Puberty can be a challenging time for both parents and children. Puberty is a normal phase of childhood but parents
are often unprepared for the changes that occur. In addition, many parents are uncomfortable talking about puberty and may also be worried about what is or is not normal.
Malik, MD, Family Physician at NorthShore, has worked with children and teens extensively, formerly in an adolescent sexual health center and currently seeing many children and teens in her practice. Also, she is anticipating this phase in her own children
who are now six and eight and thus has a keen personal interest. Recently, she sat down with us to answer questions and share her insights:
When should I expect my child to enter puberty?Although there is a wide range of
normal ages, girls typically begin the process of puberty at ages 10-11 and boys at ages 11–12. Girls usually complete puberty by ages 15–17 while boys usually complete puberty by ages 16–17.
What body changes should I expect
in my child?
How do I talk to my daughter about her period?Make her first
period less daunting by talking about it before it starts. Let her know:
How do I talk to my son about erections?Your teenage son might feel embarrassment or shame but involuntary erections are normal. Let him know:
body odor and acne common in boys and girls?The composition of perspiration changes will result in a more "adult" body odor. You might need to have a discussion about deodorant and anti-perspirant options, as you will likely notice the odor
before your son or daughter does. There is also increased secretion of oil from the skin which may cause acne. Acne varies greatly in its severity but it is important to see your healthcare provider before there is a chance of scarring and damage.
child has become moody. Is this normal?Moodiness is very common during puberty. You may see dramatic changes in your child’s personality. Your child may be less willing to spend time with you, may be less interested in talking to you and
may develop new interests. Though moodiness is to be expected, some mood changes can signal possible depression. Symptoms of depression include: changes in sleep pattern, loss of appetite, loss of interest in things that they used to enjoy, low energy, frequent
crying, withdrawing from friends and family, irritability and anger, talking about feeling worthless or hopeless and/or a noticeable drop in grades. If you notice any of these signs, bring your child to see his or her healthcare provider right away.
How and when should I start talking to my child about sex?Sex can be an uncomfortable topic for both kids and parents to discuss. Nevertheless it’s important that your child is prepared with all the information necessary to
prevent unwanted pregnancy and sexually transmitted disease. So, talk to your child about sex early and often! Parents, you are the most influential people in your child's life and you should be his or her source for reliable information when it comes
to sex. It’s important that the conversations begin before your child starts to experience any bodily changes. While it might feel embarrassing or awkward to discuss these sensitive topics, your child likely will be relieved to have you take the lead.
Initiate the discussion by providing your child with a book or pamphlet from a trusted source to read on their own. Make sure you are available afterwards to answer questions. Try to use proper anatomic terminology
whenever possible. Using specific names for each part will make it much easier to identify medical issues later in life. Some parents worry that scientific terms are too complicated for their children, but I’ve found that these terms actually
simplify things in the long run. Children can then easily explain future symptoms to you in a clear, understandable way. Each time you talk, provide more detail, depending on your child’s maturity level and interest in the topic. If you feel unable,
ask your healthcare provider for advice or bring your child in for a well child visit to provide an opportunity to discuss puberty one-on-one. This can be a chance for your child to ask the questions they may not be comfortable asking you.
I be worried if my teenager is masturbating?During puberty as hormone levels increase, interest in sex increases. Masturbation is a common, very normal way for boys and girls to explore their own sexuality and changing bodies. It’s not
harmful to your child. It is important to respect your child’s privacy, but, again, be sure your child knows that you are always available to answer any questions.
Patient Michael Heyman had no idea that a routine visit to the dentist
the day after Christmas would turn into a cancer diagnosis exactly one week later. After his dentist noticed a lump on the left side of his neck, Michael saw his doctor, who, despite his overall good health and active lifestyle, referred him to an ear, nose
and throat doctor for further tests. Surprisingly, for both doctor and patient, the diagnosis would be stage IV oropharynx (throat) cancer. Lab tests would confirm that his cancer was related to the human papillomavirus (HPV).
Michael shares his story
of diagnosis and recovery and what he discovered about the HPV-related throat cancers, currently on the rise in men, and why he recommends all parents ensure their children are vaccinated:
What was your reaction when your doctor said “cancer?”I know it sounds like a cliché but it was surreal, like he was talking to someone else. Two days before he had said it was likely a slow-growing benign tumor, which he based on other factors in my medical history. He said he would remove it at my
convenience. So, a cancer diagnosis was shocking.
We looked up the type of cancer on the Internet and this same cancer is often skin based so for an hour before our visit, we were concerned but we had no idea that if left untreated, my cancer
would be fatal. We didn't look much up on the Internet after that. There were too many stories and we quickly learned that every cancer case is different.
