Stolen, with permission, from Currents.

Has anyone suggested that Reno's health is a negative factor in her holding any kind of serious job? In a BBC article over a year ago, it was reported about Janet Reno that "She also continued to work despite being diagnosed in 1995 with Parkinson's disease, which has caused trembling in both her arms." Hence, this is at least her sixth year with the disease. This is important, as you will see when you read the following.

http://www.parkinson.org/encarta99.htm

Encarta Encyclopedia August 1999

PARKINSON DISEASE

INTRODUCTION

Parkinson disease (PD) is a slowly progressive disease of the nervous system. . . . PD progresses from diagnosis to major disability over 10 - 20 years. Most symptoms are improved by levodopa (given as Atamet or Sinemet).

PD is characterized by four principal symptoms:

(1) Rigidity of the limbs. This is appreciated as stiffness of the joints simulating arthritis.

(2) Tremor of the limbs. This is more prominent in the hands and is asymmetrical. While most people regard PD as synonymous with tremor, 30% of PD patients do not have tremor. . . .

(3) Bradykinesia of the limbs and body. Bradykinesia includes difficulty initiating movement, slowness in movement, and paucity or incompleteness of movement. Bradykinesia is the most prominent and disabling symptom of PD.

Rigidity, tremor, and bradykinesia result, primarily, from a loss of dopamine in two regions of the brain: the substantia nigra and striatum. Dopamine is a chemical, or neurotransmitter, which enhances or facilitates the flow of impulses from nerve cells (neurons) in the substantia nigra to nerve cells in the striatum.

(4) Postural Instability results from impairment of righting or postural reflexes, the reflexes which allow people to adjust to abrupt changes in position. Thus, when someone trips and starts falling, they’re able to rapidly, appropriately, and without thinking adjust their trunk and limbs to stop falling, or, if they fall, ease their fall. In PD postural reflexes are impaired and when patients trip, they are unable to stop falling, or ease their fall–resulting in injury. To the PD patient the impaired postural reflexes may be perceived as unsteadiness or lack-of-balance.

The above four symptoms are considered primary symptoms: symptoms resulting from a specific impairment or imbalance in the nervous system. Difficulty walking is often considered a secondary symptom: a symptom resulting from a combination of bradykinesia and postural instability. The difficulty walking is characterized by short-steps (the heel of the advancing-foot not clearing the toes of the lagging-foot), a tendency to run (festination), be propelled forward (anteropulsion), or backward (retropulsion), a difficulty turning, and a tendency to abruptly and inexplicably stop (freeze). The difficulty walking sometimes resembles a car without steering or brakes.

Although PD is considered a motor disorder, one only affecting those regions of the nervous system that regulate movement, PD is more: when fully developed it affects multiple regions of the nervous system. 40% of PD patients are depressed. In some patients depression is a natural reaction to PD (exogenous depression). In most depression is part of PD (endogenous depression) and in some depression precedes the motor symptoms. 30% of PD develop dementia: a global deterioration in intellect. The dementia develops in older patients: 70+ years and resembles Alzheimer Disease (AD). 30% of PD patients develop symptoms related to impairment of the Autonomic Nervous System, the region of the nervous system that regulates, among other things, blood pressure, gut motility, and bladder function.

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SYMPTOMS AND DIAGNOSIS

Parkinson disease (PD) is diagnosed if a patient has 2 or more of the principal symptoms, one of which is resting tremor or bradykinesia. Resting tremor alone or a combination of it and bradykinesia, or rigidity, or postural instability is sufficient to diagnose PD--and, invariably, within 2-5 years, other PD symptoms appear. Combinations of bradykinesia and rigidity, or postural instability may be sufficient to diagnose PD. The combination of rigidity and postural instability may be sufficient to diagnose PD--but, within 2-5 years, non-PD symptoms may appear and a PD-like disorder, not PD may be diagnosed. . . .

