Keith Roach

To Your Health

Dear Dr. Roach: Could you please explain the difference between Parkinson’s disease and parkinsonism? My neurologist told me that I have parkinsonism. I have been reading about Parkinson’s disease and read that with it, one does not produce dopamine, which regulates movement. My internist (a geriatrician) wonders why I am not on medication from my neurologist. I had a couple of strokes, many years ago, which affected my motion and my speech (slightly). I always believed that my walking difficulty came from the strokes. Can parkinsonism turn into Parkinson’s disease?

B.B.

Dear B.B.: Motor parkinsonism is always seen in Parkinson’s disease, but it also may be found in numerous other conditions, which is why an expert is sometimes required to confirm the diagnosis. The word “parkinsonism” refers to slowed movements (called bradykinesia) and either a tremor at rest or muscle rigidity. In Parkinson’s disease, the underlying problem is loss of dopamine-producing nerve cells in an area of the brain called the substantia nigra, which itself is part of the basal ganglia in the midbrain.

In addition to Parkinson’s disease, other causes of parkinsonism include essential tremor, several uncommon degenerative diseases of the nervous system, some medications (medications for psychosis and to prevent nausea and vomiting, such as chlorpromazine, are the most common). Some neurologists believe that multiple small strokes (in or near the basal ganglia) can cause parkinsonism. Not everybody with strokes in this area of the brain develops the motor problems that resemble Parkinson’s disease, but that might be the case in you.

Often, neurologists will give dopamine medication (the combination of levodopa and carbidopa works best) as a diagnostic test: People with Parkinson’s disease markedly improve with this treatment, whereas people with parkinsonism from other causes may not.

Next time you see your neurologist, you need to find out what condition he or she thinks you have that is causing parkinsonism.

Dear Dr. Roach: How can I control the urge to pass gas (that has a very bad odor) after I eat? I have no control over it, and it is quite embarrassing. I have avoided gas-producing vegetables and other foods. I have only 7 inches of my colon left due to diverticulitis surgery when I was 35 (I am now 74). I have tried Gas-X, Beano, drinking lots of water after my meal, eating more slowly, not talking, etc. This has been going on for the past five years. Any advice?

L.M.

Dear L.M.: You have already done everything I would advise you to do. I might have you keep a diary of food versus how bad the gas is, to find if there are triggers you might not be aware of (it’s usually those with a lot of fiber).

A registered dietician nutritionist might help you cut down on foods with FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). I am afraid that some gas production is always going to be present, and because of the surgery, you have less ability to control it. Hopefully your friends and family won’t be too bothered by these natural occurrences over which you have no control.

I am publishing your letter in hopes that people with such experience might share their advice.

Email questions to ToYourGoodHealth@med.cornell.edu.