Tag Archives: Exercise

9 Things to Know About Exercise-induced Neuroplasticity in Human Parkinson’s

“A willing mind makes a hard journey easy.” Philip Massinger

“Lack of activity destroys the good condition of every human being.” Plato

Introduction: Much of my life has been spent exercising. Most of this exercise has been done with sheer delight.  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.  Why?  Animal models (mouse and rat) of Parkinson’s have convincing shown the effect of exercise-induced neuroplasticity.  These animal studies demonstrated neuroprotection and even neurorestoration of Parkinson’s.  But we’re neither mice/rats nor are we an animal model of Parkinson’s disease; thus, this post is an update on exercise-induced neuroplasticity in human Parkinson’s.

“If you don’t do what’s best for your body, you’re the one who comes up on the short end.” Julius Erving

cartoon-brain-exercise

9 Things to Know About Exercise-induced Neuroplasticity in Human Parkinson’s: Neuroplasticity,  neuroprotection and neurorestoration are catchy words that populate a lot of publications, blogs from many of us with Parkinson’s and from professionals who study/work in the field of Parkinson’s.  It is important for you to develop your own opinion about exercise-induced neuroplasticity. My goal in this post is to provide the basic elements, concepts and key reference material to help you with this opinion. Here is a 1-page summary of “9 Things to Know About Exercise-induced Neuroplasticity in Human Parkinson’s” (click here to download page).

9_things_exercise_neuroplasticity_parkinsons

(1) Parkinson’s Disease (PD): Parkinson’s is a neurodegenerative disorder. Parkinson’s usually presents as a movement disorder, which is a slow progressive loss of motor coordination, gait disturbance, slowness of movement, rigidity, and tremor.  Parkinson’s can also include cognitive/psychological impairments. ~170 people/day are diagnosed with Parkinson’s in the USA; the average age of onset is ~60 years-old.

(2) Safety First: The benefit of an exercise routine/program will only work if you have (i) talked about it with your Neurologist and have his/her consent; (ii) you have received advice from a physical therapist/certified personal trainer about which exercises are ‘best’ for you; and (iii) you recognize that PD usually comes with gait and balance issues, and you are ready to begin. Safety first, always stay safe!

(3) Exercise: Exercise is activity requiring physical effort, carried out especially to sustain or improve health and fitness. Exercise is viewed by movement disorders clinicians, physical therapists, and certified personal trainers as a key medicinal ingredient in both treating and enabling patients at all stages of Parkinson’s.

(4) Brain Health: With or without Parkinson’s disease, taking care of your brain is all-important to your overall well-being, life-attitude, and health. For a balanced-healthy brain, strive for: proper nutrition and be cognitively fit; exercise; reduce stress; work and be mentally alert; practice mindfulness/meditation; sleep; and stay positive.

(5) Neuroplasticity: Neuroplasticity describes how neurons in the brain compensate for injury/disease and adjust their actions in response to environmental changes. “Forced-use exercise” of the more affected limb/side can be effective in driving neural network adaptation.  Ultimately, this can lead to improved function of the limb/side.

(6) Synapses are junctions between two nerve cells whereby neurotransmitters diffuse across small gaps to transmit and receive signals.

(7) Circuitry: A key result of neuroplasticity is the re-routing of neuronal pathways of the brain along which electrical and chemical signals travel in the central nervous system (CNS).

(8) Parkinson’s-specific Exercise Programs:
PWR!Moves (click here to learn more)
Rock Steady Boxing (click here to learn more)
LSVT BIG (click here to learn more)
Dance for PD (click here to learn more)
LIM Yoga (click here to learn more)
Tai Chi for PD (click here to learn more)

What types of exercise are best for people with Parkinson’s disease? Here is a nice overview of the benefits of exercise for those of us with Parkinson’s  (click here). Regarding the PD-specific exercise programs,  I am most familiar with PWR!Moves, Rock Steady Boxing and LSVT BIG (I’m certified to teach PWR!Moves, I’m a graduate of LSVT BIG, and I’ve participated in Rock Steady Boxing). A goal for you is to re-read ‘Safety First’ above and begin to decide which type of exercise you’d benefit from and would enjoy the most.

(9) Brain/Behavior Changes: The collective results found increase in corticomotor excitability, increase in brain grey matter volume, increase in serum BDNF levels, and decrease in serum tumor necrosis factor-alpha (TNFα) levels. These results imply that neuroplasticity from exercise may potentially either slow or halt progression of Parkinson’s.

What the terms mean: Corticomotor describes motor functions controlled by the cerebral cortex (people with Parkinson’s show reduced corticomotor excitability). Brain grey matter is a major component of the central nervous system consisting of neuronal cells, myelinated and unmyelinated axons, microglial cells, synapses, and capillaries. BDNF is brain-derived neurotrophic factor, which is a protein involved in brain plasticity and it is important for survival of dopaminergic neurons. Tumor necrosis factor-alpha (TNFα) is an inflammatory cytokine (protein) that is involved in systemic inflammation.  Some studies of exercise-induced neuroplasticity in human Parkinson’s found the above-mentioned changes, which would imply a positive impact of exercise to promote neuroplastic changes.

What can you do with all of the cited articles listed at the end? Compiled below are some comprehensive and outstanding reviews about exercise-induced neuroplasticity in Parkinson’s.  Looking through these papers, you’ll see years of work, but this work has all of the details to everything I’ve described.