Your throat cancer was caused by HPV. Before your diagnosis, did you know that HPV-related
throat cancers were on the rise? I was largely unaware of throat cancers or HPV. My two older sons were never vaccinated because the HPV vaccine wasn't available. Our youngest son was vaccinated. I did know something about Michael Douglas
and mouth cancer but not HPV. Of course, now, we are quite versed in many aspects of throat cancer and actively trying to educate parents, grandparents and friends about the importance of the vaccine, and awareness of the dangers of snuff and chewing tobaccos,
which increase chances of mouth cancers by as much as ten times.
What would you tell parents who are hesitant when it comes administering the HPV vaccine to their children? My 88-year-old mother had to drive her 61-year-old
son to radiation treatments every day for seven weeks. I hope that image and the knowledge they can prevent this type of cancer will help them make the right choices for their kids now. The HPV vaccine must be given to every boy and girl prior to sexual activity.
Don’t wait until it is too late. And, there are no known adverse effects.
What was the most challenging aspect of your treatment? A friend who had gone through treatment told me that it would be a day-by-day,
hour-by-hour struggle. I kept a journal of the first six months of cancer and treatments. I guess it was a way to complain without bothering my wife. On the rare occasions that I go back and read entries, it’s very painful, near impossible to remember.
The most challenging part was the trying to drink four bottles of Ensure each day. My tongue was so badly burned from treatments that an hour of preparation only allowed me to get a couple sips down but I had one goal—avoid a feeding tube. I managed
to do that but just barely.
What advice would you give to others newly diagnosed with a throat cancer caused by HPV? Connect with others who have gone through this and do it early. It helped to know what we had to get through
at every stage. We weren’t alone so very little surprised us.
What’s next for you and your family? This past week I had all of my one-year scopes and scans, and all were clean. My short-term goal is to be clear
of this cancer for another two years, which would give me three years cancer-free after treatment. After that, I'm doubtful that this cancer will return though I have a 30% chance that it could. I choose to focus on the 70%.
Taking my illness
as a sign, I haven’t returned to work and closed my business of 19 years. We decided that it made more sense to live a stress-free life out West in the mountains. I haven't missed work or business and had no trouble letting go, maybe because of
What did you learn during this process? There are a lot of huge things over which we have no control so I try not to stress about the little things. Also if I have a list of things to do and something more fun
pops up, that's what I do. Lots of stuff gets deferred but it turns out most of it doesn't matter much.
Also, I try to reach out and be available when someone asks me to talk to others about cancer. This has happened a few times already and
resulted in new relationships. A survivor friend told me that it would be impossible to thank all the people who helped, supported and cared for me during treatment and recovery and that the best way to thank them would be to help others in the same position
I was 16 months ago.
Mr. Heyman underwent treatment at the NorthShore Kellogg Cancer Center. His treatment plan was supervised by head and neck cancer expert Dr. Bruce Brockstein (pictured above). For more information on the Kellogg Cancer
Center, click here.
Lack of sleep can impair your ability to focus at work and school and it can also prematurely age skin and contribute to weight gain. But, did you know that chronic sleep deprivation can lead to even more serious health issues like heart disease, heart
attack, stroke, diabetes and depression? In other words, getting enough sleep is an essential part of a healthy lifestyle. Do you get enough?
The experts at NorthShore University HealthSystem share simple sleeping tips to help you start sleeping better
and deeper now. Check out our full sleep tips infographic below to enjoy the health benefits of a good night’s sleep:
Annette Sereika, APRN
at the Kellogg Cancer Center and NorthShore Center for Personalized Medicine, comes from a family of nurses; in fact, you could say nursing is in her genes. The natural progression of her career, from NorthShore’s Neuro-Oncology Clinic to the Center
for Personalized Medicine, reflects her passion for providing the best possible care and acquiring in-depth knowledge about the cutting-edge treatments that could dramatically improve outcomes for her patients.
NorthShore is proud to
have been the professional home Annette chose at the outset of her career and is honored that she has stayed with us. This National Nurses Week, we extend our thanks to Annette and every single one of our nearly 2,500 NorthShore University HealthSystem nurses.
Annette shares her story, from what brought her to NorthShore’s Kellogg Cancer Center to the rewards of caring for her patients:
When did you know you wanted to be a nurse? Was there a particular moment or experience that led
to you this area of the medical field? There was no “lightning bolt” moment for me. Actually, I can’t remember a time when I did not want to be a nurse. Providing healthcare seems to be in my “genes”—three
of my sisters are in healthcare-delivery fields, as well as two aunts and several cousins.
