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Looking for participants for a new Parkinson’s Disease study

Parkinson’s Disease (PD), thought to affect approximately 1% of all persons over 50 years of age, is characterized by symptoms involving the nervous system including slowness of movement, rigidity, shaking of the hands (and sometimes the legs) at rest, and posture disorders. Although there is no known cure, drugs used to treat Parkinson's Disease may include Amantadine (Symmetrel), Levodopa-Cardidopa (Sinemet), Levodopa-Benserazide (Madopar), Bromocriptine (Parlodel), Pergolide (Permar) and Eldepryl (selegiline hydrochloride). Other, nonpharmacologic, measures used to control the effects of Parkinson’s Disease include physical therapy, occupational therapy and speech therapy.

Dr. A.J. Ayers, a Tucson based dentist who has been working with head and neck pain patients for the past 10 years relates that while attending a head and neck pain seminar recently he observed a dentist demonstrate the relationship between muscles, nerves, joints and teeth. The dentist in the demonstration placed a wax bite between a patient’s teeth. This patient was diagnosed with PD and was experiencing visible tremors prior to the demonstration. Immediately after the wax bite was placed the patient’s shaking subsided and the patients movements were nearly normal while the wax bite was in position.

Dr. Ayers states “the neurological input from the head, neck, and teeth go into the trigeminal system. These nerves have secondary fibers that go to the reticular activating system that continues down the spinal column and crosses over at the lumber region of the back.” He believes that the head, neck and teeth play a role in the entire body posturing mechanism due to these nerve structures, and that subtle changes in the way these nerves are triggered affect the entire body.

Dr. Ayers would like to see if placing wax between the teeth could alter the tremors associated with PD. The purpose of the wax is to separate the teeth and hold the jaw in a relaxed position to simulate a splint. Dr. Ayers wishes to screen and evaluate patients’ responses to assess this technique’s effectiveness. The procedure is simple and without discomfort and there is no cost for the evaluation or appointment.

If you, or anyone you know, has visible tremors related to PD and would be interested in participating in the study please contact Dr. A. J. Ayers at 520 881 8585.

For further information on Parkinson’s Disease visit www.parkinsonsinfo.com/, www.parkinson.org/, or http://www.apdaparkinson.com/.


A review of Arizona’s abuse, neglect and exploitation reporting and prevention laws

After having several conversations within the last six months or so with owners or caregivers about their concerns of abuse and their understanding of the abuse, neglect and exploitation laws in Arizona, it seems that a review would be helpful.

R9-10-704-A of the Arizona Administrative Code requires “a manager, employee, or volunteer” to “immediately report or cause a report to be made to Adult Protective Services (APS) or local law enforcement of suspected or alleged abuse, neglect, or exploitation as required by ARS 46-454.”

R-10-704-B requires “the licensee” to (1) “notify the department (of health services) (DHS) of suspected or alleged abuse, neglect, or exploitation within 24 hours of receiving the allegation, (2) document the initial report and maintain documentation of the report on the premises for 12 months from the date of the report, (3) report suspected or alleged abuse, neglect or exploitation to Adult Protective Services or to a local law enforcement agency as prescribed in ARS 46-454 and (4) investigate suspected or alleged abuse, neglect, or exploitation and develop a written report within 14 days of the initial report of the suspected or alleged abuse, neglect, or exploitation. The licensee is required to send the written report to the department (of health services), Adult Protective Services, and any local law enforcement agency previously notified and to maintain a copy of the written report on the premises for 12 months from the date of the report. The written report must contain (1) dates, times, and description of the suspected or alleged abuse, neglect, or exploitation; description of any injury to the resident; change in the resident’s physical, cognitive, functional, or emotional condition; actions taken by the licensee; individuals and agencies notified by the licensee; names of witnesses to the suspected or alleged abuse, neglect, or exploitation; and (2) action taken by the licensee to prevent the suspected or alleged abuse, neglect, or exploitation from occurring in the future.

What all of this means, in a nut shell, is if you suspect, or someone tells you they suspect abuse, neglect or exploitation, it must reported - within 24 hours - to both APS and to DHS. You must make a report, investigate the incident, and include preventative measures taken to prevent future occurrences. That is the law. Sound like an in-depth Incident Report? It should.