“All life is an experiment. The more experiments you make the better.” Ralph Waldo Emerson

What I believe about neuroplasticity and exercise in Parkinson’s: [Please remember I am not a physician; definitely talk with your neurologist before beginning any exercise program.]  I think about exercising each day; I try to do it on a daily basis.  As a scientist, I’m impressed by the rodent Parkinson’s data and how exercise promotes neuroplasticity. The human studies are also believable; sustained aerobic exercise induces neuroplasticity to improve overall brain health. “Forced-use exercise” is an important concept; I try to work my right-side (arm and leg), which are slightly weaker and stiffer from Parkinson’s. Initially, I used my left arm more, now I ‘force’ myself on both sides with the hope my neural network is stabilized or even improving. If you enjoy exercising as I do, I view it as both an event and a reward; ultimately, I believe it can work and improve my response to Parkinson’s. If you don’t enjoy exercising, this may be more of a task and duty; however, the benefits over time can be better health. Exercise is good for you (heart and brain).  Begin slow, make progress, and see if you are living better with your disorder.  Remain hopeful and be both persistent and positive; try to enjoy your exercise.

“I am not afraid of storms for I am learning how to sail my ship.” Louisa May Alcott

Past blog posts: Both exercise itself and the benefit of exercise-induced neuroplasticity have been common themes for this blog, including (click on title to view blog posting):
Believe in Life in the Presence of Parkinson’s;
Déjà Vu and Neuroplasticity in Parkinson’s;
Golf And Parkinson’s: A Game For Life;
The Evolving Portrait of Parkinson’s;
Believe In Big Movements Of LSVT BIG Physical Therapy For Parkinson’s;
Meditation, Yoga, and Exercise in Parkinson’s;
Exercise and Parkinson’s.

“Do not let what you cannot do interfere with what you can do.” John Wooden

References on neuroplasticity and exercise in Parkinson’s:
Farley, B. G. and G. F. Koshland (2005). “Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease.” Exp Brain Res 167(3): 462-467 (click here to view paper).

Fisher, B. E., et al. (2008). “The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease.” Arch Phys Med Rehabil 89(7): 1221-1229 (click here to view paper).

Hirsch, M. A. and B. G. Farley (2009). “Exercise and neuroplasticity in persons living with Parkinson’s disease.” Eur J Phys Rehabil Med 45(2): 215-229 (click here to view paper).

Petzinger, G. M., et al. (2010). “Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson’s disease.” Mov Disord 25 Suppl 1: S141-145 (click here to view paper).

Bassuk, S. S., et al. (2013). “Why Exercise Works Magic.” Scientific American 309(2): 74-79.

Lima, L. O., et al. (2013). “Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson’s disease: a systematic review.” Journal of Physiotherapy 59(1): 7-13 (click here to view paper).

Petzinger, G. M., et al. (2013). “Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease.” Lancet Neurol 12(7): 716-726 (click here to view paper)..

Ebersbach, G., et al. (2015). “Amplitude-oriented exercise in Parkinson’s disease: a randomized study comparing LSVT-BIG and a short training protocol.” J Neural Transm (Vienna) 122(2): 253-256 (click here to view paper).

Petzinger, G. M., et al. (2015). “The Effects of Exercise on Dopamine Neurotransmission in Parkinson’s Disease: Targeting Neuroplasticity to Modulate Basal Ganglia Circuitry.” Brain Plast 1(1): 29-39 (click here to view paper).

Abbruzzese, G., et al. (2016). “Rehabilitation for Parkinson’s disease: Current outlook and future challenges.” Parkinsonism Relat Disord 22 Suppl 1: S60-64 (click here to view paper).

Hirsch, M. A., et al. (2016). “Exercise-induced neuroplasticity in human Parkinson’s disease: What is the evidence telling us?” Parkinsonism & Related Disorders 22, Supplement 1: S78-S81 (click here to view paper)

Tessitore, A., et al. (2016). “Structural connectivity in Parkinson’s disease.” Parkinsonism Relat Disord 22 Suppl 1: S56-59 (click here to view paper).

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” Hippocrates

“Life is complex. Each one of us must make his own path through life. There are no self-help manuals, no formulas, no easy answers. The right road for one is the wrong road for another…The journey of life is not paved in blacktop; it is not brightly lit, and it has no road signs. It is a rocky path through the wilderness.” M. Scott Peck

Cover photo credit: http://paper4pc.com/free-seascape.html#gal_post_55564_free-seascape-wallpaper-1.jpg

Brain exercising cartoon: http://tactustherapy.com/neuroplasticity-stroke-survivors/

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7 Healthy Habits For Your Brain

   “Your brain – every brain – is a work in progress. It is ‘plastic.’ From the day we’re born to the day we die, it continuously revises and remodels, improving or slowly declining, as a function of how we use it.” Michael Merzenich

“The root of all health is in the brain. The trunk of it is in emotion. The branches and leaves are the body. The flower of health blooms when all parts work together.” Kurdish Saying

7 Basic Brain Facts [click here for more facts]: (1) The typical brain is ~2% of your total weight but it uses 20% of your total energy and oxygen intake. (2) >100,000 chemicals reactions/sec occur in your brain. (3) The latest estimate is that our brains contain ~86 billion brain cells. (4) In contrast to the popular belief that we use ~10% of our brains; brain scans show we use most of our brain most of the time. (5) There are as many as 10,000 specific types of neurons in the brain.  (6) Cholesterol is an integral part of every brain cell. Twenty-five percent of the body’s cholesterol resides within the brain. (7) Your brain generates between 12-25 watts of electricity, which is enough to power a low wattage LED light.

7 Healthy Habits for Your Brain: With or without Parkinson’s disease, taking care of your brain is all-important to your overall well-being, life-attitude, and health. These are  straightforward suggestions of healthy habits for your brain; hopefully, this list will serve as a reminder about their importance.  Here is a 1-page summary of the “7 Healthy Habits for Your Brain” (Click here to download file).

