Category Archives: Hope

Understanding The Positive Health Benefits of Gratitude

“If the only prayer you ever say in your entire life is ‘thank you’, it will be enough.” Medieval German Theologian Meister Eckhart

“The smallest act of kindness is worth more than the greatest intention.” Khalil Gibran.

Preface: Gratitude is good for you. The Roman philosopher Seneca said, “Nothing is more honorable than a grateful heart.” The Roman senator Cicero remarked, “Gratitude is not only the greatest of virtues but the parent of all others.” Recognize the health benefits of being grateful.  Why? Gratitude will lead you to the fountain of hope; it is good for your heart, soul, mind, and practicing gratitude will be beneficial for your life with Parkinson’s.

Introduction: In the backdrop of having a chronic disorder like Parkinson’s disease, it is easy to get trapped and driven down emotionally from its daily burden. Life happens and we are constantly making micro- and macro-decisions, big and small changes in direction, and it seems to me the list grows with time. Today’s post is centered on gratitude, not to complicate your life, but as a reminder that being thankful can improve your health all on its own.

“Develop an attitude of gratitude, and give thanks for everything that happens to you, knowing that every step forward is a step toward achieving something bigger and better than your current situation.” Brian Tracy

Gratitude Defined: [grat·i·tudeˈɡradəˌt(y)o͞od/] Gratitude is from the Latin word gratus, meaning “pleasing” or “thankful,” Words from the Latin gratus have something to do with being pleasing or being thankful. To feel grateful is to feel thankful for something. Gratitude is a feeling of thankfulness (Merriam-Webster). Thank you in several languages is shown below (image credit).

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“No duty is more urgent than that of returning thanks.” James Allen

Studies on Gratitude and Health: Doing a PubMed search for “Gratitude” reveals >1000 papers/chapters/books; searching for “gratitude and health” shows >500 citations.  Outside of PubMed, there are numerous reviews and magazine/newspaper/journal articles describing the health benefits of being thankful (having gratitude).  In the end, I will list several for your further viewing/reading. Here are some highlights linking gratitude and a better life.

  • Blessings vs. Burdens- In 2003, Emmons and McCullough published a landmark study of gratitude and well being entitled “Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-being in Daily Life”.  They described 3 experiments, two groups were healthy college-aged students and the third group was adults with various neuromuscular disorders.  Within each separate study, some subjects were asked to maintain a journal on a weekly basis for 10 weeks, and others on a daily basis for 2 or 3 weeks.  They all kept records of both positive and negative effects they had experienced; including their behavior coping with these events (health behavior and physical symptoms), and their overall appraisal of life.  Subgroups from each study were asked to focus their journal entries on different things: (Group A) this group recorded things for which they were grateful (they were “counting their blessings”); (Group B) this group recorded things they found irritating and/or annoying (they were “counting their burdens”); and (Group C) this group recorded things that had a major impact on them.  After compiling the data from the 3 experiments, two trends stood out. (1) The participants from ‘Group A’, those recording things for which they were ”grateful’, showed much higher levels of well-being compared to Groups ‘B’ and ‘C’; and this was particularly evident when compared to those recording events that were ‘annoying or irritating’. (2) The positive effects of gratitude in the 10 week study, compared to the 2 or 3 week studies, showed not only better well-being; these participants also showed social and physical benefits.
  • Feeling Happy- In a separate study from 2002, McCullough et al. reported that recording your blessings on a regular basis was linked with increased happiness. In a separate study, Kurtz et al. (2008) showed that this feeling of happiness through gratitude was sustained for several months.
  • Optimism– A study by Overwalle et al. (1995) found a positive link between the ability to express gratitude and the feeling of well-being; suggesting these individuals had an improved/optimistic outlook of their future.
  • Strengthening Bonds and Building Relationships- The link of happiness from gratitude was shown to strengthen bonds, enable friendships, and support social networks.  The results from Reynolds (2008) showed that by practicing gratitude, participants felt more cared for/loved by others.
  • Mapping Neural Networks of Gratitude- In a 2015 paper entitled “Neural correlates of gratitude”, Fox et al. used magnetic resonance imaging (MRI) to map the effect of gratitude in volunteers. They tested a hypothesis that gratitude activity would be linked to brain regions associated with moral cognition, value judgment and theory of mind. Their results showed that gratitude was correlated with brain activity in the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC), which supported their hypothesis (see drawing below).

18.04.12.ACC_mPFC_Thalamus.

“Let us be grateful to people who make us happy.” Marcel Proust

 Linking Gratitude to the Anterior Cingulate Cortex and Basal Ganglia:  The anterior cingulate cortex (ACC) can be described as a ‘neural network interface’ between emotion, sensation, and action. The ACC is linked anatomically with brain areas associated with each of these functions. An important interaction of the ACC is highlighted by its reciprocal connections to the reward centers of the brain, which includes the orbitofrontal cortex, insula, and the basal ganglia. Thus, the ACC is a target for the dopamine-expressing neurons from the substantia nigra (part of the basal ganglia; see figure below).  Understanding the reward of gratitude within the brain has given us an appreciation to what leads to a healthier and happier self. To further augment the benefits of gratitude, we enlist neurotransmitters (serotonin and dopamine):

serotonin.A Squeeze of Serotonin-  Serotonin is an elixir that boosts our mood, enhances will-power and eliminates self-doubt. The anterior cingulate cortex (ACC)  releases serotonin (i) when we write about gratitude and (ii) when we reflect about the positives in our lives (and our work).

dopamine.A Drop of Dopamine- Dopamine makes us feel good. With respect to practicing gratitude, we release dopamine (from the substantia nigra in the basal ganglia) (i) when we express gratitude for what’s good in our lives and (ii) when we offer gratitude for someone who has helped us thrive at life/work,

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“We must find time to stop and thank the people who make a difference in our lives.” John F. Kennedy

Gratitude Promotes the “4H Club” That Includes Happy, Healthy, Heartfelt, and Hopeful: I am neither a psychologist nor a neurologist, but I truly enjoyed reading the Emmons and McCullough (2003) paper described above (“Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-being in Daily Life”).  First, it was well-written and easy to follow.  Second, they asked and answered some very important questions linked to gratitude.  Clearly, their work was preceded by other studies; however, their results likely provided a foothold for others to launch their ideas about how gratitude influences the human condition. In summarizing many studies, the folks at Happier Human (What About Happiness?) posted an amazing article entitled “The 31 Benefits of Gratitude You Didn’t Know About: How Gratitude Can Change Your Life” (click here) along with the figure below showing the huge overall impact of gratitude on human happiness (credit).

Benefits-of-Gratitude5

Remember, I am not a psychologist.  However, I felt that four major themes could be used to represent the positive impact of gratitude. Borrowing from the ‘4H Club’ name, the benefits of gratitude could make someone Happy, Healthy, Heartfelt, and Hopeful (see Figure below). And there are numerous studies to support the positive impact of gratitude on these four aspects of life (see references cited at the end).

Screenshot 2018-04-10 23.49.01

“To give thanks in solitude is enough. Thanksgiving has wings and goes where it must go. Your prayer knows much more about it than you do.” Victor Hugo

Pursuing Happiness Through Gratitude and How to Achieve it: The best strategy for expressing gratitude requires your investment of time to create and maintain a gratitude-journal.  The idea is for your gratitude-journal to have short statements where you describe your gratitude, you reflect on your positive life-events, you give thanks to others, you think-ponder deeply, and write 3-5 things per time and you decide on the frequency (every few days, more or less, but you decide).   Here are some examples:

  • I hit golf balls at the driving range 2 days in a row this week, what fun;
  • Spring weather finally has arrived, it waited ’til now but that’s OK;
  • Got 6.5 hours of sleep one night last weekend (yay!);
  • A reader of the blog wrote to tell me how much he appreciates and values my blog posts [and that he was my biggest fan (thank you so much)];
  • I’ve enjoyed teaching my undergraduate class this semester;
  • Thankful for all of my favorite Physical Therapists who inspire me to exercise and to stay healthy (“Keeping your body healthy is an expression of gratitude to the whole cosmos — the trees, the clouds, everything.” Nhat Hanh);
  • So very proud of CJ for presenting her poster this week at the University Undergraduate Student Research Day;
  • Very thankful for the incredible help Marissa and Shelby have provided me as Teaching Assistants this semester;
  • Look forward to seeing my sisters in the near future;
  • Having lunch tomorrow with 2 former students from my undergraduate class, and this week I went out for lunch with the current class (I learn much from these events);
  • Received an amazing thank-you note from a former student;
  • Very fortunate to have Susan in my life, look forward to catching up soon.

