Moving Forward

Post written by Dr. Serena Hung

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“Life is full of special moments. And the key is to be present when they happen. These are the little victories, that when added up, signify a life well-lived. When you face a challenge like Parkinson’s disease, where so much of your capability is slowly stripped way, it is even more imperative to acknowledge — and to celebrate — these moments.”

- Davis Phinney

I started my new year enjoying some special moments in Costa Rica with my husband, exploring nature and enjoying the sun, the sea and the rain forest. I reminded myself that I don’t have to keep my nose so closely to the grindstone all the time. I want my life to reflect a certain well-roundedness that can’t be achieved by only identifying myself as a neurologist. My goal is to have this “life well-lived” that Davis Phinney speaks of.

I want to encourage all of you to think about what a life well-lived means to you and how are you going to achieve it. For one of my Parkinson’s patients, Gottfried Georgi, 71, a life well-lived means working 40 hours a week as a volunteer at Racine United’s HS Automotive Program. Check out his story at the Racine Journal Times.

Oscar Wile said, “I don’t say we ought to misbehave, but we should look as though we could.” It’s that “twinkle in the eye” spirit that I see in my patient Paula Moore. Her husband, Jim, doesn’t think she’s ever “misbehaved,” but she has that open and honest and inviting look that puts people at ease and makes them want to be with her. Paula attends the Parkinson’s support group at Small Stones on the third Tuesday of each month and she always leaves the meeting with a new friend — or two. At over 80, with a variety of health concerns, Paula could be grumpy and closed off. Instead, she wears bright colors, smiles constantly, asks about people’s children and grandchildren, and encourages, encourages, encourages others to find those small victories of which Davis Phinney speaks.

I am very proud of my patient, Sr. Ann Bisek. She was initially devastated by the diagnosis of Parkinson’s disease. It took her the better part of a year to adjust and to regain her confidence. In the process, she has discovered new things about herself — like she can dance. Sr. Ann attends the Young Onset support group every month. She also attends Moving and Grooving: the Parkinson’s Dance Class and she dances faithfully, every week. Sr. Ann might not agree with Henri Matisse about original sin but she definitely agrees about the joy in dancing!

“Ever since there have been men, man has given ‘himself’ over to too little joy. That alone, my brothers, is our orginal sin ... I should believe only in a god who understands how to dance.”

- Henri Matisse

Post written by Dr. Bradley Hiner

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Last winter I took a spill on some ice, hit my head and ended up with a concussion. I’ve been so much more cautious this year. Falls are common, can be costly and affect quality of life. Here are some facts:*

• On average, one out of three people age 65 and over fall each year
• Older adults who have fallen previously are two to three times more likely to fall again in the following year.
• Falls are an increasing burden to the healthcare system
• Falling increases the risk of nursing home placement
• Post-hospitalization is a high-risk time as most falls happen in the first two weeks after discharge.

Falls can be prevented by addressing ALL of the risk factors associated with falling.*

• Balance problems
• Mobility issues
• Multiple medications
• Low blood pressure
• Sensory deficits
• Home hazard

Let’s look at each of these risks for a moment.

Balance Problems are often part of the multiple symptoms of Parkinson’s disease. Balance can be improved through a course of physical therapy followed by an exercise program that works those muscles needed to keep balanced. Fundamental tai chi or yoga also improves balance.

Mobility Issues are almost always a part of Parkinson’s disease. Again, physical therapy can improve mobility. Follow therapy with one of the Parkinson’s exercise programs — treadmill or dance. At the various least, find somewhere to walk for a sustained period of time safely — the mall in this weather is ideal.

Multiple Medications and multiple diagnoses are quite common as we age. Be sure that each of your doctors is aware of all of your medications. Also request that each of your doctors update the others on your treatment. My patients that see only providers here at Froedtert & The Medical College of Wisconsin are lucky in that each doctor can access the patient's entire file and can easily communicate with each other. Finally, some patients take certain medications “historically,” and may no longer need them. Bring in an up-to-date list of your meds with the dosage and timing or bring in the prescription bottles themselves. And don’t forget your over-the-counter meds and vitamins and supplements.

Low Blood Pressure, more specifically orthostatic hypotension (blood pressure that drops quickly when going from lying to standing or sitting to standing), is a very serious fall risk for people with Parkinson’s. Remember, Parkinson’s can affect the autonomic system. If you suspect orthostatic hypotension, please let your doctor know. He or she will measure your blood pressure both sitting and standing. There are a variety of ways to treat orthostatic hypotension that were addressed in my earlier blog, “Dr. I Feel Dizzy.” 

Sensory Deficits are such things as poor hearing, poor eyesight or even peripheral neuropathies that can affect one’s ability to have adequate feeling in hands or feet. If we can’t see, hear or feel properly, we can miss steps or potholes. Discuss these limitations with your doctor. If your vision, hearing or touch can’t be improved, a physical and/or occupational therapist can help you develop compensatory strategies.

Home Hazards include throw rugs, electrical cords, too much furniture, low lighting, lack of handrails or shower grab bars ... even pets. While I would never give up my fierce, little dachshund, Fritzie, I might put a bell on his collar if I couldn’t hear him coming. I would certainly give away the extra rugs or coffee table if I tended to trip on the rug or bump into the table.

Finally, if you fall, keep these points in mind.

• Stay down until you or a companion can assess the damage. There is no point in trying to hurry back up if something is torn or broken.
  
• There is no reason a spouse or companion should injure him/herself while assisting you. Everyone should remain calm and formulate a plan for how to assist you in rising. Usually bringing a chair into close proximity will allow you to get on your hands and knees and allow you to place your hands on the seat of the chair to move slowing from the kneeling position into the seat of the chair.
  
• Sit for a few minutes before you try to do anything else.
  
• Talk to your physician about having a fall-risk evaluation.
  
• If you live alone, or are alone a good deal of the day or night, consider using a medical alert service.
  
• View Dr. Dorothy Baker’s video demonstration at www.learntofall.com.

*Source: Baker, Dorothy, PhD. RNCS., Research Scientist, Yale University School of Medicine New Haven, Connecticut; Connecticut Collaboration for Fall Prevention.