DEAR DR. ROACH: A friend of mine has Parkinson’s disease. She is 90 years old and has been very active for her age, but recently she has not enjoyed life as much as she had. What do you know about Parkinson’s? Are there any cures or relief? — W.W.

ANSWER: Parkinson’s disease is caused by loss of dopamine in cells in a deep area of the brain. The cells are responsible for smooth, coordinated movement. As a consequence, people with Parkinson’s usually have a tremor, a rhythmic shaking of the hands while at rest, often worse on one side. “Pillrolling” is a characteristic movement of the forefinger and thumb. Muscles become rigid, and as the disease progresses, the muscle rigidity causes people with Parkinson’s to get “frozen,” unable to move at all for a few seconds or longer.

Slow movement is common. The gait can become shuffling, which can predispose the patient to falls.

Parkinson’s disease affects more than a million North Americans and usually is diagnosed in people over 60. Those diagnosed younger than age 60 frequently have a more rapidly progressive form, but the disease is variable.

Often, the face shows less emotion than before the diagnosis, but it’s predominately an effect of Parkinson’s on the muscles of the face, not a lack of emotion. I have had patients become very frustrated with the inability to show their feelings — or perhaps I should say with others’ inabilities to read their emotions.

There are many treatments for Parkinson’s disease, and they can bring dramatic relief even if there isn’t a cure. Sinemet is one medicine that helps by restoring dopamine to the brain, but there are now many others. In my opinion, Parkinson’s disease should always be evaluated and treated by an expert, usually a neurologist with special expertise in movement disorders.

DEAR DR. ROACH: My granddaughter was recently diagnosed with Von Willebrand’s disease. Do you have any information on this disease or its treatment? — R.G.

ANSWER: Von Willebrand disease (vWD) is bleeding disorder. About 1 percent of the population has the condition, but only about 1 percent of those who have it get appreciable symptoms. Von Willebrand disease is caused by the lack of a blood clotting protein (von Willebrand factor), and shows up as easily bruised skin or mucosa bleeding (bleeding in areas such as the gums, stomach or uterus).

There are several subtypes of vWD, and because the range of severity is so large, it’s impossible to say just how much any one person will be affected. Most often, people with vWD don’t need treatment unless they have significant bleeding or are planning surgery. Treatment is usually with dDAVP, which can be given as a nasal spray or by injection.

VWD is related to hemophilia, but usually isn’t as severe. Both are treated by hematologists. The National Hemophilia Foundation has much more information. You can find it on the Internet at www.hemophilia.org.

DEAR DR. ROACH: I have a Franklin wood stove that I use to heat my house from November to April. Is it harmful to breath in ashes and air when cleaning it out and adding wood? — G.M.

ANSWER: Wood smoke can be harmful to your lungs, and can cause chronic bronchitis and emphysema. However, a well-functioning wood stove will minimize the danger. Make sure it is inspected yearly and try to add several pieces of wood at the same time to minimize the number of times the doors of the stove are open. If you smell smoke, your stove isn’t working efficiently. A smoke detector and carbon monoxide detector should be in your home. Newer EPA-

certified stoves are cleaner and safer than older ones.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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