“For each new morning with its light, For rest and shelter of the night, For health and food, for love and friends… Feeling gratitude and not expressing it is like wrapping a present and not giving it.” William Arthur Ward

Benefits of Gratitude and Health in the Presence of Parkinson’s: The anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) of the brain are the key components that respond to gratitude. There is no doubt that people-with-Parkinson’s experience the benefits of gratitude and the 4H’s (Happy, Healthy, Heartfelt, and Hopeful).  However, the ACC communicates with the basal ganglia, which implies some role for dopamine. Thus, we must believe we still synthesize enough dopamine to realize the positive effects from gratitude (well, this is what I believe).

In closing, as I said at the start, I am convinced that gratitude will lead you to the fountain of hope; it is good for your heart, soul, mind, and practicing gratitude will be beneficial for your life with Parkinson’s. May you continue to be thankful. May the positive effects from gratitude provide you a constant source of happiness and good health that are reinforced by heartfelt feelings and hope for years to come.

“Thanks are the highest form of thought.” Gilbert K Chesterton

References For Your Further Reading:
Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. Journal of personality and social psychology. 2003;84(2):377-89. Epub 2003/02/15. PubMed PMID: 12585811.

Fox GR, Kaplan J, Damasio H, Damasio A. Neural correlates of gratitude. Frontiers in psychology. 2015;6:1491. Epub 2015/10/21. doi: 10.3389/fpsyg.2015.01491. PubMed PMID: 26483740; PMCID: PMC4588123.

The 31 Benefits of Gratitude You Didn’t Know About: How Gratitude Can Change Your Life (click here).

McCullough ME, Emmons RA, Tsang J. The grateful disposition: a conceptual and empirical typology. J Pers Soc Psychol. 2002;82:112–127.

Kurtz JL, Lyubomirsky S. Towards a durable happiness. In: Lopez SJ, Rettew JG, eds. The Positive Psychology Perspective Series. Vol 4. West-port, CT: Greenwood Publishing Group; 2008:21–36.

Overwalle FV, Mervielde I, De Schuyter J. Structural modeling of the relationships between attributional dimensions, emotions, and performance of college freshmen. Cognition Emotion. 1995;9:59–85.

7 Surprising Health Benefits of Gratitude (click here).

Martins A, Ramalho N, Morin E. A comprehensive meta-analysis of the relationship between Emotional Intelligence and health. Personality and Individual Differences. 2010;49(6):554-64. doi: https://doi.org/10.1016/j.paid.2010.05.029.

Alspach G. Extending the tradition of giving thanks recognizing the health benefits of gratitude. Crit Care Nurse. 2009;29(6):12-8. doi: 10.4037/ccn2009331. PubMed PMID: 19952333.

Emmons RA, Crumpler CA. Gratitude as a Human Strength: Appraising the Evidence. Journal of Social and Clinical Psychology. 2000;19(1):56-69. doi: 10.1521/jscp.2000.19.1.56.

Ma LK, Tunney RJ, Ferguson E. Does gratitude enhance prosociality?: A meta-analytic review. Psychological bulletin. 2017;143(6):601-35. Epub 2017/04/14. doi: 10.1037/bul0000103. PubMed PMID: 28406659.

7 Ways to Boost Your Gratitude (click here).

Reynolds DK. Naikan Psychotherapy: Meditation for Self-Development. Chicago, IL: University of Chicago Press; 1983.

O’Connell BH, O’Shea D, Gallagher S. Feeling Thanks and Saying Thanks: A Randomized Controlled Trial Examining If and How Socially Oriented Gratitude Journals Work. Journal of clinical psychology. 2017;73(10):1280-300. Epub 2017/03/07. doi: 10.1002/jclp.22469. PubMed PMID: 28263399.

Sirois FM, Wood AM. Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2017;36(2):122-32. Epub 2016/10/28. doi: 10.1037/hea0000436. PubMed PMID: 27786519.

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend.” Melody Beattie

 Cover photo credit: https://visitsrilanka.com/news/its-blooming-spring-22-great-uk-walks/

2018 Parkinson’s Awareness Month and 65 Quotes to Support Your Life With Parkinson’s

“Don’t give up. Don’t ever give up.” Jim Valvano

“Courage starts with showing up and letting ourselves be seen.” Brené Brown

Parkinson’s disease Awareness Month: Parkinson’s awareness month is exactly that.  You simply start by making people around you familiar with this disorder.  And you can help others learn more about this neurodegenerative disease.

Description of Parkinson’s disease: Instead of the usual written narrative, here are a couple of video presentations.

NPFiconFor further information also see: Understanding Parkinson’s.

 65* Quotes on Adversity, Hope, Journey, Life, and Persistence to Help You During the ‘Off-moments’ and to Remind You to Never Give up (*Why 65? My age later this year):

  1. “To me, hope is informed optimism.” Michael J. Fox
  2. “The truth is that on most days, there comes a point where I literally can’t stop laughing at my own symptoms.” Michael J. Fox
  3. “The strongest people are not those who show strength in front of us but those who win battles we know nothing about.” Anonymous

