The Way of the Tortoise

Earlier this year... I came home from running errands for my parents and stopping for tea with a friend and looked through our little free library by our house. We enjoy seeing neighbors and other passersby stop and pick up books. Often, people leave books, too. This day, there were a number of new children's books, including The Tortoise and the Hare.

I've always loved the story of the tortoise and the hare. I identify with the tortoise. He might be slow, but he's determined and focused on where he is going. Yup. I'm the tortoise. Slow and steady. Someone who is dependable. 

Yup, that's me. 

I brought the book into the house with me and set it on the desk so I could read it to the grandkids. Then I put the kettle on, started fixing some lunch, went out to get the mail, chatted with our neighbor, remembered I needed to give them some eggs, went back in to the kettle, which was whistling loudly and sputtering, took the kettle off the stove and finished making my sandwich. I suddenly realized my neighbor was waiting at the door for her eggs. I dashed off with the eggs and an apology then returned to sit with my tea...and book.

Good old Tortoise kicks Hare's ass and wins the race while Hare is hopping here and there, stopping in the meadow to have coffee with his cousin Rabbit, taking a quick nap or two, and dashing over to the store to buy some lettuce and carrots for dinner. He's so busy, he forgets all about the race and, when he remembers, he's already far behind.

Wait a minute. I sound more like the hare. I don't want to be the hare. I'm the tortoise, right? No? Damn.

This spring... Medication change. It's a good change as it prevents the awful dystonic storms like the one that landed me in the Emergency room a few months ago. It's also hard to get used to. I feel heavy.. and slow, both physically and, to some degree, mentally. I can do one thing at a time. If I try to do more, I fail miserably, but I'm not too motivated to try. I feel as though I am carrying a heavy weight. I keep going all day, slowly. I get things done, slowly. If I want to say something, I have to think about it for a while first. I feel like I'm going crazy.

Um... I am the tortoise? Damn. 

I didn't realize how much I was enjoying being the hare. If it wasn't for the fact this medicine really works well without too many weird effects, I would talk to my doc and go off, but I know what I have to do:  learn the way of the tortoise.

Will the heavy slow effects of these meds lessen in time? Can I learn to be a successful tortoise and be the dependable wife/mom/friend I want to be? 

I've always believed that medications are the biggest challenge we face when we have a chronic disorder. If the odd, non-marketable effects weren't enough, there's the challenge of wondering who the heck we are.  Am I a tortoise or a hare? Am I an extrovert or an introvert? Am I happy and positive or depressed and negative? If I'm a tortoise, am I still me?

And the real question is: What is me, the real me, and what about me is just simply due to the chemical changes in my brain and the medications? 

It's not an easy question when you're at the mercy of medications that affect the brain. At one point, I read on a Parkinson's website about how impulse control disorder is a part of PD for many people. It's not. It's an effect of the drugs. Asking about DBS surgery, I admitted my fear of the surgery is due to the possible effects of personality changes and short term memory loss. I was told I was being unreasonable because short term memory loss and personality changes eventually would happen with Parkinson's anyway.

Huh? Even if this is a valid statement, and I don't believe it is, the concern remains. Why risk hurrying that along?

Methinks we're just prone to identity crises. We have had to give up jobs and change the way we live. Some lose their spouses who can't handle living with someone who has PD. Not all of our friends like to put up with us as our health and our meds change. WE don't always like to put up with ourselves as our health and our meds change. We all struggle with the question of who we are and what can we do that is meaningful. 

This last week, I received part of the answer, sort of, anyway. Regardless of anything else, we are the family our children and grandchildren and my parents can count on.  No matter what, I am still Mom, Grandma, daughter, wife. 

And Tortoise. Can't forget the tortoise. 

Please wait till the ride comes to a complete stop

"Bienvenue! Willkomen! Croeso! Welcome to the new triple loop roller coaster! Please take your seats, make sure the safety belt is fastened properly and the safety bar is secure. Keep hands and feet inside the car at all times and do not attempt to exit until the ride comes to a complete stop. Enjoy the ride, folks!"