Other PD symptoms include difficulty speaking (a low or hoarse voice), lack of facial expression (hypo-mimia, Poker-face), drooling (sialorrhea), difficulty swallowing (dysphagia), oily skin (seborrhea), cramped handwriting (micrographia), stooped-posture (kyphoscoliosis), hand and foot contractures (dystonic posture), shortness of breath, light-headiness on standing, increased sweating, difficulty urinating including frequency, hesitancy, and urgency, sexual dysfunction including impotence and loss of libido, leg cramps, dementia, cognitive impairment without dementia, depression, anxiety, sleep disturbances. These are called secondary symptoms, not because they’re unimportant or untroubling but because:

(1) They’re not essential for the diagnosis e.g. seborrhea, drooling

(2) Appear after the principal symptoms e.g. difficulty swallowing

(3) Are present in a smaller number of patients e.g. hand and foot deformities, leg cramps

(4) Are a specific manifestation of a principal symptoms e.g. lack of facial expression results from rigidity of the facial muscles, cramped handwriting: results from finger bradykinesia, shortness of breath results from bradykinesia and rigidity of the chest-wall muscles.

(5) Represent involvement of the nervous system outside the basal ganglia e.g. light headiness on standing, difficulty urinating result from dysfunction of the Autonomic Nervous System, while dementia results from dysfunction of the cortex.

In some patients secondary symptom such as difficulty swallowing and dementia are more troubling than the principal symptoms.

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NEURO-PSYCHIATRIC DISORDERS

PD is regarded as a motor disorder but neuropsychiatric disorders including dementia, cognitive impairment without dementia, depression, and anxiety may be prominent. These symptoms are usually appreciated after the motor symptoms appear. When these symptoms precede the motor symptoms, as they sometimes do, other diagnoses such as Alzheimer disease (AD), Diffuse Lewy Body disease (DLBD), or depression may be made. Usually, only after the motor symptoms are prominent are the neuropsychiatric symptoms appreciated as PD.

1. Parkinson Disease with Dementia

Approximately 30% of PD patients, usually age 70+, develop a dementia, a global deterioration in intellect: PD-dementia. In 90% of these patients there are changes in the cortex of the brain as well as the basal ganglia. In 76% of the patients the changes in the cortex are similar to Alzheimer Disease. In 24% of the changes consist of the presence of Lewy bodies in nerve cells throughout the cortex: Diffuse Lewy Body Disease. However, there’s an overlap: In many patients with Alzheimer changes there are diffuse Lewy bodies and in many patients with diffuse Lewy bodies there are Alzheimer changes. Diffuse Lewy Body Disease may begin earlier, in the 50s and 60s. Most of the neuropsychiatric symptoms of PD-dementia are aggravated by anti-parkinson drugs.

* * *

3. Cognitive Impairment Without Dementia

Symptoms include slowness of information processing: bradyphrenia analogous to slowness of moment, bradykinesia. Symptoms also include impaired executive function such as difficulty in planning, sequencing, organizing, and innovating. Cognitive impairment may present as a loss of drive or initiative, as a declining job performance, or as difficulty in performing previously learned tasks such as balancing a checkbook or doing a crossword puzzle. However, unlike dementia, cognitive impairment may go unrecognized by the patient’s family, friends, or associates. Cognitive impairment occurs in approximately 20% of PD patients and may be a fore-runner of dementia.

4. Depression.

An endogenous depression accompanied by feelings of guilt, remorse, hopelessness, and pessimism occurs in approximately 40% of PD patients. The endogenous depression is part of PD and is independent of age, disease duration, or disease severity. In approximately 20% of PD patients, depression precedes the motor symptoms. The endogenous depression is often accompanied by an exogenous, reactive depression–reactive to external events. The exogenous depression may be related to job loss, retirement, impotence , or fear of having PD--a chronic and debilitating illness. The depression responds to anti-depressant drugs. The depression may be severe.

5. Relationship of Cognitive Impairment Without Dementia and Depression

Cognitive impairment without dementia and depression may overlap and it may be difficult to separate them. This is especially so when cognitive impairment is associated with depression-like symptoms such as anergy, apathy, and passivity. These patients usually don’t respond to anti-depressant drugs. Cognitive impairment without dementia and the endogenous depression of PD may both arise because of a loss of dopamine cells adjacent to the nigra, a loss of noradrenaline cells in the locus ceruleus (a region of the brainstem), a loss of serotonin cells in the raphe nucleus (a region of the brainstem), and loss of acetyl-choline cells in the nucleus basalis of Meynert (a region of the brain near the striatum). The loss of non-nigral dopamine, noradrenaline, serotonin, and acetyl-choline nerve cells may release one or more non-motor cortical-subcortical loops triggering cognitive impairment without dementia or depression.