  4. “Behind every chronic illness is just a person trying to find their way in the world. We want to find love and be loved and be happy just like you. We want to be successful and do something that matters. We’re just dealing with unwanted limitations in our hero’s journey.” Glenn Schweitzer
  5. “Friendship is the hardest thing in the world to explain. It’s not something you learn in school. But if you haven’t learned the meaning of friendship, you really haven’t learned anything.”Muhammad Ali
  6. “Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.” Muhammad Ali
  7. “Sometimes the smallest step in the right direction ends up being the biggest step of your life. Tip Toe if you must, but take a step.” Naeem Callaway
  8. “When the unthinkable happens, the lighthouse is hope. Once we choose hope, everything is possible.”  Christopher Reeve
  9. “Believe in yourself and all that you are. Know that there is something inside of you that is greater than any obstacle.” Christian D. Larson
  10. “You shouldn’t focus on why you can’t do something, which is what most people do. You should focus on why perhaps you can, and be one of the exceptions.” Steve Case
  11. “Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work; you don’t give up.” Anne Lamott
  12. “You are strong when you know your weaknesses. You are beautiful when you appreciate your flaws. You are wise when you learn from your mistakes.”  unknown
  13. “Champions aren’t made in gyms. Champions are made from something they have deep inside them—a desire, a dream, a vision. They have to have last-minute stamina, they have to be a little faster, they have to have the skill and the will. But the will must be stronger than the skill.”Muhammad Ali
  14. “The strongest people I’ve met have not been given an easier life. They’ve learned to create strength and happiness from dark places.”  Kristen Butler
  15. “You either get bitter or you get better. It’s that simple. You either take what has been dealt to you and allow it to make you a better person, or you allow it to tear you down. The choice does not belong to fate, it belongs to you.” Josh Shipp
  16. “It’s not selfish to love yourself, take care of yourself, and to make your happiness a priority.” Mandy Hale
  17. “Live to inspire, and one day people will say, because of you, I didn’t give up” unknown
  18. Some days are better, some days are worse. Look for the blessing instead of the curse. Be positive, stay strong, and get enough rest. You can’t do it all, but you can do your best. Doe Zantamata
  19. “I can’t tell you when, but I can promise you it will get better, it will get easier, and it will all be worthwhile. Just promise me you won’t ever give up.” unknown
  20. “Maybe life isn’t about avoiding the bruises. Maybe it’s about collecting the scars to prove that we showed up for it.” Hannah Brecher
  21. “We are stronger in the places we have been broken.” Ernest Hemingway
  22. “Just put one foot in front of the other.”  Austin Peck
  23. “Coming together is a beginning; keeping together is progress; working together is success.”  Henry Ford
  24. “Alone we can do so little; together we can do so much.”  Helen Keller
  25. “If everyone is moving forward together, then success takes care of itself.”  Henry Ford
  26. “We keep moving forward, opening new doors, and doing new things, because we’re curious and curiosity keeps leading us down new paths.” Walt Disney
  27. “I find that the best way to do things is to constantly move forward and to never doubt anything and keep moving forward, if you make a mistake say you made a mistake.”  John Frusciante
  28. “Don’t dwell on what went wrong. / Instead, focus on what to do next. / Spend your energies on moving forward / toward finding the answer.” Denis Waitley
  29. “If you stumble, make it part of the dance.” unknown
  30. “If opening your eyes, or getting out of bed, or holding a spoon, or combing your hair is the daunting Mount Everest you climb today, that is okay.” Carmen Ambrosio
  31. “Please be patient with me. Sometimes when I’m quiet, it’s because I need to figure myself out. It’s not because I don’t want to talk. Sometimes there are no words for my thoughts.”  Kamla Bolaños
  32. “What would the hero of your life’s movie do right now? Do that!” Joe Rogan
  33. “Inspirations knock and hang around for a while and wait for some kind of response, which is the beginning of a creative act.” Thomas Moore
  34. “What you do makes a difference, and you have to decide what kind of difference you want to make.” Jane Goodall
  35. “What’s meant to be will always find a way” Trisha Yearwood
  36. “Do not pray for an easy life, pray for the strength to endure a difficult one.”  Bruce Lee
  37. “One who gains strength by overcoming obstacles possesses the only strength which can overcome adversity.” Albert Schweitzer
  38. “When we long for life without difficulties, remind us that oaks grow strong in contrary winds and diamonds are made under pressure.” Peter Marshall
  39. “Ask yourself what problem you have right now. Not next year, tomorrow or five minutes from now. You can always cope with the now, but you can never cope with the future. Nor do you have to. The answer, the strength and the right action will be there when you need it. Not before or after.” Eckhart Tolle
  40. “Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever.” Lance Armstrong
  41. “If you are depressed you are living in the past.
    If you are anxious you are living in the future.
    If you are at peace you are living in the present.”
    Lao Tzu
  42. “To die is poignantly bitter, but the idea of having to die without having lived is unbearable.” Erich Fromm
  43. “Sometimes the hardest part isn’t letting go but rather learning to start over.” Nicole Sobon
  44. “You do not need to know precisely what is happening, or exactly where it is all going. What you need is to recognize the possibilities and challenges offered by the present moment, and to embrace them with courage, faith and hope.” Thomas Merton
  45. “The journey of a thousand miles begins with one step.” Lao Tzu
  46. “Everyone is handed adversity in life. No one’s journey is easy. It’s how they handle it that makes people unique.” Kevin Conroy
  47. “You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.” Eleanor Roosevelt
  48. “Hope is faith holding out its hand in the dark.” George Iles
  49. “Every day you may make progress. Every step may be fruitful. Yet there will stretch out before you an ever-lengthening, ever-ascending, ever-improving path. You know you will never get to the end of the journey. But this, so far from discouraging, only adds to the joy and glory of the climb.” Winston S. Churchill
  50. “Hope is being able to see that there is light despite all of the darkness.” Desmond Tutu
  51. “Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.” Thich Nhat Hanh
  52. “There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow.” Orison Swett Marden
  53. “Courage is not having the strength to go on; it is going on when you don’t have the strength. ”Theodore Roosevelt
  54. “The most authentic thing about us is our capacity to create, to overcome, to endure, to transform, to love and to be greater than our suffering.” Ben Okri
  55. “Sometimes you will be in control of your illness and other times you’ll sink into despair, and that’s OK! Freak out, forgive yourself, and try again tomorrow.” Kelly Hemingway
  56. “You may be the only person left who believes in you, but it’s enough. It takes just one star to pierce a universe of darkness. Never give up.” Richelle E. Goodrich
  57. “You can have anything you want if you want it badly enough. You can be anything you want to be, do anything you set out to accomplish if you hold to that desire with singleness of purpose.” Abraham Lincoln
  58. “Whatever you are, be a good one.” Abraham Lincoln
  59. “I know now, after fifty years, that the finding/losing, forgetting/remembering, leaving/returning, never stops. The whole of life is about another chance, and while we are alive, till the very end, there is always another chance.” Jeanette Winterson
  60. “Affliction comes to us, not to make us sad but sober; not to make us sorry but wise.” H.G. Wells
  61. “Since receiving my Parkinson’s diagnosis, my opinion of exercise has changed.  With Parkinson’s, I’m now exercising as if my life depends on it.”  Frank C. Church
  62. We are identified by our characteristic symptoms of our unwanted companion named Parkinson’s. We are all in this together, united by our disorder; held together by those who love and care for us.” Frank C. Church
  63. Today renews your lease on the rest of your life, enjoy it (get up, get out, get going). Today acknowledge your Parkinson’s; give it a nudge, because you are ready for the battle and for life.” Frank C. Church
  64. “The sum total of our health is a complex formula that differs slightly for each one of us.  Those of us with a progressive neurodegenerative disorder like Parkinson’s increases the complexity of this life-equation.” Frank C. Church
  65. “Living with Parkinson’s requires you to adapt to its subtle but progressive changes over a long period of time; you need to remain hopeful for many different things.” Frank C. Church

“When nothing seems to help, I go and look at a sonecutter hammering away at his rock, perhaps a hundred times without as much as a crack showing in it. Yet at the hundred and first blow it will split in two, and I know it was not that last blow that did it, but all that had gone before.”  Jacob A. Riis

Cover photo credit: https://uspstrackingtool.com/red-tulips-bouquet-of-flowers-wallpaper/

 

Neuroprotection with Taurine in a Parkinson’s Model System

“There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow.” Orison Swett Marden

“Hope sees the invisible, feels the intangible, and achieves the impossible.” Helen Keller

Introduction: Many of us take levodopa/carbidopa for substantial symptomatic relief; however, this dopamine replacement treatment only relieves symptoms without offering either neuroprotection or neuro-restoration. We are still anxiously waiting for the study to be released that announces “We describe a new Parkinson’s compound and we’ve nicknamed it hopeful, helpful, and protective“.   Today’s post will review an interesting paper from Yuning Che and associates in Dalian, China recently published in Cell Death and Disease (open access, click here to download paper).  The ‘hopeful’ neuroprotective compound is the amino sulfonic compound taurine.  Before we get lost in all of the possibilities, let’s discuss the science and see what they describe, ok? First, we begin with some background.

Screenshot 2018-04-02 09.55.23

“I truly believe in positive synergy, that your positive mindset gives you a more hopeful outlook, and belief that you can do something great means you will do something great.” Russell Wilson

Neuroinflammation and Oxidative Stress are Pathological Processes that  Promote the Development of Parkinson’s:   Parkinson’s is a neurodegenerative disorder where we lose dopamine-producing neurons in the mid-brain substantia nigra.   There are several pathological patterns known to contribute to the development of Parkinson’s as highlighted below.  Related to this post is the negative-effect contributed by long-term neuroinflammation and oxidative stress.