I braced myself and already felt a little queasy. It was anticipation, I'm sure, but my tummy wasn't listening to the voice of reason. It was listening to the ride operator... and the ride operator was simply my brain's translation of the far more reasonable voice of my doctor saying, "I wrote you a prescription for a new medication."

My usual response of "How normal do I have to be?" didn't work this time. After several recent experiences with headache, nausea, dyskinesia, and full dystonic storm hitting all at once, I wasn't in a position to argue. Being a wee bit testy, I let her know I wasn't thrilled about adding any new drugs, but I'd be a good patient and do whatever she wanted me to do. Grrr. I didn't have to be happy about it. 

The next morning, I took my regular meds and my new one, got on the roller coaster and hung on tight. Who knew what thrills and chills awaited me? The ride promised at least some relief from dyskinesias, the rolling-won't-stop involuntary movements often associated with having been on levodopa for a number of years, and extend the time when my regular meds were "on".  I already knew the twists and turns on this ride could include purple blotches on my legs and ankles, weight loss, and dizziness. So far, it sounded not unlike a few of my rides on old wooden roller coasters when I was in high school. My husband was on standby in case anything went wrong.

Mostly I wanted to make sure I kept breathing. Like I've said before, my docs know I'm somewhat paranoid about drugs. I'm ultra sensitive to most of them. And when I mean ultra sensitive, I mean like, my docs may seem to take me seriously, but it's only when they see for themselves what can happen, that they suddenly look panicked and proclaim me the most medication sensitive person they've ever seen. 

Yeah. I got it. 

So, back to the ride: husband on standby, bracing myself....

I fell asleep.

All that anticipation. All the nervousness, nailbiting, and worry. I slept for 2 hours. Then I got up, spacey, a little dizzy, and wandered, unfocused, around the house for awhile. Then I fell asleep again. Fortunately, husband on standby had also thought to make a big pot of stew in the crockpot earlier in the week. I didn't have to make dinner. Wasn't hungry, either. After a little stew broth and some bread and butter, I took another nap before going to bed. It hadn't been a very exciting ride.

That was yesterday. I only took two real naps today - and a short cat nap. The rest of the time I've felt scattered and bored silly. Not enough stamina to do anything, but tired of being scattered and tired of sleeping away the day. We'll see how my body adjusts over the next few weeks. My doc says to be patient. I said something else. 

In the meantime, I'm fairly easy on my husband. I sleep a lot and don't eat much. I'm not the best company, but at least I don't scratch up the furniture and I don't shed.

The ride's not over yet.

The Patient's Voice - A PCORI Experience

I wish I could say I did this for purely noble purposes, but I have to admit, part of the draw was being able to travel to Washington D.C. for the in person panel reviews. Now that I'm home, I'm still very glad I went, but for different reasons. To attend and be the voice, the advocate of patients in the decision making process for funding clinical studies is an amazing and humbling experience. 

I found out about PCORI from my niece, Anne Schuster, who received her Master's degree in Health Economics at Johns Hopkins University. She knew I had been on patient panels at the University of Colorado Medical School and School of Pharmacy and she knew I valued the chance to speak on behalf of patients. She suggested I apply.

I was assigned 4 applications to review under 3 different criteria. I did not have to grade the appications on technical merit. There were plenty of scientists to do that bit. The criteria we looked at as patients were: whether the study identified a critical gap in knowledge, whether the study was patient centered, and whether there was adequate patient/stakeholder engagement in every stage of the study proposal.

If it was a challenge for me to read and determine the strengths and weaknesses in each of these areas, I know it was even more of a challenge to write up the proposals. PCORI is unique in insisting upon patient and stakeholder engagement and many scientists are struggling to figure out just what this means. So far, I'm truly impressed with the work the organizations have done in this area. For our part as reviewers, it was helpful to have a mentor to guide us and answer our questions. My mentor, Kayte, was very patient.