Why oncology as a specialty? It’s more like oncology chose me. I was given the opportunity to work in the Kellogg Cancer Center (KCC)
in the early 1980s. At that time, I was a young nurse looking for a change and a challenge. A colleague who worked in the KCC recommended I interview for an open position. I still remember the group interview so clearly. That was 1984 and
I never left.
I learned quickly that this is a very special place to work. The KCC exemplifies what it means to have a “team approach” to patient care, where physicians, nurses, pharmacists, psychosocial support and the administration
all work together to provide the best comprehensive care possible.
Why was continuing your education by becoming a nurse practitioner with advanced practice certification in oncology so important to you? I graduated from
Loyola University with my BSN in 1981 but science and medicine have evolved so much since then. I wanted to know more so that I could be a part of those changes in healthcare, especially in the field of oncology.
Having an advanced degree
as a nurse practitioner has provided me with more autonomy as a healthcare provider, but, it’s my years of direct-to-patient care that has given me an appreciation of the important role everyone plays in care. My advanced degree has also enhanced
my role as an educator, not just for my patients but for staff too. I’m involved in the recent launch of the Personalized Medicine education module that is available to all clinicians on DevelopU.
Why have you now decided to work
more closely with NorthShore’s new Center for Personalized Medicine? Oncology is one of the first fields of medicine to recognize the role genetics plays in preventing, diagnosing and treating diseases. For many years I worked in
NorthShore’s Neuro-Oncology Clinic within the KCC. I was involved in several clinical trials that used a patient’s genetic information to determine their treatment options, which was different from previous trials where everyone received
the same therapy. This was life changing for many of my patients; the ability to provide molecular analysis of a patient’s brain tumor played a huge role in determining the best treatment options and delivery strategies, which improved responses
and minimized side effects. For one young woman, molecular testing helped us create a treatment strategy that minimized her side effects. This allowed her to continue her work as a nurse and raise her family. Similarly, another patient was able
to continue to exercise throughout her therapy program and ran a marathon shortly after its completion.
What impact has this new personalized treatment had on patient outcomes?NorthShore’s ability to provide genetic
and genomic testing has transformed our ability to tailor treatment decisions for patients not only in oncology but in other fields like cardiology, endocrinology, and neurology. In March of this year, NorthShore launched the first pharmacogenomics clinic
in the Chicago area. The specialists in this clinic use genetic testing to provide information about a patient’s response to certain medications, including an adverse response. This allows doctors to provide the right drug at the right dose the
first time. Our patients are medically savvy, and many are participating in NorthShore’s Genomic Health Initiative as they recognize the need for “cutting-edge” research to advance our understanding in this field.
What do you
find most rewarding about your job?I have met incredible, inspirational people, both patients and colleagues that have had a profound impact on my life. By far, the most rewarding aspect of my job is the relationship I develop with patients
and their families. And while in some cases the treatments provided don’t change the course of the disease, I’m convinced that the personalized, compassionate care we provide enhances their quality of life.
What do you find
most challenging? Unfortunately the economics associated with healthcare are often very frustrating. The costs of medical care and some medications can be thousands of dollars monthly and many people don’t have the insurance
coverage or the finances for that. Also, many insurances companies are still investigating their responsibility for coverage on some of the “cutting edge” areas of medicine. I spend a lot of time obtaining authorizations and appeals for recommended
What would you tell other men and women contemplating a career in nursing? I think a career in healthcare is an excellent choice and the nursing field has a wide variety of possibilities: inpatient care, outpatient
care and research are all available within many medical disciplines. There are many opportunities for advancement. Most importantly, as a nurse, you have the chance to make an important and meaningful impact on the lives of others. I am very proud
to say I am a nurse.
This National Nurses Week, honor and recognize a NorthShore nurse by sharing your story or making a gift that will go to the Nursing STARS program at NorthShore. Find out more by clicking here.
Cinco de Mayo is a time to get together with friends and family to celebrate Mexican culture and, of course, food. This year, try one or all of these delicious vegetarian recipes and keep your Cinco de Mayo happy and healthy.
Herrejon, RD, Certified Diabetes Educator, Adult Endocrinology Group at NorthShore, shares three of her favorite Cinco de Mayo recipes:
“Mexican-Style” Gazpacho Traditional Spanish gazpacho is a tomato-based vegetable soup that is served
cold. This “Mexican-style” gazpacho is also served cold (or at room temperature), but it’s more like a fruit and vegetable salad. If you have never had this type of gazpacho before, you may be surprised how well the sweet, salty,
tart and spicy aspects enhance the natural flavors of the fruit and vegetables.