7-healthy-habits-for-your-brain


[1] Exercise and neuroplasticity:
  Exercise is almost like a soothing salve for your brain.  Some benefits of exercise include helping your memory and increased flow of oxygen to brain, which energizes the brain.  Exercise is good for both your heart and your brain. Exercise can reduce inflammation in the brain and increase hormones circulating to your brain.  For a brief overview on the benefits of exercise to your brain, click here.

Neuroplasticity is the ability to re-draw, re-wire the connections in your brain. What this means is that neuroplasticity is a concerted attempt of neurons to compensate for brain injury/disease. Neuroplasticity ultimately modifies your brain’s activities in response to changes in these neuronal-environments.

There is much positive evidence in animal models of Parkinson’s regarding exercise-induced neuroplasticity.  The same benefits are now being tested in humans with Parkinson’s and the results are most encouraging. One of the numerous backlogged blog drafts that will be completed in the near-future is a “Review of Exercise and Neuroplasticity in Parkinson’s”.

“Exercise is really for the brain, not the body. It affects mood, vitality, alertness, and feelings of well-being.” John Ratey

“Neuroplasticity research showed that the brain changes its very structure with each different activity it performs, perfecting its circuits so it is better suited to the task at hand.” Naveen Jain

[2] Diet and brain food: Your memory is aided by ‘what’ you eat.  Harvard’s Women Health Watch makes the following suggestion to boost your memory through diet (click here to read entire article): “The Mediterranean diet includes several components that might promote brain health: Fruits, vegetables, whole grains, fish, and olive oil help improve the health of blood vessels, reducing the risk for a memory-damaging stroke; Fish are high in omega-3 fatty acids, which have been linked to lower levels of beta-amyloid proteins in the blood and better vascular health; Moderate alcohol consumption raises levels of healthy high-density lipoprotein (HDL) cholesterol. Alcohol also lowers our cells’ resistance to insulin, allowing it to lower blood sugar more effectively. Insulin resistance has been linked to dementia.”  WebMD summarized the role of diet and brain health in “Eat Smart for a Healthier Brain” (click here to read article).

A large group of women (>13,000 participants) over the age of 70 were studied and the results showed that the women who ate the most vegetables had the greater mental agility (click here to read the article). These results suggest for a healthy brain we should eat colorful fruits and vegetables high in antioxidants; and foods rich in natural vitamin E, vitamin C, B (B6, B12) folic acid and omega-3 fatty acids. Furthermore, we should avoid refined carbohydrates and saturated fats. In small amounts, vitamin D3 is almost like candy for your brain.

“Hunger, prolonged, is temporary madness! The brain is at work without its required food, and the most fantastic notions fill the mind.” Jules Verne

“Everything one reads is nourishment of some sort – good food or junk food – and one assumes it all goes in and has its way with your brain cells.” Lorrie Moore

[3] Mindfulness/meditation: Greater Good (The Science of a Meaningful Life) describes mindfulness as “…maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment. Mindfulness also involves acceptance, meaning that we pay attention to our thoughts and feelings without judging them—without believing, for instance, that there’s a ‘right’ or ‘wrong’ way to think or feel in a given moment.”  I recently described mindfulness as “Mindfulness means you stay within your breath, and focus within yourself, with no remembrance of the past minute and no planning for the future moment.”  Here’s a simple mindfulness experience/moment: simply be aware of the steam leaving your morning cup of coffee/tea, clear your immediate thoughts, then sip, focus and savor this moment.

“The picture we have is that mindfulness practice increases one’s ability to recruit higher order, pre-frontal cortex regions in order to down-regulate lower-order brain activity,” a comment from Dr. Adrienne Taren, a researcher studying mindfulness at the University of Pittsburgh. She also said  “it’s the disconnection of our mind from its ‘stress center’ that seems to give rise to a range of physical as well as mental health benefits.”  (Click here to read this article).  “What Does Mindfulness Meditation Do to Your Brain?” (click here to read more)

“Mindfulness practices enhance the connection between our body, our mind and everything else that is around us.” Nhat Hanh

“Mindfulness is a pause — the space between stimulus and response: that’s where choice lies.” Tara Brach

 [4] Stress reduction: When you are under constant or chronic stress your body makes more of the steroid hormone cortisol (a glucocorticoid), which is produced by the adrenal glands above your kidneys.  Over time, chronic stress can trigger changes in brain structure and function. Excess cortisol production reduces neuronal cells, over-produces myelin protective covering to our nerves, and we make more oligodendrocytes.  How do you reduce chronic stress?  Exercise and mindfulness/meditation are both able to lower cortisol levels.  Easier said then done to making life-style changes to reduce chronic stress; however, doing it will allow the neuroplastic process to begin re-wiring your brain. For an overview of stress and trying to manage/reduce chronic stress, click here.

“Stress is an ignorant state. It believes that everything is an emergency.” Natalie Goldberg

“There is more to life than increasing its speed.” Mahatma Gandhi

[5] Work, keep active mentally:  There are 2 sides to this topic.  First, stay engaged at work and you won’t age as fast as someone disengaged.  What I’m trying to say is simply staying active mentally at work will assist your brain during the ageing process.  Keep your brain stimulated with work, thought, challenges; the effort provides your brain with significant growth.  Your reward will be an active-focused and rejuvenated mind.  Second, by contrast, we’re all working long hours balancing too many tasks, all-the-time; ultimately, we’re trying to multi-task when we really can’t multi-task very well.  In a nice article entitled “The Magic of Doing One Thing at a Time“, Tony Schwartz summarized a key problem: “It’s not just the number of hours we’re working, but also the fact that we spend too many continuous hours juggling too many things at the same time. What we’ve lost, above all, are stopping points, finish lines and boundaries.”  As you balance the 2-sides-of-the-topic, focus your energy on the first-side by performing each individual task/topic; clear your mind, keep your brain engaged, focus hard and then let your brain renew.

