Showing posts with label Parkinson's Disease. Show all posts
Showing posts with label Parkinson's Disease. Show all posts

Sunday, January 10, 2016

Episode 68: Hepatitis C and Parkinson's Disease Linked--Could This Be the Answer?

I hate writing about my health all the time, but I guess I want a record of what I've gone through in case it helps anyone else. Maybe it will help my kids someday to understand why I have had so little energy and have fallen so far in my life, from a promising career as a college English professor some seven years ago to my current status as poverty-stricken, disabled fifty-something slug.

Etsy T Shirt Slug Life


I've tended to downplay my hepatitis C since being diagnosed early in the 2000s after giving blood for the very first time. I don't like needles, so I'd avoided giving blood my whole life, but while teaching college-level classes in the local high school I was talked into donating by my over-achieving kids. I wanted to help them reach their goals as Red Cross volunteers. And I subsequently received a letter from the Red Cross telling me my blood had been tested two or three times, and it was positive for Hepatitis C.

Sometime between 1979 and 1983, the years my boys were born, I was given two D and Cs (procedures to scrape out the uterus) at Columbia Hospital for Women in Washington, DC. I kept bleeding heavily after the birth of my first baby, so my OB/GYN suggested the procedure. The first one didn't work, so they did it again. I was given two pints of blood in a transfusion during one of the procedures. This was the pre-AIDS era, and Hep C didn't even have a name yet (and wouldn't until 1989). Blood was not screened then, and IV drug users were the most common blood donors since they could do it for money.

I had no clue that I had this disease until some two and a half decades later. And now, it has been--yikes!--close to forty years since the virus began circulating in my veins. Thus far, my liver has proven strong. My last liver biopsy--admittedly some six or seven years ago--showed no fibrosis, the first step toward cirrhosis and potentially liver cancer that can happen due to infection with Hep C, or, rather, HCV, as the virus is known.

My genotype (1A) is the most difficult to cure. In the past, treatment required 49 or so weeks (nearly a year) of interferon injections as well as daily oral doses of ribaviron. Interferon has nasty, sometimes debilitating side effects. Not only that--the grueling treatment is only effective in about 50 percent of those with my genotype. Pretty lousy odds when having to potentially give up a year of one's life. As I have been my sole means of support since my husband and I split in 1985, I never felt I could afford the time off to be treated.

I also hoped that treatments would improve and, lucky me, that has happened. There are now several options to treat my genotype with oral medications over six to eight weeks, and the cure rate is 98-99 percent.

Just in time. And, truly, I am lucky. I now have a chance to feel better. I realize my trying to find the cause of my problems may all have been simplified if I'd just attributed them to hepatitis C. The thing is, the HCV virus's neurotoxicity has only recently been recognized.

The eminent Dr. A., my local neurologist, told me c. 2013 that I have some sort of neurodegenerative disease, but he couldn't say for sure which one it might be. "If you had white matter disease in your cervical spine," he told me, "I would say you have MS." I don't, though. I just have white matter lesions all through my brain. What are they? Could they be the Lewy bodies of Parkinson's?

Not too long ago, I wrote about the possibility that my problems could be due to Parkinson's Disease. What had struck me most about an interview with Linda Ronstadt, the songbird of my youth, was her saying that she totally lacked motivation to do much of anything other than chill out and read books. Those weren't her exact words, but the symptom struck me as so very similar to the ones I've endured for the past five years or so. (See Episode 64.)

It's as if a switch just won't turn on when I need to shift gears (sorry if that's a mixed metaphor, though they are both mechanical :) ). I get stuck on one mode, whether that be lying on the couch watching TV when I need to sleep, or sleeping itself. Although I dearly love my friends and the times I've spent out on the town with them, I rarely feel motivated to go out with them these days. Even when I plan an evening out, I have a hard time actually leaving the house.

It just seems monumentally difficult to get up, take a shower, get dressed, and go out. I can't tell you how many times during the holidays I let my friends down when I couldn't get together or go to a party with them. And these are the best friends on the planet. I have to be sick if I can't muster up the energy to hang out with them.