Serving size 1 cup Recipe makes 4 servings Ingredients: 1c fresh pineapple, finely chopped 1c cucumber, finely chopped 1c jicama, finely chopped 1c mango, finely chopped 1/4c freshly squeezed orange juice 2 tbsp lime juice 1 tsp your favorite dried chili powder or cayenne pepper or paprika 1/4c queso fresco (optional)
Nutrition Information (without cheese) Calories: 80 Total Fat: 0g Total Carbohydrate:
19g Fiber: 3g Protein: 1g
Nutrition Information (with cheese) Calories: 104 Total Fat: 2g Total Carbohydrate: 19g Fiber: 3g Protein: 2.5g
Guacamole Some people avoid avocados because they are high in fat. Luckily,
avocados contain unsaturated fats, which, when eaten in moderation, are a delicious part of a healthy diet. And it’s not Cinco de Mayo without a little guacamole. By serving guacamole with carrot and jicama sticks, you will be able to enjoy this
tasty side dish without the extra calories and fat of tortilla chips.
Serving size 1/4c Recipe makes 10 servings Ingredients: 3 ripe avocados, halved, seeded and peeled 1 Roma tomato, diced ½
of a medium onion, diced 1 serrano pepper, seeded and minced 1 tbsp cilantro, finely chopped 1 lime, juiced Salt to taste 2.5c carrot sticks (for dipping) 2.5c jicama sticks (for dipping)
Nutrition Information Calories: 106 Total Fat: 6g Total Carbohydrate: 11g Fiber: 2.5g Protein: 2g
Poblano Peppers and Onions This traditional dish is often made with high fat crema Mexicana and/or cheese. By using light
sour cream and omitting the cheese in this recipe, the calorie content is greatly reduced and the star ingredients—the poblano peppers and onions—can really shine.
Servings size 3 tacos Recipe makes 4 servings Ingredients: 5 poblano peppers 1 large onion, sliced Cooking spray 3/4c light sour cream 12 corn tortillas Salt to taste
Nutrition Information (without tortillas) Calories: 92 Total Fat: 4g Total Carbohydrate: 9g Fiber: 2g Protein: 5g
Nutrition Information (with tortillas) Calories: 242 Total Fat: 6 g Total Carbohydrate: 39g Fiber: 6.5 g Protein: 8g
What are your favorite Cinco de Mayo recipes?
Foodborne illness is in the news, from listeria recalls across the country to
botulism in Ohio. Foodborne illness should always be taken seriously. Prevention is key—cooking meat properly and ensuring that raw food is thoroughly washed before serving—but knowledge of symptoms and treatment options can keep foodborne illnesses
from becoming much worse.
Jerrold B. Leikin, MD, Medical Toxicologist discusses five food-borne bacterium,
including symptoms and required treatments:
Listeria is a bacterium that is found in soil, water and animal feces. The bacteria can find its way into food, however, typically via raw vegetables that have not been properly cleaned, animal
protein, unpasteurized milk or foods that include unpasteurized milk and some processed foods like soft cheese and deli meats. Recently, outbreaks due to contaminated ice cream, cole slaw, alfalfa sprouts and hot dogs have occurred. Symptoms:
Exposure to the listeria bacteria can cause fever, muscle aches, diarrhea and nausea. Symptoms can develop as quickly as a few days after exposure or take as long as two months to appear. If the infection is more severe and spreads to the nervous system, symptoms
could also include headache, stiffness in the neck, confusion or inability to remain alert, loss of balance and convulsions. These symptoms could indicate bacterial meningitis, which is life-threatening, and will require immediate medical attention.Treatment:
If you have eaten food that has been recalled because of a concern over listeria and believe you are experiencing any of the symptoms listed, seek medical attention as soon as possible. If you are pregnant, see your doctor immediately as even a mild infection
can cause severe harm to your baby.
Salmonella is most commonly found in meat and eggs but raw vegetables can also be contaminated if they are handled by unwashed hands. If meat and eggs are undercooked or vegetables are
not properly washed, salmonella can cause mild to severe gastrointestinal illness. Unpasteurized milk can also harbor salmonella. Symptoms: Those who have salmonella poisoning will run a fever and experience diarrhea and abdominal
cramping. Symptoms usually develop 12 to 72 hours after exposure and symptoms can last from four to seven days. Treatment: Most people will not require treatment. Babies and older adults who have weaker immune systems should be carefully
monitored as dehydration could cause more severe reactions.