After writing up my critiques of each application and submitting them, it was soon time to go to Washington DC for the in person panel review. We started early on Thursday with breakfast and a short training. Then we were welcomed by Dr. Joe Selby, the Executive Director of PCORI, and others. Then came the actual panel reviews. We presented and discussed each application before giving them our individual scores. Everyone had a chance to speak and everyone's voice was respected equally. The discussions were quite lively. 

Dinner was lively the first night, too, as Kayte and company cheerfully welcomed me to sit at their table. I found out what PCORI mentors and staff do when they're not working. Before long, someone mentioned the new tequila diet, which certainly must be a great idea for another study proposal. The conversation went round and round and I laughed till I hurt. At some point, the originator of the tequila idea looked at us seriously, "But no salt and no lemon. This is a clinical study." And we all collapsed laughing again.

After dinner, I went for a walk with a very nice young doctor. Most of the doctors seem young and I felt a bit like a grandma. Oh, right. I am a grandma. We walked around a few blocks and then back to the hotel, where a nice staff person saw me and came over to give me directions to my room... again. Time to rest up for another day of reviews.

If invited, I would do it again. I believe in what they are trying to do.

Interested? There are many ways to get involved. Start here! Let me know. Maybe one day we'll be on a panel together. 

Pray for me? Let me think about it.

I'm not embarrassed by my Parkinson's. I don't want sympathy because of it. I don't generally say much about it, but when an old classmate of mine was taken aback after I told her I was retired, I was suddenly self conscious. Not wanting her to think I had retired because I didn't want to work, I told her it wasn't my choice, I had left teaching after I was diagnosed with Parkinson's disease. 

She looked at me earnestly, put her hand on my arm, and said she was sorry. I was confused at first. Sorry I was retired? Oh. That's right. I have Parkinson's disease. She asked if she could pray for me. 

It was my turn to be taken aback. Not that I have anything against prayer. There is a lot I question about religion and spiritual matters, but holding an individual in warmth, interest, and love is not something I question. Whether or not there is a God listening in and acting on their prayers is secondary.

Regardless, I have not always been comfortable with the Christian idea of prayer. When our daughter did so well in the NICU after being born at 28 weeks gestation, a colleague told me she was sure Emma was doing well because so many people were praying for her. Something in me snapped. And... the little girl who died in the NICU the day before? Did she die because not enough people prayed? I know all the standard Christian responses to this and I still struggle with it.

For now, I have my own request. If anyone wishes to pray on my behalf because I have Parkinson's disease, please do not ask God to cure me. I do not want a miraculous, magical cure. You're welcome to ask God to nudge the researchers in the right direction for a scientific cure. A miraculous, magical cure would only affect me. That's not fair. If there is a cure to be had, it should be for everyone. I'm sort of a spiritual socialist.

I stumbled around before answering my old classmate. Yes, of course she could pray for me. I just wanted her to realize I see my Parkinson's as much as a gift as anything else. There are so many people I wouldn't have met, so many things I would never have been able to do, and so much I wouldn't have learned if it I didn't have Parkinson's. Those of you who read my blog know this already. I hope she will forward a message of gratitude with her prayer.

On the other hand, my husband has become an expert in the Heimlich maneuver. I'm not sure he looks at this as a gift, so... if anyone is listening up there, I could use a little help with the whole chew, swallow, breathe thing. 

(I'd even take the magical miracle cure for this one.)

A Magic Wand?

“As a first step, any ‘cure’ would have to stop the spread of the dysfunction in PD brains, so it would have to arrest progression. Brains do ‘heal’ through making new nerve cells and incorporating them into existing networks, but the healing process is slow. Potential ‘cures’ may include therapies that accelerate the healing processes, although it is likely that the first ‘cures’ would arrest progress and not reverse the disease or make symptoms go away entirely.”