I rarely shower or even change clothes nowadays. I know this sounds disgusting. And, no, I'm not depressed. It's just so damned exhausting. And I'm lucky; I don't get "BO." I've confirmed this with Honey. And so the idea of washing my hair, holding my arms up long enough to do that, just wears me out. I've come out of the shower faint and out of breath, with barely the strength to dry off with a towel. The idea of having to do all that gets harder and harder as time goes by, so most of the time I just don't bother.

Rapid Eye Movement (REM) Sleep Disorder is another early Parkinson's symptom that I've experienced over the past year. I recounted those experiences in my previous PD post. Fortunately, the episodes stopped happening after that until one very recently when I actually awoke punching myself in the face! The dream made sense at the time, but I can't remember now what it was.

A few other problems I have that could be attributed to early Parkinson's: increasing episodes of anomic aphasia and paraphasia, difficulty hand writing anything, stiffness and slow movements, frequently feeling faint upon standing, a fall and concussion two years ago while walking and talking at the same time--strangely enough, this is a complicated task for the human body, and doing so with Parkinson's or other brain disorders may lead one to fall, as I did (see "Talking While Walking: Cognitive Loading and Injurious Falls in Parkinson's Disease," among others). A few of my other symptoms include heat intolerance, increasingly stooped posture (so unattractive!), recent onset of chronic constipation, urinary urgency and incontinence, and more.

Every one of these cognitive changes listed on the Northwest Parkinson's Association site applies to me BIGTIME:
  • Slowed thinking speed;
  • Word finding difficulty;
  • Trouble with multitasking;
  • Difficulty organizing complex tasks, steps, or instructions;
  • Memory problems.
Added to that list is frequent errors in writing that I frequently do not catch--this is a big change for me, an uber-accurate typist and compulsive proofreader in my former life ... though I hope I'm still the "word sorceress" Honey called me recently (I love it!).

More often than not these days, I'll begin talking and my words will jumble up--as if my mouth has not yet caught up to my brain, or vice versa. A previous episode of The Mary Dell is devoted to the frequently humorous and always fascinating word scrambles I've come out with lately.

All of these signs and symptoms point to a degenerating brain--quite the scary thing for a gal always rather smug about the quality of hers.

On the other hand, the diagnostic criteria for Parkinson's includes four cardinal signs, and I can't say that these clearly apply to my muscle and balance symptoms, so perhaps this STILL doesn't explain my neurodegeneration--and none of the possibilities are exactly keen.

Last month, I finally met with my gastroenterologist, who will look into treating my Hep C after he does a few other tests relating to my digestive problems--specifically, a colonoscopy in early February. He informs me, however, that insurance companies will not pay for treatment unless one is showing signs of liver degeneration.

In fact, I've been having some of those signs recently. My liver enzymes were elevated for the first time recently. My digestive problems have increased. And bile was found in my urine when it was tested recently for a urinary tract infection--and that's a sign of liver problems.

Now also, lucky me, I say ironically, because it really is true--I can show even more potential deterioration from the HCV virus, thanks to Medicine's recently linking Hep C to Parkinson's. Yes. Lucky, lucky me. And I will feel lucky indeed if, in fact, the treatment turns my life around again, at least enough that I can enjoy some reasonably healthy years left with my Honey and my kids, not to mention the chance to reach my hopes and dreams. I've thought for some time I've got something degenerative that will take me away sooner than should be--but maybe, just maybe, treatment will stop that process in its tracks and give me some good years left on this planet.

Here are two separate studies that show "significant" evidence linking Hep C and Parkinson's:

Hepatitis C Virus: A Risk Factor for Parkinson's. "In conclusion, our study demonstrated a significantly positive epidemiological association between HCV infection and PD and corroborated the dopaminergic toxicity of HCV similar to that of MPP(+)."

Hepatitis C Virus as a Risk Factor for Parkinson Disease: A Nationwide Cohort Study. "We conducted a large nationwide population-based study and found that patients with HCV exhibit a significantly increased risk of developing PD."

Will curing the hepatitis C arrest the Parkinson's Disease? Whether or not I end up having PD, I guess only time will tell for those who do--I see that a clinical trial on this very question is being conducted. No matter what, getting rid of a damaging virus circulating in the blood has to be a good thing.