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“It’s hope as a decision that makes change possible.” Jim Willis

Macrophages in the Brain are Called Microglia Cells:  In many instances, the body initiates and uses the pro-inflammatory machinery as a host-defense response; in other words, we use it to protect ourselves.  When it gets highjacked and becomes detrimental to be host, we realize the sheer firepower of our inflammatory system.  The good-and-the-bad of inflammation is mediated primarily by the cells named neutrophils (along with the eosinophils and basophils), monocytes and macrophages.  The monocyte leaves the bloodstream and migrates to various organs/tissues where it can ‘mature’ into a macrophage, which is a ‘field commander’ type-of-cell.  Think of a macrophage as a General in the bunker of a battlefield, not only giving detailed marching orders but they are also leading the charging brigade of soldiers.  Macrophages in the brain are named microglia cells .  First, macrophages (microglia cells) are ‘phagocytic’ cells that are capable of engulfing foreign-damaged-invading substances/cells (phagocyte comes from the Greek phagein, “to eat” or “devour”, and “-cyte”, the suffix in biology denoting “cell”).  Second, macrophages (microglia cells) direct the inflammatory response by releasing all kinds of substances that give other inflammatory/immune cells their instructions.  Sometimes these cells and their instructions become bad to the neighboring tissue/organs; in our case, the dopamine-produing neurons in the midbrain.

activated_microgliaMicroglia-mediated neuroinflammation(Figure credit): Various substances initiate contact with resting unstimulated microglia cells.  This ‘activates’ the microglia cell into an cell of considerable fire-power by producing and releasing many substances [nitric oxide (NO), reactive oxygen species (ROS),  and several inflammatory cytokines (e.g., IL-1, IL-6, and  TNF-alpha)]. This collection of pro-inflammatory substances secreted by the activated microglia cells creates a hostile microenvironment that promotes neuronal cell dysfunction and potential death to the cell.

Depending on the need and response of the ‘environmental challenge’, macrophages (microglia cells) can be activated to become either ‘M1’ (focused on becoming a pro-inflammatory) microglia cell or ‘M2’ (transforms into an anti-inflammatory) microglia cell [see Figure below, credit].  In the setting of an invasion or infiltration by microbes, you would want the microglia cell to be activated to a M1 state’ they could attack, engulf and kill the invading microorganism. In this setting, the M1 microglia cell would be protective of you. By contrast, the role of M2 microglia cells would be to turn-off the resultant pro-inflammatory response.  This implies that long-term inflammatory events that promote inappropriate M1 microglia cell activation could lead to dysfunction and even cell/tissue death. This description of appropriate/inapproriate microglia cell activation illustrates the complex nature of these inflammatory cells. What this says is in Parkinson’s, chronic activation to M1 microglia cells could generate a detrimental neuroinflammatory environment able to attack host cells/tissues.

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“It is difficult to say what is impossible, for the dream of yesterday is the hope of today and the reality of tomorrow.” Robert H. Goddard

Taurine: Taurine is an amino sulfonic compound (many erronously use the term amino acid) and it is considered to be a conditionally essential nutritient.  We do not use taurine in the assembly of proteins from genes; however, it participates in several physiological systems.  Taurine is apparently a popular additive/supplement in many different energy drinks.  Both WebMD (click here) and the Mayo Clinic (click here) have posted overviews of taurine and consider it mostly safe.  The structure of taurine is shown below (credit). Taurine is found in the brain, heart, muscle and in many other organs.  Good sources of dietary taurine are animal and fish proteins. An interesting overview for using taurine to stay healthy and to promote longevity has recently been posted (click here). Taurine has many proposed physiological functions that range from neurotransmitter to cell anti-oxidant, from anti-inflammatory to enhancing sports performance.  The ‘problem’ with having a multi-talented substance like taurine is actually studying these diverse functions individually and trying to test them in rigorous scientific studies, which leads us (finally!) to the paper introduced at the beginning.

Taurine.svg

“Hope is the mainspring of life.” Henry L. Stimson

Taurine protects dopaminergic neurons in a mouse Parkinson’s disease model through inhibition of microglial M1 polarization: Here are some key aspects to this  study:

  • It is becoming more evident that neuroinflammation and oxidative stress are likely key participants to the development of Parkinson’s.
  • Surrounding the substantia nigra are a lot of unactivated microglia cells, which when activated to become M1 microglia cells they secrete several cytotoxic compounds that can easily harm or kill dopaminergic-producing neurons.
  • In particular, these neurons are susceptible to ‘injury’ due to their low antioxidant potential, low levels of calcium, increased amounts of iron, and the oxidation-susceptible dopamine.
  • Taurine has been shown in several reports to be a neuromodulating substance, boosting intracellular levels of calcium, anti-oxidant, and anti-inflammatory.
  • A recent report linked motor severity in Parkinson’s to low levels of taurine in blood plasma.
  • The authors tested a hypothesis that the supplementation with exogenous taurine might be neuroprotective in a Parkinson’s model sy\stem.
  • Previous studies have revealed a neuroprotective role for taurine in both glutamate-induced and hypoxic-ischemic brain models.
  • They used a mouse model of Parkinson’s caused by injection with paraquat and maneb [(P + M) a two-pesticide model of Parkinson’s], which showed progressive dopaminergic neurodegenera-
  • tion, gait abnormality and α-synuclein aggregation.
  • Taurine treatment protected the mouse from the detrimental effect of  P + Mu.
  • Their results revealed three effects of taurine in the P + M model of Parkinson’s (i) inhibition of microglia cell activation; (ii) reduced M1 microglia cell polarization; and (iii) reduced activation of cellular NOX2 and nuclear factor-kappa B (NF-κB).

“Losing the possibility of something is the exact same thing as losing hope and without hope nothing can survive.” Mark Z. Danielewski

Overview of Some of Their Results: Figure 1 presents the effect of P + M to promote a pathological state that resembles Parkinson’s.  Panels 1A and 1B show the loss of dopaminergic neurons by the staining of the brain with an antibody to tyrosine hydroxylase (a major dopaminergic neuron protein) following P + M injection.  Panels !C and 1D show that P + M treatment lead to expression of the toxic olgiometic α-synuclein.  Not shown here, but P + M treatment resulted in displayed abnormal gaits (Figure 2 in the paper). Screenshot 2018-04-05 11.18.39

Taurine protected against P + M-mediated neurotoxicity.  Using the same tests as done in Figure 1 above, taurine preserved neurons even with P + M present (Figure 3 panels A and B) and taurine reduced expression of oligomeric α-synuclein in the presence of P + M (Figure 3 panels C and D).  Not included here, the protective effects of taurine during P + M treatment was partly due to the inhibition of migroglia cell-mediated chronic inflammation.  Furthermore, the ability of microglia cells to become  ‘polarized’ or activated to either M1 (pro-inflammatory) or M2 (anti-inflammatory) was also studied in the presence of taurine plus P + M-treatment.  Both M1 and M2 microglia cells are present in the mid-brain of the mice treated with P + M; interestingly, taurine treatment reduced expression levels of damaging M1 microglia cell products (results not included here).  Finally, two key M1-linked gene products were studied, NOX2 and NF-kB.  They found that taurine was able to reduce expression of both NOX2 and NF-kB, which indicates that taurine blocked these key products important for neuroinflammation (NOX2) and polarization of the M1 microglia cell-type (NF-kB)

Screenshot 2018-04-05 11.37.57

“The present is the ever moving shadow that divides yesterday from tomorrow. In that lies hope.” Frank Lloyd Wright

What do these results show? (1) In an interesting model of Parkinson’s, taurine showed  a potent benefit to the mice; (2) taurine reduced loss of dopamine-producing neurons in P + M mice; (3) taurine reduced oligomeric α-synuclein in P + M mice; (4) taurine treatment reduced neuroinflammation by suppressing M1 microglia cells to suggest a neuroprotectice effect; and finally, (5) taurine reduced expression of both NOX2 and NF-kB,  important genes for microglia cell activation. A similar neuroprotective effect was also found for taurine in an experimental model of Alzheimer’s disease, which resulted in improved coognitive ability. The Parkinson’s model clearly suggests that disease progression by P + M treatment is promoted by chronic neuroinflammation and M1-type microglia cells.  Under the test conditions used, taurine was shown to convincingly reduce dopamine-producing neuronal cell degeneration in the presence of the pesticides P + M.

What do these results suggest? There is still much to learn about taurine. There is much potential to taurine being neuroprotective.  However, there have been other seriously–convincing-positive mouse model results with other compounds that failed miserably in human clinical trials.  The data shown here uses an interesting mouse model of Parkinson’s with a simple yet elegant and solid set of data (that does not appear to be overly interpreted).  Taurine has been shown to be safe in treating other human maladies (diabetes and cardiovascular disease).  The results here are hopeful that taurine could provide neuroprotection in human Parkinson’s. Hopefully, clinical trials will be started somewhere soon to determine the ability of taurine to provide neuroprotection in human Parkinson’s disease.