— Dr. Rohit Dhall

I have lost track of the number of ways I've been told my Parkinson's disease could be cured. The stories generally come from well meaning friends or friends of friends about someone they know, or someone a friend of theirs knows who was cured of their Parkinson's disease by taking a certain supplement, or drinking an herbal tea or following a special diet. Often people are offended when I don't jump to try the new sure-cure they've suggested. After all, so-and-so tried it and they've been symptom free ever since!

When we go to our doctors, we tend to expect them to have miracle cures, too. Antibiotics were, and still are, miracle drugs, even as we know more about the downside of overusing them. Sinemet (carbodopa/levadopa) is a miracle drug for Parkinson's which has allowed those of us with PD to function. We've come so far with modern medicine, we've become impatient. We really want a magic wand hey presto throw your crutches down and dance kind of cure.

I would be happy with this first step, described to me by Dr. Rohit Dhall. This is enough for me to know. It's exciting to think there may be a time when PD will not be progressive. Even if it's not in my lifetime and it's not totally cured, halting the progression of the disease would be amazing. Levadopa, after all, was a throw your crutches down and dance kind of cure for the time. When it was first given to Parkinsonian patients in 1961, people who were bedridden were suddenly able to walk and run and even jump. (History of Parkinson's Disease)

Dr. Rohit Dhall is the Director of Clinical Studies and Movement Disorders Specialist at the Parkinson's Institute and Clinical Center in Sunnyvale, California. He recently took 45 minutes of his time, precious time to a busy neurologist, to talk with me on the phone about the issues of Parkinson's Dementia and Parkinson's Psychosis. During our conversation, I asked some questions about a cure. The answer he gave, which I have quoted at the beginning of this article, was reassuring to me.

Perhaps because he wasn't promising a miracle, magical cure, it sounded like it might actually happen some day. 

Learning How to Grow Older

As I watch my parents get older, there are so many things I think about. In fact, there are so many things, I have to keep lists. Most of this is purely practical: the paperwork I need to get done so they can move to their assisted living apartment, what they will need to bring with them, what are all those things they can't take with them and what will be do with them. That's a long enough list to last a few months right there. 

For better or for worse, we can't be only practical when it comes to our parents aging. There's a whole range of emotions and memories, as well. There's also some dirty laundry to deal with, even if it's just in my own mind, and it has to be sorted, cleaned, and hung out on the line to dry. 

It's also made me look at how I want to be as I get older. Do we have a choice?

It's debatable how much of our health is due to our lifestyle choices and how much is due to luck, karma, and good genes. Eating healthy and exercising is good, but then my grandmother ate lots of rich desserts and she lived to be 97.  My choice, my ideal, would be to live a full life and be able to say at the end, as my mother-in-law did, "It's been fun, hasn't it!"

What I've learned this summer is I don't ever want to resent being a year older. I'm not going to buy into the youth obsessed culture. I don't want to pretend I'm still 35. I'm not. I don't want to dye my hair or hesitate when someone asks my age. Why would I? Being 57 is cool! Each time in our life is unique and I'm enjoying my life right now.

Don't tell me I'm 57 years young. We wouldn't tell a child he is 10 years young. I'm getting older, not younger. All of me is getting older. I don't have the physical body of a teenager or young adult and, thankfully, I don't have the mind of a teenager, either. I wouldn't want it. A lot of work goes into learning and developing as an adult, and the work never stops. 

I don't want to fear getting older. I don't even want to fear getting very old. Many people don't make it that far. I'm not afraid of nursing homes. I worked in one. There's also the example of our former neighbor who, at the age of 92, met a lovely old lady in the nursing home where they both lived. They spent their days holding hands and talking to each other. No one else understood what they were saying, but they enjoyed every moment. I'd like that. If the other person was my husband getting very old with me, it would be even cooler.

The only thing that scares me about dementia and Alzheimer's is the possibility of becoming mean to people I care about. Even then, I know it's a phase which sometimes, but not always, accompanies these diseases and inevitably will disappear in the fog of memory loss. The memory loss doesn't worry me nearly as much. The heart often remembers, even if the brain doesn't. At least I believe this is true.