“To let the brain work without sufficient material is like racing an engine. It racks itself to pieces.” Arthur Conan Doyle

“A fresh mind keeps the body fresh. Take in the ideas of the day, drain off those of yesterday.” Edward Bulwer-Lytton

 [6] Positive and happy is better for your brain:  I truly believe you need to be positive in dealing with Parkinson’s; trying to focus on staying happy will benefit all-around you and bolster your brain’s health. Using positivity will allow you to creatively handle many obstacles ahead, whether in the absence or presence of Parkinson’s.  Susan Reynolds summarized in “Happy Brain, Happy Life” that being happy: “stimulates the growth of nerve connections; improves cognition by increasing mental productivity; improves your ability to analyze and think; affects your view of surroundings; increases attentiveness; and leads to more happy thoughts.”  On the notion of staying positive, she said: “…thinking positive, happy, hopeful, optimistic, joyful thoughts decreases cortisol and produces serotonin, which creates a sense of well-being. This helps your brain function at peak capacity.”


Positive

“Do the best you can until you know better. Then when you know better, do better.” Maya Angelou

“You have to train your brain to be positive just like you work out your body.” Shawn Achor

[7] Sleep: It’s simple; our brains, our bodies need sleep.  Many of us battle with less than adequate daily sleep habits.  However, it’s really simple; our brains, our bodies need sleep.  Much of our day’s success resides in the quality of sleep the night before.  The science of sleep is complex but much of it revolves around our brain.  We use sleep to renew and de-fragment our brain; and sleep helps strengthen our memory.  For more details on sleep science, please look over “What Happens in the Brain During Sleep?” (click here).  Alice G. Walton very nicely summarized several aspects of the sleep-brain interactions focusing on the following 7 headings: “Sleep helps solidify memory; Toxins, including those associated with Alzheimer’s disease, are cleared during sleep; Sleep is necessary for cognition; Creativity needs sleep; Sleep loss and depression are  intertwined; Physical health and longevity; and Kids need their sleep” [click here for “7 Ways Sleep Affects The Brain (And What Happens If It Doesn’t Get Enough)”].  Finally, the Rand Corp. just released a comprehensive study on sleep and the economic burden being caused by the lack of sleep (click here to read the 100-page report).

Sleep is the golden chain that ties health and our bodies together.Thomas Dekker

A good laugh and a long sleep are the best cures in the doctor’s book.   Irish Proverb

A Personal Reflection on the “7 Healthy Habits for Your Brain”:  My fall semester is physically, mentally, and emotionally draining; and I cherish doing all of these tasks, I really do.  The writing of this blog is a deliberate attempt to remind me what I need to be doing, to re-initiate tomorrow in my daily life.  I could explain each point in detail in what poor-brain-health-habits I’ve developed this semester (but I won’t).  However, I am printing out the 1-page handout of 7-healthy-brain-habits to keep it with me as I spend the rest of December re-establishing effective habits for my brain; and doing a better job of balancing work with life-love-fun.

“Your body, which is bonding millions of molecules every second, depends on transformation. Breathing and digestion harness transformation. Food and air aren’t just shuffled about but, rather, undergo the exact chemical bonding needed to keep you alive. The sugar extracted from an orange travels to the brain and fuels a thought. The emergent property in this case is the newness of the thought; no molecules in the history of the universe ever combined to produce that exact thought.” Deepak Chopra

Cover image: https://img1.etsystatic.com/000/0/6392236/il_fullxfull.267319437.jpg

Mindfulness list: http://www.mindful.org/7-things-mindful-people-do-differently-and-how-to-get-started/

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Believe in Life in the Presence of Parkinson’s

“Life is not only merriment, it is desire and determination.” Kahlil Gibran

“Nothing will work unless you do.” Maya Angelou

Dedication: I recently participated in a Parkinson Wellness Recovery (PWR!) Instructor Workshop in Greenville, SC (July 30-31, 2016); now I am certified in PWR!Moves.  This post is dedicated to the workshop instructor Jennifer Bazan-Wigle; and to my classmates, all of the personal trainers interested in working with Parkinson’s disease patients.  Jennifer was simply a great instructor, with a real understanding of Parkinson’s and a true ability to ‘teach’.  The personal trainers who participated were very dedicated in their effort to master PWR!Moves and their willingness to instruct me during the weekend workshop made for a memorable experience.  And not to forget Steve Miller, a PWR!Moves instructor, who also helped teach; you were the inspiration that led me to apply for this workshop. To everyone certified in PWR!Moves and to those involved in my PWR!Moves workshop, thank you, thank you so very much.

PWR! Logo

“There are no shortcuts to any place worth going.” Beverly Sills

Introduction: Coach Lou Holtz said “Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.”  This got me thinking about ability, motivation and attitude but especially how vital both motivation and attitude are for living successfully with Parkinson’s.

Believe in Life in the Presence of Parkinson’s:
I’m a healthy person that happens to have Parkinson’s; this is what I believe:
I believe daily exercise enhances my life in the presence of Parkinson’s.
I believe people-with-Parkinson’s can become healthier with exercise.
I believe sustained exercise can promote neuroplasticity to re-wire my neural network.
I believe I have the ability to do the repetitions to re-train my brain.
I believe staying positive will help control the course of my Parkinson’s.
I believe having courage will provide mettle in the battle against my disorder.
I believe being persistent allows me to restrain my Parkinson’s.
I believe motivation begins from within, and there can be no backing down to this disease.
I believe if I don’t give up I can slow the progression of my disorder.
I believe if you pity me it feeds the hunger of my Parkinson’s.
I believe if you join my team, you can help me stall this slowly evolving disorder.
I believe attitude is the fuel to sustain the effort to combat Parkinson’s.
I believe in science that new therapies/strategies against Parkinson’s are on the horizon.
I believe exercise with ability, motivation and attitude will work to my advantage each day.
I believe that each new day renews my chance of slowing the beast named Parkinson’s.
My daily mantra is to never give up; I refuse to surrender to Parkinson’s.