Escherichia coli (E. coli) is harmless in some cases and can cause serious illness in others. E. coli exposure could result from the consumption of contaminated raw vegetables
and undercooked ground beef. Symptoms: Diarrhea and abdominal cramping can occur. In particularly virulent strains, cramps are accompanied by bloody stools and vomiting. Symptoms are generally more severe for young children and older
adults and, while rare, both groups have a greater risk of developing a form of life-threatening kidney failure known as hemolytic uremic syndrome. Treatment: There is no medication that can treat an E. coli infection. Less severe infections
will merely require rest and fluids. Anti-diarrheal medication is not recommended because it slows digestion, which will ultimately remove the infection from the body. For those suffering an infection from a more severe strain (called enterohemorrhagic or
E. coli 0157:H7) that can cause kidney problems, hospitalization will be required.
Botulism is a rare but very serious illness that is caused by consuming food contaminated with the botulinum toxin. Unlike other foodborne illnesses
that affect mostly the gastrointestinal system, botulism attacks the nervous system causing paralysis from top to bottom, starting with the eyes and face. It is usually found in home-canned foods, poorly preserved meat, marine products, or liver pâté.
Infant (intestinal) botulism can occur in babies under one year old and has been correlated with ingesting spores found in honey. Initial symptoms of infant botulism include lethargy, poor feeding, weak cry, constipation, and progressive weakness.
Symptoms: The symptoms of botulism can be severe. In addition to paralysis, other symptoms include: fatigue, vomiting, nausea, difficulty swallowing, blurred or double vision, muscle weakness and lack of fever. Treatment:
Botulism must be treated and it must be treated quickly. If identified early, victims can be treated with an antitoxin that prevents the infection from spreading into the bloodstream. If not treated early, botulism can result in permanent paralysis or even
Shigella is a highly infectious bacterium, most commonly found in potatoes, milk products, tossed salads, stewed apples and raw oysters. Outbreaks of food poisoning usually occur in the summer. Symptoms:
Acute onset of fever, abdominal cramping and a large volume of very watery diarrhea can occur within 3 days of exposure. The fever usually resolves within 48 hours; however the diarrhea can turn bloody. Reactive arthritis can occur after diarrhea
resolves, but rarely. Treatment: Most people will not require specific treatment. Babies and the elderly should be carefully monitored for dehydration. Anti-motility (anti diarrhea) agents are usually avoided
due to its potential for worsening the infection in the colon.
The pain of arthritis can range from mild to debilitating but there are treatments
that can help manage it. Victoria Brander, MD, Physical Medicine and Rehabilitation, answers common questions on how to cope with
arthritic pain, from how to slow the advance of arthritis and manage pain non-surgically to when surgery might be the best option:
Could knee pain after exercise be arthritis? First, it’s important to get a diagnosis.
Knee pain can be from arthritis, inflammation of soft tissues, or even from hip or spine problems. Start with ice, rest and an anti-inflammatory cream. If you can tolerate these, the next steps would be to start an anti-inflammatory over-the-counter medication
like ibuprofen or naproxen. Depending on how long the pain has been going on and whether it resolves itself, see a physician who will likely order an X-ray. If it is arthritis, physical therapy, an exercise program and other interventions, like injections,
What is left for patients who have tried prescriptions, physical therapy, chiropractic work, acupuncture and supplements to manage pain? Chronic pain is very difficult. It usually takes a combination of
interventions: medication to restore sleep, pain medication, structured exercise/physical therapy, centrally acting medication to reduce brain "hypersensitivity" to pain, stress management, etc.
It’s also important for a patient and physician
to form a relationship of trust, which leads to better patient compliance, a lessening of fears and better outcomes. Many patients with chronic pain due to arthritis are "kinesthesiophobic,” or have fear of movement, so they need to trust that their
doctors are not going to hurt them with recommendations of exercise and increased mobility. However, the single best predictor of outcome is a patient's own belief in his or her abilities to overcome difficulties. We encourage a positive belief system
through education in classes and by example—patients seeing other patients with the same problems undergoing the same treatment.
Can exercise make arthritis worse? Exercise is the single best treatment for arthritis.
It is the only treatment ever shown to change the "natural history,” or deterioration, caused by arthritis. The type of exercise would depend on the individual patient and the joint affected. For knee arthritis, exercises should focus on strengthening
the quadriceps, gluteal and abdomina muscles, as well as working on flexibility of the hips and the knees in order to normalize the pattern of walking. A bicycle is a great exercise for hip and knee osteoarthritis. I strongly believe that yoga is the best
choice for exercise classes for almost all patients with arthritis.