“Every one of us is called upon, perhaps many times, to start a new life. A frightening diagnosis, a marriage, a move, loss of a job…And onward full-tilt we go, pitched and wrecked and absurdly resolute, driven in spite of everything to make good on a new shore. To be hopeful, to embrace one possibility after another–that is surely the basic instinct…Crying out: High tide! Time to move out into the glorious debris. Time to take this life for what it is.” Barbara Kingsolver

Cover photo credit: wallpaper/nature/1024×768/Dawn_skies_over_Gulf_of_St._Lawrence_Prince_Edward_Island_Canada_1024x768.jpg

Living and Working with “HOPE” in the Presence of Parkinson’s

“Life is difficult. This is the great truth, one of the greatest truths-it is a great truth because once we see this truth, we transcend it.” M. Scott Peck

“Life is hard. Life is beautiful. Life is difficult. Life is wonderful.” Kate DiCamillo

Introduction: A student and loyal reader of this blog recently asked “What do I do with all of the advice/tips/suggestion posts from the blog?” My reply was they help me balance out my day-to-day life; especially for work and to protect my time for exercise and time to spend with the significant-people in my life.  I typically print out the 1-page summaries and keep them in a folder, or post them at work, as reminders to what I value.  “What about all of your supportive and descriptive statements about living well with Parkinson’s disease?  I bet your readers of the blog would enjoy having some of your statements compiled like your advice posts, don’t you agree?”  My response was you want me to make some 1-page handouts of my comments? Yes, I could do that. That kind of a handout could help me as well; they could also serve as a roadmap to where the blog has traveled.  Interesting questions/suggestions, thanks for asking them.

“If you don’t know where you are going, you might wind up someplace else.” Yogi Berra

The tenacity of hope: There are 4 broad goals to this blog: i) describe living with Parkinson’s (“Life Lessons“); ii) report emerging medical strategies for treating/managing/curing Parkinson’s (“Medical Education“); iii) support mechanism to anyone with Parkinson’s or any of the neurodegenerative disorders (“Strategy for Living“); and iv) educate by presenting scientific aspects of Parkinson’s (“Translating Science”).  Throughout much of the posts here, I firmly believe that words/concepts like hope, positive, persistent, staying happy and healthy, exercise (a lot, daily if possible), and refuse to give up are all important ‘life-lines’ for us to adopt in our dealing with this disorder.  Today’s message returns to hope and “HOPE”.  Hope is defined by the Cambridge dictionary as “the feeling that something desired can be had or will happen”.  I use HOPE as an acronym in Parkinson’s and it stands for:

H = Hope/Health(y)
O = Optimistic/Positive
P = Persistent/Perseverance
E = Enthusiasm for life, for career, and for exercise

Steve Gleason said “Life is difficult. Not just for me or other ALS patients. Life is difficult for everyone. Finding ways to make life meaningful and purposeful and rewarding, doing the activities that you love and spending time with the people that you love – I think that’s the meaning of this human experience.”  I really like the sentiment of his statement and admire his courage through adversity.  It reminds me that we are a community with a shared theme; while we are spread out throughout the world, we understand one another because Parkinson’s has been sewn in to the fabric of our lives. I am also convinced that staying hopeful and using HOPE gives us tenacity to deal with the subtle changes being forced upon us by the ever present Parkinson’s.

“Your qualifications, your CV, are not your life, though you will meet many people of my age and older who confuse the two. Life is difficult, and complicated, and beyond anyone’s control, and the humility to know that will enable you to survive its vicissitudes.” J.K. Rowling

Living and working with HOPE: This current post reinforces the meaning for HOPE.  It reminds me of Stevie Nicks and Fleetwood Mac’s Landslide where she sings “Can I sail through the changin‘ ocean tides? / Can I handle the seasons of my life?” We confront both of these questions daily with Parkinson’s.  My hope is you find reassurance that your life and world are still meaningful, and you are not battling Parkinson’s alone. We know and we understand what you are confronting each day; thus, be persistent and remain hopeful.

Here is a link to a SlideShare file that will allow you to easily read/view all of these 1-page handouts.  You do not need a login, it’s free. You can read, clip and copy individual slides (1-page handouts); it even will let you download the entire file: click here to view Living and Working with “HOPE” in the Presence of Parkinson’s. Alternatively, here is the URL: https://www.slideshare.net/FrankChurch1/living-and-working-with-hope-in-the-presence-of-parkinsons  And finally, in case the above link proves problematic, here is a copy of these 1-page summaries (click here to download PDF file).  I have enjoyed re-reading the old blog posts these were derived from (some of these were previously posted and several are new) and they are presented as follows:

  • Part 1: Some of Frank’s quotes about living with Parkinson’s (four 1-page handouts);
  • Part 2: Suggestions, character traits, and tips for the journey through life and career in the absence and presence of Parkinson’s (seven 1-page summaries);
  • Part 3: Health and exercise while living with Parkinson’s (five 1-page summaries);
  • Part 4: Historical time-line of Parkinson’s disease (six 1-page reports)

“Life is like riding a bicycle. To keep your balance, you must keep moving.” Albert Einstein

Know that wherever you are in your life right now is both temporary, and exactly where you are supposed to be. You have arrived at this moment to learn what you must learn, so you can become the person you need to be to create the life you truly want. Even when life is difficult or challenging-especially when life is difficult and challenging-the present is always an opportunity for us to learn, grow, and become better than we’ve ever been before.” Hal Elrod

Cover photo credit: asisbiz.com/USA/17-Mile-Drive/images/The-Lonely-Cypress-Tree-17-Mile-Drive-Monterey-California-July-2011-06.jpg

A Good Life With Parkinson’s

“I choose to make the rest of my life the best of my life.” Louise Hay

“Avoiding problems you need to face is avoiding the life you need to live.” Paulo Coelho

Try to live following the advice of the opening quotes: Today renews your lease on the rest of your life, enjoy it (get up, get out, get going). Today acknowledge your Parkinson’s; give it a nudge, because you are ready for the battle and for life.

18.01.13b.Live_Better_PD

Live a better and healthier life by following this circle of words [yes, they all begin with the letter ‘F’ (click here to download the schematic above)]:
Fit/fitness-
Exercise as much as your body can take, then do some more. Getting/staying fit really matters in your battle with Parkinson’s.

Fortitude-
Stay strong in your effort with your adversity.

Food- Feed your brain properly, fuel your body well; it will make a difference.

Flexible (two definitions)-
Stay flexible by frequent (I mean really often) stretching; you’ve got a life-altering disorder, stay flexible and let your life follow what happens because it’ll be okay.

Fulltime– It takes time and effort to manage your life. You can find the time because managing your life well from this minute on will matter later in your life;

Faith (multiple definitions)– Believe in your ability to successfully navigate your life; trust in your loved ones to support your journey; believe that a higher entity truly loves you and acknowledges your strength and passion for life.

Forty-winks and sleep some more- The brain is like a sponge that fills up all day with fluid; sleep allows the brain to drain, to renew, to fire-up strong upon waking; sleep is a very good thing.

A Good Life With Parkinson’s: Our Common Bond and Hope
I feel your stiffness; I know it well.

I sense your troubled thoughts; my mind also has questions.
I notice your tremor; mine can act up too.
I perceive your frustation; life with Parkinson’s can be problematic.
I see your shuffle; my right leg drags when I’m tired.
I admire your strength; I’ve got it too.
I acknowledge your life-accomplishments; we are still the same person as before Parkinson’s.
I see your honor; our work our living makes a difference.
I see your smile; those around us still care for us, no matter what.
I feel your effort; like you, I’ll never give up.

