Building a Parkinson’s support team

Brought to You by - Home Helpers of Alpharetta and North Atlanta Suburbs

This is Parkinson’s Awareness Month. Join us on April 22nd as we help sponsor the Parkinson’s Optimism Walk. You’ll feel the hope and support provided for this progressive disease by the Georgia Chapter of the American Parkinson Disease Association. (Visit their website at apdaparkinson.org/GA for details.)

Recent studies show Parkinson’s affects over 1,000,000 Americans, with over 90,000 new cases diagnosed annually. While there are early onset cases, the main risk factor is age - with over 90% occurring after age 60. It can be hard to diagnose and comes on slowly. When the brain cells that make the chemical dopamine stop working it impacts movement, thinking and behavior. There’s no definitive cause but aging, repeated head injuries and exposure to environmental toxins are factors. Men are twice as likely to be diagnosed, and while there may be some genetic issues it’s rare to run in families.

Tremors are a major symptom but not everyone has this. Slowness of movement, stiffness or tight muscles, balance instability, walking or gait difficulties, a decrease in arm swinging when walking, loss of smell (often months or years earlier), gastrointestinal issues, loss of facial expression, monotone or decreasing vocal strength, fatigue, insomnia, cognitive changes and depression or anxiety are all symptoms. With two or more of these, it’s time to consult your doctor about a visit to a neurologist with Parkinson’s training or a Movement Disorder Specialist.

With a diagnosis of Parkinson’s, it’s important to build a support system. While there is no cure, there are a number of treatments that can maximize your potential with this disease and not let it overwhelm your life and outlook. This includes highly individualized medications like carbidopa and levodopa, physical, occupational and speech therapy for daily lifestyle changes to maintain fitness, balance and strength building, stress reduction, good sleep habits and maintaining a healthy diet high in fruits, vegetables and unprocessed foods. To help manage this you need a team of professionals that includes your Primary Care Physician, Neurologist, a Movement Disorder Specialist, Nutritionist, Therapy providers and Psychologist.

Being a Care Partner for a loved one with Parkinson’s is a critical role. As an advocate, educating yourself, managing the daily care process and coordinating with the care team is crucial. Parkinson’s is a progressive disease and can take years to progress, so it’s just as important to care for yourself. To keep up your stamina you have to take time and get some respite and additional support.

Not tan? Labrador overweight? POMC might be the answer!

Brought to You by - Brent Taylor, MD, Premiere Dermatology and Mohs Surgery of Atlanta

Are you pale? Is your labrador overweight? Then this is the article for you! Proopiomelanocortin (POMC for short) is a remarkable hormone that your brain makes and that may unlock our ability to regulate body weight and even help us get a tan without going in the sun.

If we break apart POMC’s name, pro-“opio”-“melano”-“cortin” comes from the fact that POMC is cut apart by enzymes into three main smaller proteins. First, POMC is broken into opioid hormones that regulate pain, satiety (feeling full after eating) and response to exercise. Second, POMC is broken down into melanocyte stimulating hormones that affect skin pigmentation, sexual behavior and satiety. Third, POMC is broken down into adrenocorticotropic hormone (ACTH), a cortisol-regulating hormone that affects blood sugar, responses to stress and the immune system.

To think like a doctor, imagine what could go wrong if any one of these proteins isn’t working due to a disease. In fact, a mutation in POMC has been linked to increased interest in food and obesity in labrador retrievers and might explain why your labrador is overweight. Many labradors have been found to have a mutation in beta-endorphin, which is one of the opioid hormones that POMC is broken down to form. Beta-endorphin is also famous as a protein that contributes to the “runner’s high” – the feeling of wellbeing that we get with exercise. Similarly, low POMC has been found to make affected humans constantly hungry.

To think like a pharmaceutical scientist, imagine the medical (or cosmetic) potential of developing medicines that affect our responses to pain, our sense of well-being, whether we feel hungry, blood sugar levels, immune system health, sex drive and how tan our skin is. Just one of these functions has incredible pharmaceutical potential. University of Arizona researchers got to work on the tanning applications of POMC in the 1980s and developed a synthetic form of melanocyte stimulating hormone (MSH) which became known as “Melanotan” (aka afamelanotide, aka Scenesse) and now is best identified as “Melanotan I.” As an aside, Melanotan II is another synthetic hormone similar to MSH, but it is not FDA approved for any use, has more sexual and satiety effects and has periodically received coverage in the popular press as the “Barbie Drug.”

Melanotan I causes the pigment producing cells in your skin – the melanocytes – to produce more melanin. Melanin is an important defense against ultraviolet radiation. The problem is that we normally make melanin in response to ultraviolet light exposure after a lot of damage is already done. Increasing melanin before sun exposure sounds very appealing.

Is Melanotan I ready for the masses?

Not yet…

The package insert for Melanotan I points out that carcinogenicity studies have not been performed. These studies are often required for FDA approval. Melanotan I gained approval under special circumstances for a very specific condition called erythropoietic protoporphyria – a skin disease in which people are so sensitive to sunlight that their quality of life is severely affected. The FDA sometimes issues special approval of medications used for “Orphan” diseases when no other treatments are available and when the number of patients affected is so small that the cost of fully testing a medicine would stop it from coming to market.

We do not have enough data on Melanotan I to help us know if it is appropriate for sunless tanning. Carcinogenicity studies have not been published. Long term safety studies have not been published. Melanotan increases blood pressure, and long term effects on cardiovascular health would likely not be known for decades. Case reports of individuals who developed melanoma while using Melanotan cannot know whether Melanotan had a role in causing the melanoma because they are simply case reports and not case-controlled or placebo-controlled.

So where do things stand? Some individuals are purchasing Melanotan I and II illegally, as these chemicals are part of the steroid and tanning-bed using weightlifting community. They are purchased at great personal risk because of all the above unknowns in addition to the problems with purity and safety when illegal substances are procured. For the rest of us, the pharmaceutical companies are still hard at work. They are actively testing similar compounds to identify medicines with fewer side effects. There is reason to hope that in the future a pill may allow us to develop a tan before going on vacation and better protect ourselves from the sun. In the meantime, traditional sun safety measures are best… and our labradors will remain fat and happy!