23 October 2013 Chances are

          Yesterday I had an hour-long telemed consult with a neurologist in Richmond VA.  I sat in a room in the Mountain Home VAH and he sat in his office in Hunter Holmes McGuire VAH.  It was quite satisfactory for a consult.  The equipment is set up to allow him control of the camera focused on me. 

          During the entire workup and follow-on care I’ve experienced at Mountain Home, after ruling out space occupying lesions and other physical causes for PD, no one has suggested any causation except exposure to Agent Orange.  Yesterday, I was asked for the first time about familial history of  PD related to Ashkenazi genetic heritage.  According to the information relayed yesterday, the probability of genetic causation is greater than the probability of Agent Orange induced PD. 

http://www.cdc.gov/genomics/hugenet/casestudy/parkinson/PARKcase.htm

Glucocerebrosidase Gene Mutations and Parkinson Disease

Stuart K. Shapira, M.D., Ph.D. 
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention

In November, 2004, Aharon-Peretz et al. reported that mutations in the glucocerebrosidase (GBA) gene increased the susceptibility for developing Parkinson Disease.

Aharon-Peretz J et al. Mutations in the glucocerebrosidase gene and Parkinson Disease in Ashkenazi Jews. 
N Engl J Med. 2004;351:1972-7.

http://www.parkinsons.va.gov/resources/PtEdTri_AO.pdf

http://www.publichealth.va.gov/exposures/agentorange/diseases.asp

• Parkinson’s Disease
  A progressive disorder of the nervous system that affects muscle movement
• Peripheral Neuropathy, Early-Onset
  A nervous system condition that causes numbness, tingling, and motor weakness. Under VA's rating regulations, it must be at least 10 percent disabling within one year of herbicide exposure.

The question concerning the origin of PD has not been fully settled but VA has instituted an assumed causation following Agent Orange exposure.  I was first seen by VA in 1980 with symptoms consistent with peripheral neuropathy.  There was no assumed status then and nothing more was done other than putting my name into the Agent Orange Registry. 

          The assumed status decision has been beneficial to me. 

Still, I wonder how much of this is genetically caused and how much herbicide induced.  While there are ongoing studies to determine the prevalence of mutated genes among Ashkenazim, there has been no study to determine a correlation between mutated genes and Agent Orange exposure in Ashkenazi serving in VietNam.  We discussed this yesterday and both agreed that the sample cohort would be remarkably small.

          Therefore, whether my PD is genetic in origin, (no family history) or chemically induced, the treatment I will undergo is the same.  The prognosis is the same, and it doesn’t matter which door, 1, 2, or 3 the surprise leapt from.  The VA, in the absence of knowledge of causation, is doing the right thing for veterans.