If you have reported a suspected abuse, neglect or exploitation incident to a manager or owner and feel that they have not reported the alleged abuse, neglect or exploitation to either DHS or APS, you must then report the incident yourself! Please, please do not wait two weeks or two months to report the incident. This could place you in a position of neglect under the same laws.

It is never easy to cause reports to be made to APS or DHS, but it is the law. You do not need substantiating
evidence, just an allegation or suspicion. You may make the report anonymously but a report with your name will hold more weight, and both DHS and APS keep all names confidential. By not reporting, according to ARS 46-454, you place yourself at risk of being charged with a felony - not a misdemeanor - a felony!

Don’t know where to call? The Licensee is required to have the current phone numbers of the Arizona Department of Health Services’ Office of Assisted Living Licensure and Adult Protective Services (among others) conspicuously posted (R9-10-703-B-2-a).


Rabies on the rise

After years of decline in America, rabies is now on the rise.

Rabies is an acute and deadly viral infection of the central nervous system. It is one of the most terrifying diseases known to man. In the United States as many as 18,000 Americans get rabies shots each year because they have been in contact with animals that may be rabid. World wide the World Health Organization (WHO) estimates that more than 40,000 people die every year from rabies.

Arizona Department of Health Services’ Prevention Bulletin (Jan/Feb 2001, Vol 15, No. 1) reports animals, in Arizona, testing positive for the rabies virus increased 21% in 2000 compared to the previous year’s data.

In Arizona, bats, skunks and gray foxes are the reservoirs for the rabies virus. Other animals affected are thought to have acquired infections from the reservoir animals.

According to the FDA “The fear caused by rabies begins with its very transmission. A viral infection affecting the brain and spinal cord, rabies is transmitted through the saliva of an infected animal, usually by a bite. It can also be transmitted when infected saliva comes in contact with a cut or skin break. Infected bat droppings are suspected of transmitting the disease, and at least two people are believed to have been exposed to rabies by breathing the air in caves where rabid bats live. Other rare deaths have occurred in people who have received corneal eye transplants from donors with undiagnosed rabies.”

Prevention is the best way to keep you and your pets safe from rabies. Keep pet shots up-to-date and observe lease laws. Don't leave your dog chained alone in the yard. If attacked by a rabid animal, it can’t escape. Don’t make your house or yard attractive to wildlife; feed your pet indoors, and keep garbage cans closed tightly. Seal basement, porch and attic openings, and cap chimneys with screens. No matter how cute, avoid contact with wild or unfamiliar animals. Don’t touch a wild animal even if it’s dead. Report strays or animals acting strangely or sick to local authorities.

If you have been bitten or scratched by any animal you should (1) clean the wound immediately with soap and water to remove saliva from the area. If soap is not available, you can use water alone. But be sure to wash with soap and water as soon as possible. Allow the wound to bleed, bleeding will also help clean the wound. (2) Call a doctor right away, and (3) notify the state or local health department.

And, there are situations in which it is possible that a person has had close contact with a bat and not known it, as when a sleeping person awakens to find a bat in the room. Therefore, the CDC now recommends that people seek medical help even if they can’t see a bat bite or scratch, or may have had mucous membrane exposure.

For more information about rabies visit the U.S. Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/ncidod/dvrd/rabies, The U.S. Food and Drug Administration (FDA) at htp://www.da.gov, or the World Health Organization (WHO) at http://www.who.int.



Medications


New Combination

Hydrochlorothiazide; telmisartan (Micardis) by Boehringer Ingelheim Pharmaceuticals, Inc., (http://www.boehringer-ingelheim.com/corporate/home/home.asp) approved November 17, 2000. angiotensin II inhibitor used for the treatment of hypertension (high blood pressure).

Use cautiously with aortic valve damage, congestive heart failure, dehydration, kidney disease and liver disease.

Racial considerations - Black patients may have a smaller response to the blood pressure lowering effect.

Be sure to review drug information on web site, from physician or package inserts for full information.


New Indication for use

Neurontin, Parke Davis Pharmaceuticals Ltd., (http://www.pfizer.com/find/wlindex.html#pd) approved October 12, 2000 for use as an adjunctive therapy in the treatment of partial seizures.