“Keep your thoughts positive because your thoughts become your words. Keep your words positive because your words become your behavior. Keep your behavior positive because your behavior becomes your habits. Keep your habits positive because your habits become your values. Keep your values positive because your values become your destiny.” Mahatma Gandhi

Cover photo credit: https://c7.staticflickr.com/9/8615/16157237102_f15e505c19_b.jpg

 

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Parkinson’s Treatment With Dopamine Agonist, Complementary and Alternative Medicine (CAM), and Exercise

“Stop taking identity in illness and start taking identity in wellness” Nina Leavins

“The thought of hope is the seed to healing.” Shilpa Menon

Précis: Several of you have asked for an update on my strategy for treating my  Parkinson’s.  My current plan consists of traditional Parkinson’s medication,  augmented by a complementary and alternative medicine (CAM) approach, and supplemented by exercise.

Is current Parkinson’s therapy similar to the new models of personalized medicine?:  Those of us with Parkinson’s have a  constellation of symptoms that vary from person-to-person.   There is no doubt that people with Parkinson’s have a movement disorder with unifying clinical features. However, expression and rate of progression of the common physical symptoms (rigidity; slowness of movement; postural instability and gait problems; and tremor) differ in each of us. This degree-of-difference in how we express our Parkinson’s is likely a combination of environmental  influences [both internal (physiologic) and external (life-style)] and genetics.

Ask 10 people with Parkinson’s to describe their symptoms and their therapy; I wouldn’t be surprised if you get 10 (slightly) different answers. In someway we are lucky (okay, relieved is likely a better word choice) because we received the diagnosis, we began being treated, and probably we started feeling better.

There is a new (and developing) trend in treating patients using a more personalized approach aimed at preventing disease with individualized treatment once the disease is diagnosed (and includes individual genetic tests). This is called personalized medicine or precision medicine (‡given at the bottom is a fuller definition).   Although there is no specific genetic test for the most common form of Parkinson’s (termed idiopathic or sporadic), I believe our neurologists are already using a form of personalized medicine to manage our individual and varied (but still somewhat similar) symptoms.

“When you got a condition, it’s bad to forget your medicine.”  Frank Miller

“If you suspect that you have Parkinson’s, knowing for certain will be much better than uncertainty.” Glenna Wotton Atwood

My Parkinson’s treatment strategy involves traditional drugs, complementary and alternative medicine (CAM), and  exercise: Compared to others, my treatment plan may seem relatively simple. It has been devised by many conversations with my Neurologist and Internist. Combined with a lot of reading and internet searching of the medical literature on what has worked in Parkinson’s treatment, the CAM list continues to evolve and be refined [e.g., I believe that NAC travels to the brain in a usable form to then boost intracellular  glutathione levels.].  The diagram below  presents an overview of the strategy for treating my Parkinson’s.

16.04.28.Brain.Med.CAM.Exercise

-Dopamine agonists: For the past two years I’ve been taking the dopamine agonist Ropinirole. Recently, we decided to add the Neupro transdermal patch, which is another dopamine agonist (Rotigotine).  By  using the dopamine agonist patch, the thought is to normalize the amount of dopamine agonist in my body throughout the day (i.e., smooth out the peaks and valleys). I have tried to  draw it schematically below.

16.05.02.Normalizing.DA.Levels

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 altering the progression of my Parkinson’s. [Please consult with your physician before taking any type of new medication.]

-Complementary and Alternative Medicine (CAM): “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.”  (http://www.cancer.gov/cancertopics/cam). My CAM strategy for treating Parkinson’s goes as follows: compounds (reportedly) able to penetrate the blood brain barrier; compounds (possibly) able to slow progression of the disorder; compounds that are anti-oxidative and anti-inflammatory; compounds that don’t adversely alter dopamine synthesis/activity; and compounds that support general brain/nervous system health. [Please consult with your physician before taking any type of supplements.]

-Exercise: Exercise improves flexibility, builds muscle mass,  aids sleep, and reduces stress. Exercise is neuroprotective in Parkinson’s (see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136051/ and http://www.neurology.org/content/77/3/288 and http://www.ncbi.nlm.nih.gov/pubmed/21375602 ).  For anyone with Parkinson’s, it is important to stretch and exercise on a very regular basis. Brian Lambert remarked: “With Parkinson’s, exercise is better than taking a bottle of pills. If you don’t do anything you’ll just stagnate.”  My strategy is relatively simple, make time in each day to exercise (it’s that important): stretch every couple of hours (the exercises in LSVT BIG are fantastic); and try to exercise every day for 30-60 minutes (playing/walking 18 holes of golf takes ~4-5 hr). I do a lot of exercises with range of motion sports like golf and boxing on a reflex bag (more tennis this summer).  Most importantly, I do exercises that I really enjoy doing and it brings a lot of enjoyment to the way my body feels. [Please consult with your physician before beginning any new exercise routine.]

 -The Table below summarizes my  approach to managing my Parkinson’s:

16.05.04.DailyTherapy*Footnote to Table: Medical (MED), Experimental (EXP), Complementary and alternative medicine (CAM), Exercise (EXERC).

 -Past References: In previous posts linked here, I have described various aspects of my treatment strategy (click on word/phrase):  first treatment plan; complementary and alternative medicine (CAM); Isradipine; exercise-1; exercise-2; exercise-3; LSVT BIG.