___________

N.B.  It is now 2021, and I've been cured of Hep C for some five years.  I can say that most of the symptoms of Parkinson's that I list here have cleared up. I don't think Parkinson's goes away once it starts, so clearly I didn't and don't have it, thank goodness.  Just goes to show how debilitating Hep C can be.  Nevertheless, the articles listed here do show that this link exists, so maybe this blog entry will help someone.

Sunday, March 1, 2015

Episode 58: More Sleuthing: Brain Tumor? If So, That Could be Lucky! OR Parkinson's (Not Lucky)


Okay, so I'm not necessarily thinking that I have a brain tumor.

However, in fact, in January 2012 I was found to have a mass in my sphenoid sinus. The sphenoid sinus lies right next to the brain stem, right where the hypothalamus lies and directs autonomic functions by sending hormones to the pituitary gland.

The sphenoid sinus is the deepest one,
located next to the brain stem where
autonomic functions are governed.

And, as you know, sports fans, I identified dysfunction in my autonomic system long ago in my quest for answers to my health problems. For instance, the hypothalamus controls such autonomic functions as sleep and wakefulness--identified in my case as idiopathic hypersomnolence (in other words, I sleep way, way too much and am powerless to change that), breathing (an ongoing problem), appetite (another problem for me these days), heart rate (a possible problem for me, as identified on a stress test and ECGs), temperature control (I'm about 20 degrees warmer than everyone else, and not from hot flashes), and more.

Symptoms of brain tumor/cancer listed at the Canadian Virtual Hospice include:
  • increased sleepiness - I obviously have that;
  • decreased ability to move around - very clumsy these days, including a fall I'll discuss in this episode;
  • trouble speaking or understanding conversation - I've already posted on my losing some fluency while talking and very frequently using weird substitutions for words (substitution aphasia);
  • loss of memory and especially the ability to form new memories - I can still form new memories, but I'm not nearly as sharp about things as I used to be and have noticed some real holes in my memory for recent events;
  • weakness, which may affect only one side of the body - I definitely have overall body weakness, and today I had a weird weak feeling on the right side of my face;
  • seizures - None of these, thank goodness;
  • extreme mood changes - I don't think this is going on, but I do know I've had some despondent moods lately far beyond what I normally feel.
Of course, I have already received a diagnosis of neurodegenerative disease, so perhaps all this stuff relates back to that--but I'm thinking that if it turns out, instead, that the culprit is this sphenoid sinus mass, I might actually be CURED! Or at least symptoms could be slowed down. And since symptoms lately seem to be speeding up, that would be an absolute dream.

I recently posted about increasing headaches that are intractable to all meds I've tried, including the Tramadol prescribed to me because I'm not supposed to take NSAIDS due to my (mild) kidney disease. But in desperation I did take NSAIDS when the Tramadol didn't work, and yet nothing really helped.  I just suffered with it for days and nights, five or six or so.

Of course, masses in the sphenoid sinus can cause headaches. In fact, I spent a little time researching those masses once again. I'd already read that all sphenoid sinus masses should be investigated. In my case, that wasn't done when it was found early in 2012, nor has anything been done since. My Ear, Nose, and Throat (ENT) specialist told me it was just a polyp and not a problem.

And who am I to argue that I'd seen literature saying it should be investigated anyway? You have to pick your battles, as I've learned--and what I've actually learned, basically, is don't even bother to battle because your research and theories will be utterly ignored, if not ridiculed (as happened to me by a neurologist at Johns Hopkins).

But now that I have these new symptoms, I'm going to take that earlier report of the sphenoid mass to the eminent Dr. A., my neurologist, when I see him in April. I already reported in The Mary Dell Show recently how disappointed I was when I called his office about the headaches and his message came back to me as "If the headaches are bad, go to the emergency department," a non-answer if I ever heard one.

I've learned the ED is not the place for someone with my type of health problems. I mean, obviously, if I break an ankle or I am positively in a heart attack, I'll go. But for something as nebulous as headaches, very little will be done. Maybe an MRI, but one of that particular sinus? Doubtful. That's why we patients should be able to go to our doctors, NOT the emergency department, with these kinds of complaints, but it seems the buck is being passed by nearly all doctors nowadays, who are sending patients to the ED rather than scheduling an appointment in the office.