6. Anxiety

This is a prominent feature in 40% of PD patients. Whether it’s part of the disease or a reaction to the disease in unknown. The anxiety may or may not be associated with depression. In addition, many PD patients have panic attacks: episodic outbursts of anxiety. The attacks are characterized by a variety of symptoms including: fear of dying, fear of going insane, breathlessness, sweating, chest pain, choking, and dizziness. Panic attack may simulate a heart attack, and occasionally, a panic attack must be distinguished from a heart attack. In many PD patients the panic attacks are situationally cued and are linked to sudden immobility.

7. Sleep Disturbance

This may present as inability to sleep at night and daytime drowsiness. The sleep disturbance may be related to anxiety, depression, or the anti-parkinson drugs. The sleep disturbance maybe related to an inability to turn in bed: a manifestation of PD. Or, the sleep disturbance may be unrelated to any of the above. The sleep centers are in the brainstem near the substantia nigra and may be altered in PD. It must be remembered that von Economo’s encephalitis which between 1918-1926 resulted in 6 million cases of parkinsonism was called "sleeping sickness" because sleep disturbances were so prevalent.

MEDICAL TREATMENT

Most PD symptoms arise from a deficiency of dopamine and most anti-parkinson drugs restore dopamine or mimic dopamine’s actions. However, the drugs don’t permanently restore dopamine or exactly mimic dopamine’s actions. While a loss of dopamine cells in the nigra is the main feature of PD, non-dopamine nerve cells are also lost. This explains why anti-parkinson drugs don’t help all symptoms. Moreover, dopamine cells are present not only in the nigra but in other brain regions. Thus drugs that are effective in PD can, by stimulating non-nigral dopamine cells, cause side-effects such as nausea, hallucinations, and confusion.

[There follows a discussion of the various drugs used to treat the disease. There is also a section on surgical treatment for Parkinson's. One wonders if Ms. Reno has undergone some surgery, given that the very obvious tremors observed in her last days as Attorney General are no longer evident. Or is she being maintained on drug cocktails?]

-- Alas Poor Florida! (I knew@her.well), September 05, 2001

Answers

Personally, I don’t consider Janet Reno fit for public service under ANY circumstances, but that is just my opinion. Putting that bias aside, I would like to comment on the health issues brought forth in this thread.

Janet Reno has been known to have Parkinson disease for at least 6 years and the whole world watched as her uncontrollable tremors got progressively worse. Even though I’m not one of her fans, I found myself admiring her courage under a great deal of pressure and scrutiny. I suggest that Ms. Reno follow the sterling example set by M.J. Fox, and spend her remaining ‘quality time’ working with PD groups and her personal health issues.

My Uncle has PD and I’ve seen firsthand how debilitating it can be on the human mind and body. Janet Reno should have more respect for the high office of Florida State Governor and not allow her ego and the Democratic puppet masters, to get in the way of sound reasoning.

Besides, what ever happened to that ‘Tour America’ trip that she and Donna Shalaya were supposed to take, once out of office?

-- So (cr@t.es), September 05, 2001.

Janet, Donna and Hillary are greatly troubled by the Ann Heche story.

-- (Roland@hatemail.com), September 05, 2001.

Everything I've read indicated that her doctors gave her the "go- ahead" on running. Apparently, she now has the disease under control, however the method [which I assume is between her and her doctors.]

The "word on the street" from the Democrats is that her name could result in her winning the primary, but result in her losing the election. It's NOT something the Democrats are encouraging.

-- Anita (Anita_S3@hotmail.com), September 05, 2001.

Anita, "she now has the disease under control".

Unfortunately, 'under control' doesn't mean much with this progressive disease. There's no way out with PD; it only gets worse. And from what I've seen, each stressful event takes its toll.

I agree with So. Given this condition, she should take the road traveled by Michael.

-- Maria (anon@ymous.com), September 05, 2001.

