walk in circles.

>> And so again we have there's so many advancements being made.

So I hope that all of you out there dealing with it or know somebody who has this will take heart in that things are getting better and we have more available certainly compared to years ago.

So the time is up.

>> Dr.

Neil, I apologize.

It goes like this again.

Dr.

Jody Nir, neurologist, thank you so much.

Great to have you on.

Thank you everybody have a good night.

Take care.

We'll see you next Tuesday.

Bye bye.