Should you wait until pain restricts your activity to consider surgery or have it done before arthritic pain becomes severe? That's a great question. You
want to wait until pain is bad enough that it starts to limit your activities, but not so long that you are disabled. People with disabling pain have a more difficult time recovering from surgery. It’s very important to reduce your joint pain before
surgery with medications or injections so that you can begin an exercise regimen preoperatively. I like to send my pre-operative hip and knee surgery patients to physical therapy for customized exercise. But, I would say that most people know deep down inside
when the time is right for surgery.
What can be done for those suffering from arthritis in their hands and fingers? Unfortunately, there is no known treatment that slows the "natural history" of arthritis of the hands. I
sympathize because I have arthritis in my hands too! The best strategies: 1)Keep your hands strong and knuckles flexible; 2) Use a brace for the thumb, especially at night to reduce movement and inflammation; 3) Try a topical anti-inflammatory cream—such
as diclofenac cream—up to 4 times a day; 4) Take adequate vitamin D (2000 international units a day); 5) Eat an anti-inflammatory diet, which means avoiding sugars, alcohol and carbohydrates); 6) Keep your hands warm in the winter (I use a paraffin—hot
wax—bath for my hands and then follow that with stretching); 7) And finally, use modified/built up handles on your kitchen tools.
Is long-term use of an over-the-counter anti-inflammatory okay?For many people, yes.
I suggest to my patients that if they are taking an anti-inflammatory every day, they need to come in for a visit every six months so we can monitor their blood pressure, look for leg edema, question them about heartburn and get blood tests. Patients who have
diabetes, disorders of the kidneys or liver, heart disease, reflux, stomach ulcers, or those who are very frail or elderly, on blood thinners, and those on multiple medications are at high risk for complications and need to re-consider taking daily anti-inflammatories.
For more information on the NorthShore Arthritis Center click here.
April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore,
MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.
Demetrius Maraganore, MD, and Ashvini Premkumar, MD
Is it possible to detect PD before symptoms begin? There is no established method of detecting Parkinson’s disease before symptoms begin. Because patients with Parkinson’s disease
may lose their sense of smell decades before the onset of their movement disorder, some investigators have explored the use of smell testing as a method of detecting Parkinson’s disease in at-risk subjects (e.g., persons who carry a rare gene mutation
known to cause Parkinson’s disease). Persons can lose their sense of smell for many unrelated reasons though (e.g., following an upper respiratory infection, head trauma, or if they smoke). Loss of smell can precede other brain degenerations such as
Alzheimer’s disease, so smell testing lacks the specificity needed for a predictive test. A more promising approach is brain imaging using a radiopharmaceutical called
DATSCAN. This is a compound that is injected into a vein and that binds to the endings of dopamine nerve cells in the brain. In Parkinson’s disease, dopamine nerve cells degenerate; hence, there is less binding of DATSCAN. The uptake and binding
of DATSCAN can be measured using a single photon emission computerized tomogram or “SPECT” camera. We are currently conducting a study at NorthShore to determine if persons with mild to moderate traumatic brain injury, who are at an 11-fold
increased risk for Parkinson’s disease, have lower DATSCAN binding than persons without a history of brain injury. This study would demonstrate that it’s possible to detect Parkinson’s disease in at-risk subjects before symptoms begin.
DATSCAN could prove useful as a method to develop asymptomatic Parkinson’s disease in at-risk subjects who could then be prescribed treatments or lifestyle changes that might delay or possibly even prevent the onset of Parkinson’s
disease symptoms. My research associate Dr. Ying Wu is also exploring the use of automated MRI brain measurements in the same brain injury population to see whether MRI may prove effective in detecting preclinical Parkinson’s disease changes in
at-risk subjects. Are PD symptoms or outcomes different between men and women? Between races? My research collaborators and I have conducted several studies of gender differences in Parkinson’s disease. At every
age men are 1.5 times more likely to develop Parkinson’s disease than women. We observed no convincing difference in survival for men and women with Parkinson’s disease. While there was no difference in motor outcomes, we observed that the risk
for dementia was greater in men than in women with Parkinson’s disease. It's possible that estrogen protects against dementia in women. My collaborators and I observed no important differences in the rates of Parkinson’s disease
worldwide, and I’m not aware of any convincing data to suggest that symptoms of Parkinson’s disease or its outcomes differ according to race or ethnicity. What are some of the later complications of Parkinson’s disease? Typically we associate Parkinson’s disease with movement disorders. As the disease progresses, patients may develop balance difficulties that result in falls. As a result, patients become increasingly dependent on assistance in walking. For