“Exercise is king. Nutrition is queen. Put them together and you’ve got a kingdom.”   Jack LaLanne

“There’s always a moment that separates the past from the future, and that moment is now.” Aniekee Tochukwu

Managing Parkinson’s: While we wait for a cure, we manage our disorder by many methods. While we wait for the potion that slows progression, we exercise and remain hopeful. While we live with a neurodegenerative disorder, we strive to remove the label and we stay positive.
Please stay involved in managing your disorder.
Please work with your Neurologist to develop your own ideal strategy.
Please stretch and exercise, it’ll make a difference.
Please use hope and positivity to remain focused and persistent.
Please use loved ones and support team to help sustain your treatment plan.
What you do in managing your disorder will help you today and for many more future days.

 “We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.” Atul Gawande

‡”Personalized medicine is a medical model that separates patients into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease.” (https://www.google.com/search?q=personalied+medicine&ie=utf-8&oe=utf-8#q=personalized+medicine)

Cover photo credit: http://az616578.vo.msecnd.net/files/2016/03/19/635940149667803087959444186_6359344127228967891155060939_nature-grass-flowers-spring-2780.jpg

Brain image modified from: http://cdn.playbuzz.com/cdn/bb0810a8-aeff-403b-b38a-e1e9fc9f7c81/79502c61-ec41-4802-8e22-92a0ddc0cc20.jpg

 

 

11 Tips And Character Traits For Living Better With Parkinson’s

“In the New Year, may your right hand always be stretched out in friendship but never in want.” Irish Toast

“As long as I am breathing, in my eyes, I am just beginning.” Criss Jami

Happy New Year!

Thanks for all of your support, feedback, responses and suggestions in 2015; they were most appreciated.

2016 begins with something old and something new; advice (and quotes) for living better with Parkinson’s. Listed alphabetically, the topics include: Believe; Courage And Strength; Exercise Is Your Best Friend; Gratitude And Contentment; Hope; Journey On; Mindfulness; Persistence; Sleep,Sleep Some More; Stay You; and Understand Nutritional Needs.  It is presented in the Table below (for a full-page image click here: 11_Tips.Traits_Living_Parkinsons.160101).

11_Tips.Traits_Living_Parkinsons.160101

Best wishes to you; may you have a wonderful, happy, productive, successful, loving, fulfilling, and most healthy 2016.

“Above all, don’t fear difficult moments. The best comes from them.” Rita Levi-Montalcini [Dr. Levi-Montalcini was a neurobiologist. She was awarded the 1986 Nobel Prize in Physiology or Medicine with Dr. Stanley Cohen for the discovery of nerve growth factor.]

6 Personal Strengths for Living Decisively with Parkinson’s

“How are they going to see me — as the colleague as I have always been, or as the patient I always will be? That was the beginning of my transition.” Alice Lazzarini (a Parkinson’s researcher who was diagnosed with Parkinson’s)

Précis: After successfully hitting a golf ball out of a sand trap and onto the putting green, I was recently asked to compare living with Parkinson’s to the obstacles presented by a sand trap on a golf course.

Strength is within each of us: We use various personal strengths to optimize our lives.  However, I believe certain personal strengths can provide a template to help you continue to live a valued life in the presence of Parkinson’s (with or without golf’s sand traps). Some of these personal strengths were beautifully summarized by Barbara Seelig, “The Heart of a Warrior: Persistence in the face of adversity; courage to face the unknown; purposeful intent to live wholeheartedly; courageous exploration of one’s weaknesses and strengths within the context of personal integration and consistent evolution toward personal growth.”  Let me describe some personal strengths of character that are important for living with Parkinson’s and also for hitting golf balls from sand traps.

“We aren’t victims, we are strong, amazing people who just happen to have a crummy disease, and we want a cure to that disease”  Kate Matheson

“It took me seventeen years to get three thousand hits in baseball. It took one afternoon on the golf course.” Hank Aaron

Personal strengths for Parkinson’s and golf’s sand traps:
Getting the diagnosis of Parkinson’s reminded me of the time I was a young boy playing organized football and had the wind knocked out of me. Hearing my Neurologist say the words “you have Parkinson’s Disease” left me gasping for a breath; I wanted to repeat the words to acknowledge my new life challenge but there was no air to form the words.

Since hearing those words, life and living have substantially changed; in reality, the majority of changes have been positive.  Some of these life-changes are centered around mindfulness and wholeheartedness; other changes revolve around Parkinson’s education/outreach.

Simply acknowledging the existence of the disorder mandates a new life inventory and re-organizing your personal priorities. Maintaining comparable quality life-experiences with the ever-present and progressive burden of Parkinson’s takes perseverance, courage, positivity, curiosity, resilience, and hope.

Golf is a wonderful sport for many reasons.  Playing and practicing golf is especially beneficial for someone with Parkinson’s (as described here previously).  Physical activity (most sports) is good for many aspects of this disorder.  Golf begins when you hit the ball off the tee aiming for the green; however simple that sounds there are usually obstacles ahead before reaching the green and putting the ball to finish. Thus, navigating these golf obstacles is similar to adapting to the daily annoyances of Parkinson’s.

There are usually 3 types of golf hazards: rough (the thick grass around/adjacent to the fairway); water (lakes, ponds, creeks) and sand traps. Sand traps exist for you to avoid them. Likewise, sand traps  are designed to capture your golf ball. Thus, occasionally, we find ourselves in a sand trap.   Getting out of the sand trap takes perseverance, positivity, resilience, and hope.