“Life is an opportunity, benefit from it. Life is beauty, admire it. Life is a dream, realize it. Life is a challenge, meet it. Life is a duty, complete it. Life is a game, play it. Life is a promise, fulfill it. Life is sorrow, overcome it. Life is a song, sing it. Life is a struggle, accept it. Life is a tragedy, confront it. Life is an adventure, dare it. Life is luck, make it. Life is too precious, do not destroy it. Life is life, fight for it.” Mother Teresa

Cover photo credit: http://ognature.com/path-snow-winter-mist-sunset-sun-trees-wallpaper-iphone-6/

 

64 Quotes on Persistence to Help Your Journey With Parkinson’s Disease

“Kites rise highest against the wind – not with it!” Winston Churchill

“Energy and persistence conquer all things.” Benjamin Franklin

Introduction: On January 1, LinkedIn announced that I had a work anniversary of 32 years at The University North Carolina at Chapel Hill ( if you include my postdoc at UNC-CH, this is a grand total of 36 years). My dear friend Lisa Cox (she is a graduate of The University North Carolina at Chapel Hill) wrote to congratulate me and said the following: “Grateful for your commitment to the University and to your students. Your steadfast determination is to be commended.”  Her use of the words ‘steadfast determination’  got me thinking about the word persistent  (steadfast is a synonym for persistent) and this thinking led to the current blog post.

Persistence in the backdrop of staying hopeful:  I truly admire and enjoy reading works by Dr. Brené Brown. Her insight, research/writing and her thoughtful commentary on many different topics are truly remarkable.  She has studied hope and when you have Parkinson’s hope is a very important word to embrace.  One of her stories on hope, mixed with persistence, deals with the work of C. R. Snyder, at the University of Kansas, Lawrence.  Embracing and expanding upon this work, “hope is a thought process; hope happens when (1) We have the ability to set realistic goals (I know where I want to go); (2) We are able to figure out how to achieve those goals, including the ability to stay flexible and develop alternative routes (I know how to get there, I’m persistent, and I can tolerate disappointment and try again); and (3) We believe in ourselves (I can do this!).” To read in-depth this presentation entitled “Learning to Hope–Brené Brown”, click here. And again the word ‘persistent’ stood out while reading this document.

Persistence and Parkinson’s:Persistence (per·sist·ence /pərˈsistəns/ noun) is defined as (1) firm or obstinate continuance in a course of action in spite of difficulty or opposition, and (2) the continued or prolonged existence of something.  If you’re going to thrive in the presence of Parkinson’s, you will definitely need persistence because you will be locked in a lifelong battle to resist its presence every minute of every day.  Besides being hopeful and positive, having persistence will help enable your daily journey with Parkinson’s.  In other words, persistence is not giving up without trying,  searching out and exploring new pathways for your life, and it certainly demands steadfast determination.

64* Quotes on Persistence to Help You Stay Positive and Hopeful, and to Keep You Exercising: (*Why 64? Because I’m 64 years old) I started with >100 quotes and ended up with this list; they are arranged alphabetically by the author’s first name. [This is the third time I’ve written about persistence in the presence of Parkinson’s; to read the first blog post “Persistence and Parkinson’s” click here, and to read the most recent blog post “Chapter 7: A Parkinson’s Reading Companion on Persistenceclick here.]  May these quotes about persistence bolster your daily dealing with this dastardly disorder named Parkinson’s.

  1. “I do the very best I know how, the very best I can and I mean to keep doing so until the end.” Abraham Lincoln
  2. “It’s not that I’m so smart, it’s just that I stay with problems longer.” Albert Einstein
  3. “The best view comes after the hardest climb.” Anonymous/Unknown
  4.  “Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide n.ot to surrender, that is strength.” Arnold Schwarzenegger
  5. “We are what we repeatedly do. Excellence, then, is not an act, but a habit.” Aristotle
  6. “Things turn out best for the people who make the best out of the way things turn out.” Art Linkletter
  7. “Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.” Atul Gawande
  8. “You just can’t beat the person who never gives up.” Babe Ruth
  9. “History has demonstrated that the most notable winners usually encountered heartbreaking obstacles before they triumphed. They won because they refused to become discouraged by their defeat.” C. Forbes
  10. “As long as there’s breath in You–Persist!” Bernard Kelvin Clive
  11. “No great achievement is possible without persistent work.” Bertrand Russell
  12. “My greatest point is my persistence. I never give up in a match. However down I am, I fight until the last ball. My list of matches shows that I have turned a great many so-called irretrievable defeats into victories.” Bjorn Borg
  13. “In the confrontation between the stream and the rock, the stream always wins – not through strength, but through persistence.” Buddha
  14. “Nothing in the world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent.” Calvin Coolidge
  15. “Success is the result of perfection, hard work, learning from failure, loyalty, and persistence.” Colin Powell
  16. “It does not matter how slowly you go as long as you do not stop.” Confucius
  17.  “Don’t let the fear of the time it will take to accomplish something stand in the way of your doing it. The time will pass anyway; we might just as well put that passing time to the best possible use.” Earl Nightingale
  18. “A little more persistence, a little more effort, and what seemed hopeless failure may turn to glorious success.”Elbert Hubbard
  19. “If you are doing all you can to the fullest of your ability as well as you can, there is nothing else that is asked of a soul.” Gary Zukav
  20. ”Morale is the state of mind. It is steadfastness and courage and hope. It is confidence and zeal and loyalty. It is elan, esprit de corps and determination.” George C. Marshall
  21. “You go on. You set one foot in front of the other, and if a thin voice cries out, somewhere behind you, you pretend not to hear, and keep going.” Geraldine Brooks
  22. “Knowing trees, I understand the meaning of patience. Knowing grass, I can appreciate persistence.” Hal Borland
  23. “Perseverance is a great element of success. If you only knock long enough and loud enough at the gate, you are sure to wake up somebody.” Henry Wadsworth Longfellow
  24. “The difference between perseverance and obstinacy is, that one often comes from a strong will, and the other from a strong won’t.” Henry Ward Beecher
  25. “When you have a great and difficult task, something perhaps almost impossible, if you only work a little at a time, every day a little, suddenly the work will finish itself.” Isak Dinesen
  26. “Look at a stone cutter hammering away at his rock, perhaps a hundred times without as much as a crack showing in it. Yet at the hundred-and-first blow it will split in two, and I know it was not the last blow that did it, but all that had gone before.” Jacob A. Riis
  27. “The most essential factor is persistence–the determination never to allow your energy or enthusiasm to be dampened by the discouragement that must inevitably come.” James Whitcomb Riley
  28. ”We all have dreams. But in order to make dreams come into reality, it takes an awful lot of determination, dedication, self-discipline, and effort.” Jesse Owens
  29. “This is the highest wisdom that I own; freedom and life are earned by those alone who conquer them each day anew.” Johann Wolfgang von Goethe
  30. “Courage and perseverance have a magical talisman, before which difficulties disappear and obstacles vanish into air.” John Quincy Adams
  31. “Perseverance is failing 19 times and succeeding the 20th.” Julie Andrews
  32. “If you wish to be out front, then act as if you were behind.” Lao Tzu
  33. “You aren’t going to find anybody that’s going to be successful without making a sacrifice and without perseverance.“ Lou Holtz
  34. “Let me tell you the secret that has led me to my goal. My strength lies solely in my tenacity.” Louis Pasteur
  35. “Full effort is full victory.” Mahatma Gandhi
  36. “You’re not obligated to win. You’re obligated to keep trying to do the best you can every day.” Marina Wright Edelman
  37. “If you can’t fly, then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do, you have to keep moving forward.” Martin Luther King, Jr.
  38. “Courage doesn’t always roar, sometimes it’s the quiet voice at the end of the day whispering I will try again tomorrow.” Mary Anne Radmacher
  39. “Courage is the most important of all the virtues because without courage, you can’t practice any other virtue consistently.” Maya Angelou
  40. “You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it.” Maya Angelou
  41. “I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.” Michael Jordan
  42. “Give the world the best you have and you may get hurt. Give the world your best anyway.” Mother Theresa
  43. “Patience, persistence, and perspiration make an unbeatable combination for success.” Napoleon Hill
  44. “It always seems impossible until it is done.” Nelson Mandela
  45. “I will persist until I succeed. Always will I take another step. If that is of no avail I will take another, and yet another. In truth, one step at a time is not too difficult. I know that small attempts, repeated, will complete any undertaking.” Og Mandino
  46. “Enter every activity without giving mental recognition to the possibility of defeat. Concentrate on your strengths, instead of your weaknesses… on your powers, instead of your problems.” Paul J. Meyer
  47. “He conquers who endures.” Persius
  48. “Our greatest glory is not in never failing, but in rising up every time we fail.” Ralph Waldo Emerson
  49. “We are human. We are not perfect. We are alive. We try things. We make mistakes. We stumble. We fall. We get hurt. We rise again. We try again. We keep learning. We keep growing. And we are thankful for this priceless opportunity called life.” Ritu Ghatourey
  50.  “Success is the sum of small efforts, repeated day in and day out.” Robert Collier
  51. “The best way out is always through.” Robert Frost
  52. “Your hardest times often lead to the greatest moments of your life. Keep going. Tough situations build strong people in the end.” Roy Bennett
  53. “There are two ways of attaining an important end, force and perseverance; the silent power of the latter grows irresistible with time.” Sophie Swetchine
  54. “To succeed, you must have tremendous perseverance, tremendous will. “I will drink the ocean,” says the persevering soul; “at my will mountains will crumble up.” Have that sort of energy, that sort of will; work hard, and you will reach the goal.” Swami Vivekananda
  55. “Our greatest weakness lies in giving up. The most certain way to succeed is to always try just one more time.” Thomas Edison
  56. “Permanence, perseverance, and persistence in spite of all obstacles, discouragement, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak.” Thomas Carlyle
  57. “With ordinary talent and extraordinary perseverance, all things are attainable.” Thomas Foxwell Buxton
  58. “I’m a great believer in luck, and I find the harder I work, the more I have of it.” Thomas Jefferson
  59. “We are made to persist. That’s how we find out who we are.” Tobias Wolff
  60. “I am not judged by the number of times I fail, but by the number of times I succeed: and the number of times I succeed is in direct proportion to the number of times I fail and keep trying.” Tom Hopkins
  61. “The quality of a person’s life is in direct proportion to their commitment to excellence regardless of their chosen field of endeavor.”  Vince Lombardi
  62. “Most people never run far enough on their first wind to find out they’ve got a second.” William James
  63. “Continuous effort–not strength or intelligence–is the key to unlocking our potential.” Winston Churchill
  64. “If you’re going through hell, keep going. Winston Churchill
Motivation using quotes on persistence and pictures/diagrams/ideas related to Parkinson’s:  I am a very visual person and I also need motivation as the new year begins with winter cold in North Carolina  (yes, we got some snow/freezing rain/ice, and yes Chapel Hill was mostly brought to a standstill; so we move on and hope for an early spring).  Therefore, to help me stay motivated to exercise every day,  and to remind me of all the benefits that exercise provides me against Parkinson’s progression I made the following images.
 Also displayed below are 12 additional quotes mounted on some colorful artful backgrounds.   Hopefully, this will provide you a template to make your own favorite motivational group of persistence quotes.