example, they may need a cane or a walker or someone to walk with them. As the movement disorder progresses more, patients may be entirely unable to stand or walk even with assistance Parkinson’s disease is not just a movement disorder
though. About one in three patients develop a significant decline in memory and mental faculties, or what we call dementia. Both falls and dementia are dreaded late complications of Parkinson’s disease because they are resistant to medical or surgical
treatments and because they carry an increased risk for nursing home placement and even death. Predicting falls and dementia as late complications of Parkinson’s disease is a research priority of the Department of Neurology at NorthShore and a current
focus of my research. Is there a way to slow or halt the progression of PD? There is no proven method of slowing or halting the progression of Parkinson's disease. Treatments that have been studied and that failed
to provide evidence of neuroprotection are: selegiline, vitamins E and C, pramipexole, ropinerole, and COQ10. There is some statistical evidence that carbidopa/levodopa therapy may slow motor progression in Parkinson's disease, but the benefits
are trivial. Azilect is being promoted as a neuroprotective agent, but it’s dubious because the beneficial effects were observed at smaller and not higher doses. The drug is also very expensive and prone to multiple drug-diet and drug-drug
interactions. At best, the benefits are nominal. A recent medical advisory panel to the FDA voted 17 to 0 that Azilect should not be approved as a neuroprotective therapy in Parkinson's disease. Inosine dietary supplementation, to increase
blood uric acid levels, may be neuroprotective; however, it may also increase the risk for heart disease, stroke or dementia. There is some evidence that vitamin D deficiency is a risk factor for Parkinson's disease; however, there are no clinical trials
to suggest that vitamin D therapy slows the progression of Parkinson's disease. Similarly, observational studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) or cholesterol lowering medications (statins) are associated with a reduced
risk for Parkinson’s disease, but clinical trials evidence of neuroprotection is lacking. There are some early clinical trials of the calcium channel blocker isradipine, which may have neuroprotective effects in animal models of Parkinson's disease.
Though, the animal models of Parkinson's disease are not always informative, and some calcium channel blockers can actually cause reversible parkinsonism. One big hope on the near horizon is therapies targeting the alpha-synuclein protein
in Parkinson's disease, including a vaccine that is in early phase clinical trials. However, while genetic studies have indicated that alpha-synuclein is neurotoxic prior to the onset of Parkinson’s disease symptoms, my research team recently
provided genetic evidence that alpha-synuclein may be neuroprotective late in the disease process. So it’s unclear if therapies targeting alpha-synuclein in Parkinson’s disease will be effective and safe.
Recent studies have suggested
that exercise might slow the progression of Parkinson’s disease. Apart from exercise, I have no recommendations regarding neuroprotection at this time. Once dementia starts is there anything that can be done to reduce the loss of
memory? There are certain “cognitive enhancing” medications that may be useful in improving cognitive symptoms and slowing the progression of dementia in patients with Parkinson’s disease. These include a class of drugs
entitled cholinesterase inhibitors (rivastigmine, galantamine, donepezil). The Exelon patch in particular was specifically studied in Parkinson’s patients and obtained FDA approval for treatment of Parkinson’s related dementia. Memantine, an NMDA
receptor antagonist, has been FDA approved for treatment of Alzheimer’s dementia; however, in clinical practice, it has also been found to be helpful in certain patients with Parkinson’s disease related dementia. In addition, nonpharmacological
interventions including exercise, social stimulation, and cognitive rehabilitation can be helpful in the treatment of dementia in Parkinson’s disease. Apart from genes, are there any environmental risk factors for PD?
My research team was funded by the National Institute for Environmental Health Sciences for more than ten years to study both genetic and environmental risk factors for Parkinson’s disease. We found that pesticide exposure, both occupational
and gardening-related, was associated with a two-fold increased risk for Parkinson’s disease. In particular, exposure to herbicides carried an increased risk. Of the herbicides recalled by our study subjects, the one most significantly associated with
Parkinson’s disease was 2,4-Dichlorophenoxyacetic acid, a major component of Agent Orange. There have been reports that Vietnam War veterans are at an increased risk for Parkinson’s disease. Pesticides may contribute to an increased risk for Parkinson’s
disease by causing the alpha-synuclein protein to misfold and form toxic accumulations within vulnerable nerve cell regions. My research team also observed that head trauma may be a risk factor for Parkinson’s disease. A closed head injury
that produced loss of consciousness or that required hospitalization was associated with an 11-fold increased risk for Parkinson’s disease. Head trauma may contribute to an increased risk for Parkinson’s disease by causing an acute spike
in alpha-synuclein levels.