“We may each have our own individual Parkinson’s, but we all share one thing in common. Hope” Michael J. Fox

“If there is one thing I have learned during my years as a professional, it is that the only thing constant about golf is its inconstancy.” Jack Nicklaus

Living decisively with Parkinson’s and managing golf’s sand traps: Living with Parkinson’s is somewhat analogous to the challenges of hitting your golf ball out of the sand trap.  Sometimes you blast the ball out of the sand trap toward the golf green and the hole/flag.  At other times, you sacrifice a stroke to hit the ball laterally just to escape a daunting and deep sand trap.

Likewise, each minute of each hour living with Parkinson’s can present one a changing landscape; moving from physically feeling close to normal to challenges with even the most routine tasks/events (like buckling your car seat belt, getting a credit card out of your wallet, a smile being confused for a frown, a soft statement just not being heard in a noisy room,  etc.).  The goal of living decisively with Parkinson’s is to successfully accomplish all the day-to-day tasks that were once a seamless part of our lives.  Living daily with Parkinson’s is like walking into that sand trap, subtle resistance between feet and sand, with a slightly unsteady balance.

Living with Parkinson’s requires several personal strengths to bolster our daily dealing with its subtle but substantial life-changes:
•Perseverance- you need steadfastness in everything you do to counter the challenges of the disorder;
•Courage- your own strength provides the fulcrum where resistance resides to confront the effects of the disorder;
•Positivity- staying positive provides the fuel that starts each life-day with Parkinson’s;
Curiosity- learn all you can about Parkinson’s and you gain clarity on you, especially as your life moves forward;
•Resilience (with acceptance of your disorder)- you need the capacity to both adapt to and recover from difficulties;  and it starts by accepting your disorder. And please remember, Parkinson’s is neither a weakness nor a failure on your part;
•Hope- we must remain hopeful as it provides the foundation that you with your loved-ones, family, friends, colleagues and healthcare team are making a difference dealing with your Parkinson’s.

Our new journey began the moment we heard the words “you have Parkinson’s Disease”; however, your journey can still be fully lived with your sustained effort. Your core values and personal strengths of character are the framework for your new life’s journey. Live decisively with Parkinson’s:  “Stay strong. Stay hopeful. Stay educated. Stay determined. Stay persistent. Stay courageous. Stay positive. Stay wholehearted. Stay mindful. Stay happy. Stay you.”

“Sometimes the best journeys are those, that start when we do not plan, continue how we do not expect and are taking us places we do not know.” Aisha Mirza

“As you walk down the fairway of life you must smell the roses, for you only get to play one round.”  Ben Hogan

Cover photo credit: https://i.ytimg.com/vi/B9xG7WmQ37g/maxresdefault.jpg

10 Life Lessons

“To live is the rarest thing in the world. Most people exist, that is all.” Oscar Wilde

 “The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.” Eleanor Roosevelt

Life lessons.  Life is a series of lessons we gather from start to finish.   We create our individual lesson-plan as we navigate our journey we call life. We all have lessons, codes and rules we follow for life, relationships, and work; they comprise the inner-lining of our human fabric. We learned the “Golden Rule” early in life; and no doubt, parents/extended family contributed many of our life-lessons/rules as we grew up. Even the popular TV show NCIS has always featured the lead character, Leroy Jethro Gibbs (played by Mark Harmon), living and working his life by rules (both numbered and unnumbered).

Life lessons from a Navy SEAL. It is typical for University commencement speakers to give advice to all of the new graduates, life-lessons to follow. Admiral William McRaven, a Navy SEAL and ninth commander of U.S. Special Operations Command, was the commencement speaker at the University of Texas at Austin in 2014. Admiral McRaven shared the 10 most important life lessons that he took away from the Navy SEAL training program (A special forces unit for the US Navy who train for unconventional warfare on sea, air, and land). His ~20-minute speech was insightful, inspiration, and powerful. Below are my interpretations of his top-10 life lessons, especially as they relate to my journey with Parkinson’s; included here are also direct quotes from Admiral McRaven.

1. Start each day by making your bed.  Every day re-starts your life-story.  Little things add up to big things.  By making your bed each day says that little things still matter. With Parkinson’s, doing the daily tasks is a simple reminder you are still functioning and alive.

Admiral McRaven: “If you can’t do the little things right, you will never do the big things right. And, if by chance you have a miserable day, you will come home to a bed that is made—that you made—and a made bed gives you encouragement that tomorrow will be better.”

2. Have good people around you. Many people tell me they could never be a scientist because they don’t like working alone. That opinion is so far from the truth.  Good science is like a team sport; the better synergy with the research team, the better your advances. Recruiting intelligent people is the first part; however, convincing the best-fit people to join a well-functioning research group is the real success story. Likewise, managing your Parkinson’s works well by assembling a good team with contributions from loved-ones, family, friends, colleagues and your healthcare providers.

Admiral McRaven: “You can’t change the world alone—you will need some help— and to truly get from your starting point to your destination takes friends, colleagues, the good will of strangers and a strong coxswain to guide them.”

3. A big heart and good attitude matter a lot. For most of us, we need to bring a maximal effort to succeed; life is rarely easy.  However, bringing the right attitude focused on the goal makes a difference.  With Parkinson’s, staying positive and hopeful  matters every single second you are breathing.  Otherwise, the shadow underneath this disorder tries to swallow you.

Admiral McRaven: “SEAL training was a great equalizer. Nothing mattered but your will to succeed. Not your color, not your ethnic background, not your education and not your social status.”

4. Life is not fair but keep moving forward. Sometimes life is not fair.  Get over it, you are still here; tomorrow renews your life-contract.  Sure, having Parkinson’s is not fair.  Life would be a lot worse by having Alzheimer’s, ALS, or Huntington’s instead of Parkinson’s. Stay persistent and keep moving forward as long as you are able.