And the ED is known to be the most expensive place health care is dispensed, and all kinds of programs exist to keep patients from going to the ED for routine care, so why is it that doctors are bailing on us and sending us to other doctors well versed in emergency medicine but not necessarily in our individual problems, including neurological ones?

Ah, well.  I've already complained enough about that.

Sphenoid sinus headaches from inflammation are said to cause pain at the base of the skull and neck and on the top of the head, and those two places, along with pain behind my eyes which would probably be the frontal sinuses--though some sites say the sphenoid sinus also causes pain there--are exactly what plagued me during these recent headaches. The sphenoid sinus is located right between the eyes, but relatively deep in the head.

Of course, my problems in the sphenoid sinus and my other sinuses might, in fact, be simply related to my diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis), which I was told at this point is limited to my nose and sinuses but which is known to cause problems in other organs, including the brain.

In other words, the possibilities are pretty much myriad, but no one--not a single one of my specialists--seems very curious to find out what is actually going on.

Anyway, in addition to these very sick headaches of late, I have a couple of new clues that could mean the mass in my sphenoid sinus has swollen.  The mass doesn't have to be malignant to cause major problems; just by this deep sinus's becoming inflamed, according to the literature, pressure can be put on the brain and cause serious symptoms, leading to severe illness or death.

So, here are the new, and in one case not-so-new, clues:

Dysguesia:  This is a disorder of taste and involves sudden changes in a person's sense of taste. Most frequently, foods we loved suddenly become unappetizing.  This has been happening to me quite a bit of late.  In fact, most foods are turning me off these days.

I first noticed this problem about six months ago when I suddenly couldn't stand the taste of Pepsi. As a lifelong Pepsiholic, this was a major--and sudden--change. For most of my adult live, I've regularly drunk so many Pepsis a day I'm embarrassed. Then one day--Yuck! Pepsi! Couldn't stand it!

I then began drinking ginger ale like a fiend. I couldn't get enough of the stuff, and in the past I've never liked it very much. I started going through close to a liter a day, grateful that even if I was taking in a ton of sugar I wasn't taking in caffeine. This went on for months, fueled by how cheap a generic liter of ginger ale is compared to Pepsi or Coke--we'd regularly find them for 72 cents apiece!

Then, about a week ago, after the headaches started, I could barely tolerate the taste of ginger ale anymore. Boom. Just like that, yuck on ginger ale.

Very weird. Other foods have gone the way of yuck as well, pretty much all of a sudden.

Even smells can be affected. Yesterday afternoon, in the midst of hypersomnia, I could smell ground beef cooking on the stove--Honey was making tacos. I've always liked the smell of ground beef cooking, but this time it smelled atrocious. I did eat the tacos later, but today he made roast beef and mashed potatoes, and for the first time in memory I didn't even like the taste of mashed potatoes, one of my favorite foods.

I sure hope this thing goes away!

Out-of-Control Sneezing and Productive Cough.  I've written about my "productive" cough over the past few months--this means that the cough brings up phlegm. I also have been sneezing like a maniac lately. Both of these are symptoms of sphenoid sinusitis, or any sinusitis, that causes infection in the brain, according to Sinus Reference.com. Obviously, a brain infection can be serious.

REM Sleep Behavior Disorder. I've commented extensively on this recently. I'll link to those posts momentarily. This problem, too, came on very suddenly and swiftly just when the headaches were at their worst. (I'm having some relief lately, but the threat of those sick headaches is always there, lurking just below the surface.)

REM Sleep Behavior Disorder is frequently a precursor (or concurrent with) Parkinson's Disease, so I have also spent some time researching that disorder.  (N.B. I still think I may have myotonic dystrophy but have not yet gotten the DNA results--but I guess it's possible to have more than one of these things at a time.)

Something happened a year ago this past Christmas that also could suggest Parkinson's, according to "Talking While Walking Puts Parkinson's Patients at Risk for Falls," published by Florida State University.

Lack of Balance/Falling.  Just before Christmas 2013, my son J. and I were walking along the sidewalks in Frederick, Maryland, while Christmas shopping, having a happy conversation about the day's activities. Suddenly, out of nowhere, my legs just didn't seem to work anymore. I recognized it as it happened--I just couldn't coordinate them; I felt a massive moment of confusion, and then I pitched forward with the momentum of walking and landed flat on my nose on the sidewalk.