Be sure to review drug information on web site, from physician or package inserts for full information.

Altace, King Pharmaceuticals, Inc., (http://www.kingpharm.com/html/swf_index.htm)
approved October 4, 2000 for use in the reduction in risk of myocardial infarction, stroke, and death from cardiovascular causes.

Be sure to review drug information on web site, from physician or package inserts for full information.


Withdrawn from the market

Glaxo Wellcome (http://www.glaxowellcome.com/) has informed the FDA that it will voluntarily withdraw alosetron hydrochloride (Lotronex) from the market November 28, 2000.

This action follows FDA analyses of the post-marketing reports of serious adverse events, which included 5 reported deaths in patients taking Lotronex. Specifically the FDA had been concerned about reported causes of intestinal damage resulting from reduced blood flow to the intestine and severely obstructed or ruptured bowels and death.

For more information on Lotronex go to http://www.fda.gov/cder/drug/infopage/lotronex/lotronex.htm (FDA Center for Drug Evaluation and Research).


Herbal Review - Ginkgo

Ginkgo (Ginkgo biloba), is used by almost 11 million Americans to improve their memory and increase circulation.

Reported medical uses: Cerebrovascular disease, peripheral vascular insufficiency, memory enhancement and overall brain function, tinnitus (ringing in the ears), and vertigo.

Contraindications and precautions: Contraindicated in children, pregnant women, and in patient with a history of allergy to ginkgo preparations. Use cautiously in patients taking anticoagulants.

Adverse reactions: Bleeding, diarrhea, flatulence, headache, nausea, and vomiting.

Interactions: Anticoagulants, antiplatelets: Use cautiously and carefully monitor patients taking aspirin, warfarin (Coumadin), ticlopidine (Ticlid), clopidogrel (Plavix) or dipridamole (Persantine).

As with most herbal supplements, information is as diverse as it is sketchy. Be sure to know why the preparation has been ordered and what the primary care provider would like you to watch for.

Sources: Professional’s Handbook of Complementary & Alternative Medicines, by C.W. Fetrow and J.R. Avila, Springhouse Corporation, 1999; The A to Z Guide to Healing Herbal Remedies, by Jason Elias, M.A., L.Ac., and Shelagh Ryan Masline, Dell Publishing, 1995; Nurses Handbook of Alternative & Complementary Therapies, Springhouse Corporation, 1999; “Anesthesiologists Warn: If you’re taking Herbal Products, Tell Your Doctor Before Surgery,” http://www.ASAhq.org/PublicEducation/herbal.html; “Herbal Health Producta-What You Should Know,” http://www.familydoctor.org/handouts/364.html; “NIEHS News, “Medicinal Herbs: NTP Extracts the Facts,” http://ehpnet1.niehs.nih.gov/docs/1999/107-12/niehsnews.html; American Botanical Council, Herbal Reference Guide, http//216.171.56.188/commonherbs/index.html


Our elderly at risk for adverse side effects (reactions) of medications

Geriatric patients experience adverse effects of medications 2-7 times more frequently than younger patients. Risk factors include advanced age, small physical stature, decreased renal function, multiple disease processes, multiple drug therapies, the type of drug prescribedand nutritional status. For early identification of adverse side effects or reactions identify high risk residents, know the drugs they are taking and monitor closely.


Providing For Your Educational Needs

DeserTortoise is proud to be able to provide for all of your continuing education needs. All courses are self paced correspondence courses. Our courses will also satisfy CNA continuing education requirements by the Arizona State Board of Nursing. Courses are available with credit card payments at our website (www.desert-t.com) or by mail with check or money order (call, write or fax us for brochure and order form).


Word Mine

Form all the 4- and 5-letter words you can by using only the letters in the words “PARKINSON’S DISEASE.” You may use a letter more than once in a word ONLY if it appears more than once in “Parkinson’s Disease.” Words beginning with a capital letter, contractions, plurals, hyphenated, obsolete, slang, poetic, archaic, foreign, and dialect words are not allowed. We found 82 4-letter words and 65 5-letter words. If you really must have our list, send us your fax number, e-mail address or a stamped self addressed envelope and we will send you what we found.

PARKINSON’S DISEASE

Good luck!