Admiral McRaven: “Sometimes no matter how well you prepare or how well you perform you still end up as a sugar cookie. It’s just the way life is sometimes.”
[“For failing the uniform inspection, the student had to run, fully clothed into the surfzone and then, wet from head to toe, roll around on the beach until every part of your body was covered with sand. The effect was known as a ‘sugar cookie’. You stayed in that uniform the rest of the day—cold, wet and sandy. There were many a student who just couldn’t accept the fact that all their effort was in vain. Those students didn’t understand the purpose of the drill. You were never going to succeed. You were never going to have a perfect uniform.”]

5. Failure is part of life. An innate part of life are our miscues, missteps, and failures.  But you learn and grow from these events.  From failure you can gain knowledge, strength and resilience. Having Parkinson’s is not failure; although doing nothing in response to its sinister grasp is like slipping when walking down a steep and wet rocky path.

Admiral McRaven: “You will fail. You will likely fail often. It will be painful. It will be discouraging. At times it will test you to your very core.”

6. Being creative and resourceful allows you to challenge life’s difficulties. Being both a scientist and a medical educator allows me to take novel and new approaches.  Staying innovative may not always prove successful; but it does gives you the opportunity to confront your life-challenges. I am doing as much as I possibly can to challenge my Parkinson’s.  I read, learn, plan, and initiate actions to do whatever is reasonably possible to resist this disorder.

Admiral McRaven: “If you want to change the world sometimes you have to slide down the obstacle head first.”

7. Don’t back down from the sharks. The biggest shark in my life is named Parkinson’s.  It has black lifeless eyes, leads an unforgiving, relentless and slowly moving existence just like a shark; meeting it upfront and not backing down is my best chance for survival.

Admiral McRaven: “To pass SEAL training there are a series of long swims that must be completed. One—is the night swim.  You are also taught that if a shark begins to circle your position—stand your ground. Do not swim away. Do not act afraid. There are a lot of sharks in the world. If you hope to complete the swim you will have to deal with them.”

8. Be your very best in your toughest times. Life is rarely that easy stroll in the park.  During the most difficult times, you need to be at your best, strongest in character, and you will come through just fine.  You likely are smarter, more creative, and better prepared to resist life’s obstacles then you give yourself credit for. Parkinson’s is one of those tough times; be cognizant of your abilities to accept this disorder and keep living.

Admiral McRaven: “At the darkest moment of the mission—is the time when you must be calm, composed—when all your tactical skills, your physical power and all your inner strength must be brought to bear.”

9. Start singing when you’re up to your neck in mud.  Your approach to life will influence those near you.  Stay positive, focus on hope, and don’t stray too far from your life-course,  Even with Parkinson’s, you and your life still matter a lot, really a lot.

Admiral McRaven: “My training class…was ordered into the mud. The mud consumed each man till there was nothing visible but our heads. The instructors told us we could leave the mud if only five men would quit—just five men and we could get out of the oppressive cold…The chattering teeth and shivering moans of the trainees were so loud it was hard to hear anything and then, one voice began to echo through the night—one voice raised in song…One voice became two and two became three and before long everyone in the class was singing. We knew that if one man could rise above the misery then others could as well.

If I have learned anything in my time traveling the world, it is the power of hope. The power of one person—Washington, Lincoln, King, Mandela and even a young girl from Pakistan—Malala—one person can change the world by giving people hope.”

10. Never quit, never give up.  Life can present itself as an obstacle course.  It’s not the winning time that matters; what matters most is your effort to finish and not to give up. Life’s obstacle course is even more exaggerated and unfair to someone with Parkinson’s. Complete the course regardless of your time.  Life and love are still thriving inside of you; just don’t give up, ever. Stay hopeful because more effective treatment strategies for Parkinson’s are coming.

Admiral McRaven: “In SEAL training there is a bell. A brass bell that hangs in the center of the compound for all the students to see. All you have to do to quit—is ring the bell. Ring the bell and you no longer have to wake up at 5 o’clock. Ring the bell and you no longer have to do the freezing cold swims. Ring the bell and you no longer have to do the runs, the obstacle course, the PT—and you no longer have to endure the hardships of training. Just ring the bell. If you want to change the world don’t ever, ever ring the bell.”

The closing words: Live on, live on. Life with Parkinson’s is a constant nuisance; like having a nagging blister between your ankle/shoe that just won’t heal.  Modern medicine, CAM, exercise, mindfulness and the right attitude can make a difference.  Remain you, stay positive and hopeful.  Live on, please live on.

Admiral McRaven: “Start each day with a task completed. Find someone to help you through life. Respect everyone. Know that life is not fair and that you will fail often, take some risks, step up when the times are toughest, face down the bullies, lift up the downtrodden and never, ever give up—if you do these things, then next generation and the generations that follow will live in a world far better than the one we have today.”

Here is a link to his speech:

“We can never judge the lives of others, because each person knows only their own pain and renunciation. It’s one thing to feel that you are on the right path, but it’s another to think that yours is the only path.” Paulo Coelho

“What lies behind us and what lies before us are tiny matters compared to what lies within us.” Ralph Waldo Emerson

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Other Resources:

http://www.utexas.edu/what-starts-here/preparing-leaders/mcraven

http://www.businessinsider.com/mcraven-best-commencement-speech-university-texas-2015-4

http://workplacepsychology.net/2014/06/10/10-life-lessons-from-basic-seal-training-from-admiral-william-h-mcraven/

http://www.inc.com/bill-murphy-jr/10-things-to-learn-from-this-years-best-graduation-speech.html

http://archive.navytimes.com/article/20140520/NEWS/305200043/Top-Navy-SEAL-s-life-advice-Make-your-bed-

*Cover photo: 52_the-gentle-rays_by_trey-ratcliff_1280x1024.jpg