Please stay focused on taking the best care of you by working well with your family and support team, be honest with your movement disorder Neurologist, get plenty of exercise and try to sleep well.  You hold the key to unlock the plan to manage your Parkinson’s.

“Strength is found in each of us.  For those of us with Parkinson’s, we use our personal strengths of character to bolster our hope, courage, mindfulness/contentment/gratitude, determination, and the will to survive. Stay strong. Stay hopeful. Stay educated. Stay determined. Stay persistent. Stay courageous. Stay positive. Stay wholehearted. Stay mindful. Stay happy. Stay you.”  Frank C. Church

Cover Photo credit: http://www.wallpaperup.com/202084/morning_ice_sunrise_lake_snow_forest_winter_reflection.html

Complementary and Alternative Medicine (CAM) and Over-the-Counter Therapies in Parkinson’s

With Parkinson’s, exercise is better than taking a bottle of pills. If you don’t do anything you’ll just stagnate.” Brian Lambert

“With Parkinson’s you have two choices: You can let it control you, or you can control it. And I’ve chosen to control it.” US Senator Isakson

Introduction: Having one of the numerous neurodegenerative disorders can be disheartening, difficult and life-threatening/ending; however, Parkinson’s remains in the forefront of treatment schemes and therapeutic options.  We may have a slowly evolving disorder, yet I remain firmly entrenched both in striking back to try-to-slow its progression and in remaining hopeful that new advances are on the horizon to throttle-back its progression.  Recently, several people have asked for an update on my strategy for treating Parkinson’s.  My plan consists of (i) traditional Parkinson’s medication,  (ii) supplemented by a complementary and alternative medicine (CAM) approach, and (iii) fueled by exercise. My philosophy is simple because I truly believe there are steps I can follow to remain as healthy as possible, which include having a positive mindset to support this effort, and to accept the axiom of the harder I try the better I’ll be.

“Life is to be lived even if we are not healthy.” David Blatt

Complementary and Alternative Medicine (CAM):The National Institutes of Health defines CAM as follows: “Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard medical care. ‘Complementary medicine’ refers to treatments that are used with standard treatment. ‘Alternative medicine’ refers to treatments that are used instead of standard treatment.”  Here is a nice overview of CAM (click here). The National Center for CAM (click here for NCCAM) gives five categories to broadly describe CAM (see below, and followed by some representative components for each of the 5 categories):

17.12.31.CAM_Summary

(1) Alternative medical systems include treatment by traditional Chinese medicine, Ayurveda and naturopathic medicine;
(2) Mind-body interventions like mindfulness meditation;
(3) Biologically-based therapies include over-the-counter natural products and herbal therapies;
(4) Manipulative and body-based methods describe chiropractic and massage therapies;
(5) Energy therapies include techniques such as Reiki and therapeutic touch.

“My way of dealing with Parkinson’s is to keep myself busy and ensure my mind is always occupied.” David Riley

CAM and Parkinson’s: Published CAM clinical trial studies have yielded only a sliver of positive response to slowing the progression of Parkinson’s, several were halted due to no change compared to the placebo-control group. Regardless of these ‘failed’ studies, many have embraced a CAM-based approach to managing their disorder, including me. Please remember that I’m not a clinician, and I’m not trying to convince you to adopt my strategy.  I am a biochemist trained in Hematology but I do read and ponder a lot, especially about Parkinson’s.  We know a lot about Parkinson’s and we’re learning a lot about the molecular details to how it promotes the disease.  There is not a cure although we have a growing array of drugs for therapeutic intervention.  Without a  cure, we look at the causes of Parkinson’s (see schematic below), we consider various CAM options, and we go from there (see schematic below). If you venture into adding to your portfolio of therapy, it is imperative you consult with your Neurologist/family medicine physician beforehand.  Your combined new knowledge with their experience can team-up to make an informed decision about your herb, over-the-counter compound use and its potential benefit/risk ratio.

17.12.31.PD_Cause.CAM“I discovered that I was part of a Parkinson’s community with similar experiences and similar questions that I’d been dealing with alone.”Michael J. Fox

A strategy for treating Parkinson’s: The treatment plan I follow uses traditional medical therapy, CAM (several mind-body/manual practices and numerous natural products) and the glue that ties it all together is exercise.  Presented here is an overview of my medical therapy and CAM natural products. I only list the exercises I am using, not describe or defend them.  Due to my own personal preference for the length of a blog post, I will return to them later this year and include an update of the mind-body/manual practices that I’m currently using. Please note that these views and opinions expressed here are my own. Content presented here is not meant as medical advice. Definitely consult with your physician before taking any type of supplements.   The schematic below gives a ‘big-picture’ view of my treatment strategy.