I can still remember seeing that sidewalk rushing up to me, and my arms giving out rather than protecting my face from the fall.  (The arms thing, of course, makes me think of muscle weakness, a symptom I also have but which the "wonderful" (NOT) neurologist at Hopkins also told me I wasn't experiencing, even though she didn't really question me about any such symptoms.)

I must have blacked out momentarily because I was later diagnosed with a concussion.I just remember lying on the sidewalk in a massive pool of blood, my nose and face really hurting, and slightly freaking out. J. was right beside me, remaining amazingly calm--I really appreciated that in the kid, who has had his own set of problems his whole live and could have also freaked out badly. But he didn't.

A wonderful meter maid (I'm sure there's a more politically correct title for the job) saw it happen and rushed over to me. Also, two men from the Weinberg Center for the Arts, a wonderful venue, who were just about to close up for the day witnessed the fall and rushed out to me with paper towels and a wheelchair. I left a ginormous blood stain on the sidewalk right in front of the Weinberg. It's probably still there.

The meter maid thought she saw me trip, and while there may have been a slight tripping over something, I don't recall that at all, and my inability to right myself once the confusion set in was far out of proportion to any minor tripping I might have had, if any.

I guess the blood pooled in my face because I ended up with a black eye, as well as a swollen (but thankfully not broken) nose. Although the incident was very scary, I was touched by the human kindness it brought out in those who witnessed it. Once the ambulance came, I was briefly checked out and asked whether I wanted to go to the ED. The bleeding had stopped, and going to a hospital was the last thing I wanted to do. I just wanted to get home (a two-hour drive, ugh) and rest. I did that until I threw up later and went to an ED near home and was diagnosed with the concussion.

Me, after the fall.

The point is, it all happened when I was walking and talking at the same time, something I rarely do as I'm not much of a shopper or walker (unfortunately) anymore--too exhausting.

"Parkinson's disease and multiple sclerosis are two common diseases that can affect the brain resulting in loss of balance," says the Neurology Muscular Dystrophy and Neuropathy Institute. And I have indications of both of those diseases; REM Sleep Behavior Disorder is highly associated with Parkinson's Disease. White matter lesions, which I have in abundance according to Dr. A., often occur in conjunction with Parkinson's Disease but are not necessarily due to it. However, of those white matter lesions, Dr. A told me he'd diagnose me with multiple sclerosis based on my symptoms and those lesions, except I didn't have any lesions in my spinal column, which almost always happens in MS. I was also slightly older than the normal range for diagnosis MS.

Thus, I can't help but worry that this incident of loss of coordination and falling was due to whatever is still happening in my brain and is now bringing on the headaches and REM sleep behavior disorder as well.  The problem is, according to the Florida State University article, one of "cognitive loading." Talking while walking is actually a very complicated thing to do, and those whose brains are impaired have trouble managing both simultaneously.

Oh, well, this is all much ado about nothing, I know, until a doctor decrees one or the other (or something else) to be the culprit. But my faith in the medical system is on such low ebb these days that I can't help but doubt I'll be taken seriously or given the right tests.

Now that I have the "neurodegenerative" diagnosis--even though the exact cause hasn't been identified--I worry that all these symptoms will just be considered par for the course, and a more acute cause--such as a sphenoid sinus tumor or inflammation, or even an ectopic pituitary tumor in the sphenoid sinus--will not even be investigated.

Such is the frustration of a patient here where I am, Down the Rabbit Hole of today's health care system.

I'm still trying hard not to get too discouraged and give up entirely, and I do think my health sleuthing is under control--NOT an obsession, just a normal curiosity for someone who has the tools to actually research the medical literature, as well as a burning desire just to KNOW.

I actually made an apple pie tonight, and now I'm going to practice making some tea sandwiches. A friend asked me to cater a service for her husband who died recently. So, you see, I'm not just sitting here obsessing about brain tumors and Parkinson's.

I just wish I could get a doctor to take all of this seriously and actually investigate the causes of all these problems.

But, as my ex-husband used to say all the time, "People in hell want ice water."

And they're not likely to get what they need, either.

It's elementary, dear Watson.