While my research team observed no evidence for an interaction of pesticide exposures and alpha-synuclein gene variants, a research team from California recently reported an interaction of head trauma and alpha-synuclein gene
variants in Parkinson’s disease. Currently, my research team at NorthShore is conducting a brain imaging study of mild traumatic brain injury to determine if there are Parkinson’s disease-like abnormalities in the brain scans of persons exposed
to head trauma, even in the absence of symptoms of Parkinson’s disease. We will also consider the interaction of traumatic brain injury and alpha-synuclein gene variations in that study.
For the estimated 30% of Americans who suffer from seasonal allergies, increased levels of pollen and mold common in spring can bring on symptoms like sneezing, congestion, runny nose and itchy, watery eyes. In other words, spring is in the air—literally.
But, don’t let that keep you inside this season.
The experts at NorthShore University HealthSystem compiled some top tips and simple allergy remedies into our seasonal allergies infographic. This year don’t just brave the great outdoors
Miriam “Mia” Boelen, Physical Therapist at NorthShore
and author of “How to Live Well with Parkinson’s: Advice from a Physical Therapist” and “Health Professionals Guide to Physical Management of Parkinson’s Disease,” discovered her passion straight out of high school. After
visiting an uncle who had been diagnosed with Parkinson’s disease 10 years earlier, she knew that helping people in similar situations was what she wanted to do with her life.
Mia tells us why physical therapy is such an important part
of Parkinson’s disease treatment and shares stories of success that she attributes fully to the strength and determination of her patients:
How long have you been working as a physical therapist? I have been a physical
therapist since 1978 and have been working with people with Parkinson’s disease (PD) since 1990.
What attracted you to the field of physical therapy, in particular specializing in the treatment of those with Parkinson’s disease?
I became interested in physical therapy when I traveled to the Netherlands after high school to visit my uncle. He had been diagnosed with Parkinson’s a decade earlier. It was the first time I assisted an individual with walking and realized I
wanted to help other people who had similar physical challenges.
In 1988, I started working at Glenbrook Hospital. Later, I volunteered to help a movement disorder neurologist who was searching for a physical therapist to treat his patients with
Parkinson’s disease. I quickly developed a passion for treating people with Parkinson’s and similar movement disorders.
Why is physical therapy for the treatment of Parkinson’s disease so important?Physical
therapy is important for people with Parkinson’s from the time the individual is initially diagnosed and functioning well through all the stages of PD. In the early stages, we teach prevention—it is less work to prevent muscles from getting weak/tight
than it is to “catch up” later. Exercise is critical to controlling the motor symptoms of Parkinson’s. The physical therapist helps to create the optimal exercise program for patients, which often requires an individualized approach since
PD affects everyone differently.
Parkinson’s affects the part of the brain that controls movement so it requires individuals to pay more attention to their movements, even walking and getting in and out of chairs and bed. Movements are
typically smaller and can require more effort to normalize. In therapy, we teach people how to effectively use their attention to improve all aspects of moving, which results in reduced difficulties with walking and transfers. Some people with Parkinson’s
may need more assistance and in such cases the therapist can teach both the individual and his or her caregiver/spouse how to assist so there is less strain.
What would you say is the biggest challenge you often have to work with your patients
to overcome in terms of physical therapy for Parkinson’s disease?The biggest challenge is often helping individuals understand the benefits of using an assistive walking device such as a cane or walker/rollator. There are some individuals
who opt to become sedentary to avoid falling or feeling very unsteady. Or, worse, they fall and become injured. Becoming more sedentary to avoid falls is not necessarily done deliberately but this situation results in a progressive loss of strength and further
decline of balance. All of this can be avoided by using a walking aid that allows an individual to become more active in a safe way. This is important because remaining active has a multitude of functional and health benefits.
What do you find
most rewarding about your job?I frequently see individuals who are stressed about how Parkinson’s affects them and the lack of control or knowledge they have about PD. My ability to see my patients for consecutive appointments, one-on-one,
addressing all of their questions, allows me to see much of their uncertainty and stress dissolve to a more manageable level for them. I simply guide these individuals. After that, I pass the baton to them so they can self manage. It’s very rewarding
to see them improve physically and emotionally, to impart a greater sense of control over a situation they previously thought they couldn’t control.
Do you have a favorite story of success that you could share?Over the years,
I have accumulated many success stories and every one of them is due to the hard work and perseverance of my patients. I have the easy job; my patients do the hard work.
Here are just a few moments of success:
Patients who questioned
their ability to travel to their country of origin to visit relatives and were able to make the trip after treatment.
Find out more about Mia Boelen and her work with Parkinson's disease on her blog here and more information on the treatment options for Parkinson's disease at the
NorthShore Neurological Institute here.