18.01.01.Daily_Take. brain.druge.CAM.Exercise

To some, my treatment plan may seem relatively conservative. It has been developed through conversations with my Neurologist and Internist.  This was followed by studying the medical literature on what has worked in Parkinson’s treatment, the list of compounds to consider was defined/refined (actually, my choice of OTC compounds has been trimmed from several years ago).  My CAM drug/vitamin/natural products strategy for treating Parkinson’s goes as follows: a) compounds (reportedly) able to penetrate the blood brain barrier; b) compounds (possibly) able to slow progression of the disorder; c) compounds that either are anti-oxidative or are anti-inflammatory; d) compounds that don’t adversely alter existing dopamine synthesis/activity; e) compounds that support overall body well-being; and f) compounds that support specific brain/nervous system health/nutrition. [Please consult with your physician before taking any type of supplements.] The Table below presents a detailed overview of my strategy for treating Parkinson’s.

18.01.01.DailyTherapy4Note of caution: Most herbs and supplements have not been rigorously studied as safe and effective treatments for PD. The U.S. Food and Drug Administration (FDA) does not strictly regulate herbs and supplements; therefore, there is no guarantee of safety, strength or purity of supplements.

REPLACING DOPAMINE:
On a daily basis, I use a combination of Carbidopa/Levodopa (25 mg/100 mg tablet x 4 daily, every 5 h on an empty stomach if possible, typically 6AM, 11AM, 4PM, 9PM) and a dopamine agonist Requip XL [Ropinirole 6 mg total (3 x 2 mg tablets) x 3 daily, every 6 h, typically 6AM, noon, 6PM).  This treatment strategy and amount combining Carbidopa/Levodopa and Ropinirole has been in place for the past 18 months (NOTE: I stopped using the additional dopamine agonist Neupro transdermal patch Rotigotine). For an overview on Carbidopa/Levodopa, I highly recommend the following 2 papers:
[1.] Ahlskog JE. Cheaper, Simpler, and Better: Tips for Treating Seniors With Parkinson Disease. Mayo Clinic Proceedings. 2011;86(12):1211-6. doi: https://doi.org/10.4065/mcp.2011.0443.
[2.] 1. Espay AJ, Lang AE. Common Myths in the Use of Levodopa in Parkinson Disease: When Clinical Trials Misinform Clinical Practice. JAMA Neurol. 2017. doi: 10.1001/jamaneurol.2017.0348. PubMed PMID: 28459962.

ISRADIPINE:
An FDA-approved calcium-channel blocker (CCB) named Isradipine penetrates the blood brain barrier to block calcium channels and potentially preserve dopamine-making cells. Isradipine may slow the progression of Parkinson’s. The primary use of Isradipine is in hypertension; thus, to treat my pre-hypertension I switched from the diuretic Hydrochlorothiazide to the CCB Isradipine.  A CCB is a more potent drug than a diuretic; importantly, my blood pressure is quite normal now and maybe I’m slowing the progression of my Parkinson’s. Please see this blog post for a review of Isradipine (click here). [Please consult with your physician before taking any type of new medication.

ANTIOXIDANTS/VITAMINS/GENERAL HEALTH:
N-Acetyl-Cysteine (NAC; 600 mg x 3 daily) is a precursor to glutathione, a powerful anti-oxidant. In several studies, NAC has been shown to be neuroprotective in Parkinson’s (click here).  I have recently posted an overview of NAC (click here). Furthermore, the ‘Science of Parkinson’s disease’ has presented their usual outstanding quality in a blog post on NAC in PD (click here);
trans-Resveratrol (200 mg daily) is an antioxidant that crosses the blood-brain barrier, which could reduce both free-radical damage and inflammation in Parkinson’s. If you decide to purchase this compound, the biologically-active form is trans-Resveratrol. The ‘Science of Parkinson’s disease’ has an excellent blog post on Resveratrol in PD (click here);
Grape Seed (100 mg polyphenols, daily) is an antioxidant that crosses the blood-brain barrier, which could reduce both free-radical damage and inflammation in Parkinson’s;
Milk Thistle (Silybum Marianum, 300 mg daily) and its active substance Silymarin protects the liver.  Dr. Jay Lombard in his book, The Brain Wellness Plan, recommends people with PD who take anti-Parkinson’s drugs (metabolized through the liver) to add 300 mg of Silymarin (standardized milk thistle extract) to their daily medication regime.
Melatonin (3 mg 1 hr before sleep) Melatonin is a hormone that promotes sustained sleep. Melatonin is also thought to be neuroprotective (click here);
Probiotic Complex with Acidophilus is a source of ‘friendly’ bacteria to contribute to a healthy GI tract.
Vitamin (daily multiple)
A high-potency multivitamin with minerals to meet requirements of essential nutrients, see label for content [I only take 1 serving instead  of the suggested 2 gummies due to my concern about taking a large amount of Vitamin B6 as described in a recent blog (click here)]:
IMG_2059 copyVitamin D3 (5000 IU 3 times/week) is important for building strong bones. Now we also know that vitamin D3 is almost like ‘brain candy’ because it stimulates hundreds of brain genes, some of which are anti-inflammatory and some support nerve health (click here). Supplementation with vitamin D3 (1200 IU/day) for a year slowed the progression of a certain type of Parkinson’s (click here). Furthermore, augmentation with vitamin D3 was recently shown to slow cognitive issues in Parkinson’s (click here).

NO LONGER TAKE Coenzyme Q10 (CoQ10), Creatine and Vitamin E because they did not delay the progression of Parkinson’s or they were harmful.
NO LONGER TAKE a high potency Vitamin B Complex (see label below) due to my concern that a large excess vitamin B6 could be detrimental to Carbidopa/Levodopa (click here for blog post):
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List of several recent PubMed peer-reviewed CAM reviews (includes a more comprehensive overview of all areas of CAM in treating Parkinson’s):
Bega D, Zadikoff C. Complementary & alternative management of Parkinson’s disease: an evidence-based review of eastern influenced practices. J Mov Disord. 2014;7(2):57-66. doi: 10.14802/jmd.14009. PubMed PMID: 25360229; PMCID: PMC4213533.

Bega D, Gonzalez-Latapi P, Zadikoff C, Simuni T. A Review of the Clinical Evidence for Complementary and Alternative Therapies in Parkinson’s Disease. Current Treatment Options in Neurology. 2014;16(10):314. doi: 10.1007/s11940-014-0314-5.

Ghaffari BD, Kluger B. Mechanisms for alternative treatments in Parkinson’s disease: acupuncture, tai chi, and other treatments. Curr Neurol Neurosci Rep. 2014;14(6):451. doi: 10.1007/s11910-014-0451-y. PubMed PMID: 24760476.

Kim HJ, Jeon B, Chung SJ. Professional ethics in complementary and alternative medicines in management of Parkinson’s disease. J Parkinsons Dis. 2016;6(4):675-83. doi: 10.3233/JPD-160890. PubMed PMID: 27589539; PMCID: PMC5088405.

Kim TH, Cho KH, Jung WS, Lee MS. Herbal medicines for Parkinson’s disease: a systematic review of randomized controlled trials. PLoS One. 2012;7(5):e35695. doi: 10.1371/journal.pone.0035695. PubMed PMID: 22615738; PMCID: PMC3352906.

Wang Y, Xie CL, Wang WW, Lu L, Fu DL, Wang XT, Zheng GQ. Epidemiology of complementary and alternative medicine use in patients with Parkinson’s disease. J Clin Neurosci. 2013;20(8):1062-7. doi: 10.1016/j.jocn.2012.10.022. PubMed PMID: 23815871. 

Today we take control over our Parkinson’s:
Please stay focused on dealing with your disorder.
Please learn as much as you can about Parkinson’s.
Please work with your neurologist to devise your own treatment strategy.
Please stretch and exercise on a daily basis, it will make a difference.
Please be involved in your own disorder; it matters that you are proactive for you.
Please stay positive and focused as you deal with this slowly evolving disease.
Please stay hopeful you can mount a challenge to slow the progression.
Please remain persistent; every morning your battle renews and you must be prepared.

 

In the midst of winter, I found there was, within me, an invincible summer.  And that makes me happy. For it says that no matter how hard the world pushes against me, within me, there’s something stronger – something better, pushing right back.” Albert Camus

Cover photo credit: news.nowmedia.co.za/medialibrary/Article/109153/Wine-grape-crop-6-7-down-in-2016-800×400.jpg