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Parkinson’s Paradoxes

Monday March 10, 2014

Of the finer miseries of Parkinson’s Disease, perhaps paradox is the finest. Paradox flourishes at every level of PD. Just to start, Parkinson’s Disease robs you of the dexterity you need to handle say, small pills. And you manage PD symptoms  with... little tiny pills! This makes for hours of fun, from getting them out of their tamper-resistant bottles to swallowing them, in a disease, by the way, that interferes with... swallowing! Fiendish! But that is only the beginning.

Experts tell us that to maintain brain health and flexibility, one of the best things we can do is seek out novel situations. Encounters with the unfamiliar build new pathways and resilience into our decaying brains, we’re told. Oh, but avoid stress! Stress will aggravate symptoms and possibly worsen your progression. And what is a big source of stress? Yes. Novel situations.

And how about that word, "progression?" Progress usually carries the connotation that things are getting better. Someone might ask “How’s the sprained ankle doing?”  “Making progress.” you might reassure them. Not with Parkinson’s Disease, where “progression” refers to the process of disease advancing, getting worse.

And how about this? One of the most important defenses the brain has against disease is a sort of firewall called the blood/brain barrier. Unfortunately, it is also the barrier to what would seem the most straightforward way of treating PD, supplying dopamine directly to the brain. Dopamine is blocked because it can't fit through this defense. This is why we take levedopa, which can pass the barrier and then is transmuted by the brain into dopamine.

I have a game I like to play whenever I meet a neurologist. I ask “What is the one thing you wish that patients would do to manage PD that they won’t do?" The answer invariably has been “exercise.” But in a condition that leaves many patients with stiff muscles and a feeling of apathy, the last thing many want to do is move their bodies. Especially when moving may lead to falling. So the best source of therapy, one that is available freely, has little in the way of dangerous side effects, and is cheap as a pair of shorts and a jump rope, is often the last thing a person with Parkinson’s feels like doing.

I could go on, but you get the idea. The question is, what does this mean for those trying to cope with this plethora of paradoxes? Before you answer, consider these three things:

First, each of us has a unique case of Parkinson’s Disease. Second, we all deal with the beast according to our unique nature. Finally, there is much we have to learn about this complex and pitiless disease.

So, what is the way to approach Parkinson’s paradoxes? Humility. Let’s not judge one another too harshly for choices about which is the proper horn of a PD dilemma to impale ourselves on. Until you have festinated for a mile in another man’s moccasins, it’s dicey to second-guess their decisions. And if I seem to not keep time, cut me a bit of slack. Perhaps I march to the beat of a different bummer.

Peter Dunlap-ShohlPeter Dunlap-Shohl
NWPF Blogger

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