National Review Online

She’s Baaaaack! Florida, beware.

By Tim Lynch, director of the Cato Institute's Project on Criminal Justice September 5, 2001 8:40 a.m.

Janet Reno is back. Yesterday, she announced her intention to unseat Jeb Bush and become Florida's next governor. Like Bill and Hillary Clinton, this woman is nothing if not audacious.

To succeed in her quest for the governor's office, Reno must spin her disastrous tenure as Attorney General into something that was innocuous. But we must never forget that Reno presided over the worst disaster in the history of American law enforcement — Waco. More than 70 men, women, and children lost their lives when Reno approved an FBI assault on the Branch Davidian residence in 1993. Reno was hailed for "taking responsibility," but she launched a cover-up, telling reporters that the FBI assault was necessary because she had received reports that "babies were being beaten." One week later, Reno admitted in congressional testimony that she had no evidence of child abuse. She subsequently appointed her crony, Richard Scruggs, to conduct an investigation into the incident. No one was very surprised when Scruggs's report exonerated Reno and the FBI.

When Congress held extensive hearings on the incident in 1995, Reno tried to place all of the blame on the Branch Davidian leader, David Koresh. When asked about the propriety of using tanks to smash into a building containing children, Reno managed to keep a straight face while comparing the tanks to good "rent-a-cars." The House Committee subsequently issued a finding that Reno's decision to approve the FBI tank assault was "premature, wrong, and highly irresponsible." That finding was lost in the partisan din — as the Democrats shouted about the National Rifle Association, the proliferation of right-wing militias, and the Oklahoma City bombing.

Seven years later, Reno approved an outrageous paramilitary raid on the home of Lazaro Gonzales in order to snatch Elian Gonzales. Regardless of where you come down on question of returning Elian to his father and Cuba, the manner in which this raid was conducted ought to shock the conscience. First, in the warrant application, Justice Department officials claimed that Lazaro Gonzalez was "concealing" Elian in his home. Please. Anyone with a television set knew Elian's whereabouts; it was on the evening news night after night for weeks.

Second, government agents sprayed tear gas into the faces of the anti-Castro protesters outside the home. Attacking someone for no reason is a criminal offense — at least for those of us who do not hold posts in the government. Castro probably got a hearty laugh.

Third, the paramilitary raid made little sense from the standpoint of police tactics. As Florida Senator Connie Mack noted, if Reno truly believed there might be a violent shootout, why did she put Elian's life in jeopardy by forcing a confrontation? What harm could possibly result from allowing Lazaro Gonzales to pursue his rights peacefully in the court system? On the other hand, if violent resistance was not expected, why send a commando team with submachine guns into a family home?

When a furor arose over the photo of the agent in military garb pointing his gun at a frightened Elian, Reno spun the photo as best she could. A careful look at the picture, she said, showed that the agent's finger was not on the trigger. In other words, the silly boy really didn't have a valid reason to be afraid.

To their credit, several of Harvard's liberal legal academics condemned the raid in Little Havana. In a Los Angeles Times op-ed, Alan Dershowitz wrote that the raid set a precedent that "endangered the rights of all Americans." In a New York Times op-ed, Laurence Tribe wrote that the raid "struck at the heart of constitutional government and shook the safeguards of liberty." In stark contrast, Reno said that she was very pleased with the operation. This is the woman who says she wants to continue her career of "public service."

Florida Republicans should not underestimate Reno. Despite her awful record, she has managed to stay above the fray by cultivating her image as an honest, if bumbling public servant. She has cleverly used that public persona to great effect. Yes, I broke an honorable tradition in the Attorney General's office by appearing on the campaign trail with the liberal governor of New Jersey, Jim Florio. Yes, my right hand man, Webster Hubbell turned out to be a felon. Yes, Richard Jewell's life was ruined by government agents who told anonymous lies to the press. Yes, my subordinates misled a federal judge about Wen Ho Lee. All of that happened, Reno allows, but why dwell on it?

To deflect attention away from her record, she's already been testing a pat soundbite: "This election is not about the past; it's about Florida's future!" Florida voters had better beware.

-- Alas Poor Florida! (I knew@her.well), September 05, 2001.