Ah, if I wasn't in the middle of taking care of my elderly parents, I wouldn't be spending time thinking of what it would be like to turn 85 or 90 years old. I've still got a long ways to go and I'm far too busy being 57 and spending time with my favorite 60 year old, 33 year old, 32 year old, 30 year old, 21 year old, 4 year old, 3 year old, and 1 year old.... not to mention my 85 and 90 year old parents.... and all those friends in between... to dwell on.. well, anything at the moment. 

So I'll just leave you with a few good quotes from some amazing women:

“Aging is not lost youth, but a new stage of opportunity and strength.”

— Betty Friedan

“At 20, we worry what others think of us. At 40, we don’t care what they think of us. At 60, we discover they haven’t been thinking of us at all.”

— Ann Landers

“The great thing about getting older is you don’t lose all the other ages you’ve been.”

— Madeleine L'Engle

“I’m a person who gets better with practice. Getting older is awesome because you get more practice.”

— Zooey Deschanel

Dance Walking with Ben Aaron

I was just going to add this as a follow-up to my journal entry, Stepping Out, but figured it deserved a place of its own.  Maybe I can work my plies into a dance walking routine such as this! 

The best news is they've found the dance walk guru.  Look up Ben Aaron on Facebook to see that video. I also shared it on my Facebook page.  Thank you to Ben for giving me permission to post this on my website.

Neither Fish, nor Fowl, nor Good Red Herring - the trials and triumphs of having a unique medical diagnosis

A civilized society is one which tolerates eccentricity to the point of doubtful sanity.
~ Robert Frost 

A funny thing happened when we got back from Chicago. The very next day, fresh from two weeks of relaxing at Ronnie's house*, I had an appointment with my study doc, a neurologist specializing in movement disorders. I'm taking part in one of her clinical studies.

This was a major visit and included a thorough neurological evaluation. I tapped my fingers and toes, made circles in the air, walked up and down the hallway, and answered questions in the cognitive part of the test. I am never thrilled when the cognitve section comes up. They have a habit of asking ridiculous questions. I mean, come on, are we really supposed to be able to count backwards from 100, subtracting 7's? When, in life, will I need this skill? Is it important to be able to look at a list of 10 totally random, unconnected words, and then recite them back without looking at the list?

I've never yet failed the test. You're probably expecting me to say, “until now”, but that's not the case. This time, not only did I not fail the test, I ACED it! There could be several explanations for this. Maybe this was an easier version of the test. Maybe I really am intelligent. Maybe I was just calmer than usual.

It's a funny thing with a lot of these neuro muscular disorders. Stress makes everything go haywire and then the meds don't work and I move like one of the monsters in a B horror movie. This effect is talked about a lot. We all know what stress does to us. What isn't talked about is the opposite. What happens if you have an extended time that is completely calm and non-stressful?

I realize this rarely happens to anyone. Maybe this is why no one mentions it. It happened to me. Ronnie's house, despite being there with our daughter, who was recovering from surgery, was surprisingly non-stressful. There were all those nooks and crannies where we could sit and read or watch a movie; and of course, there were desserts everywhere we looked. I couldn't live this way all the time. I'd be terribly bored and terribly overweight. For a couple of weeks, however, it was nice.

So I rested, relaxed, and came back to ace my neuro exam. This prompted my doctor to question my diagnosis. I'm serious. After being diagnosed for over 5 years, suddenly my doctor says maybe I don't have Parkinson's. Now, don't get me wrong. I wasn't cured suddenly. I was just looking better and performing better than I should; especially in the cognitive region. The old grey matter was functioning admirably. What was my doctor thinking? We talked for awhile and I came home and immediately got onto the internet to research something called “Dopamine Responsive Dystonia”.

The other day, I went back to Kaiser and I discussed my research with my regular neurologist, Dr. Lindsee Hudson.  She is great. We often spend at least half the visit laughing at one thing or another. This time was no exception.

“From what I read,” I informed her, “it seems I either have Early Onset Parkinson's Disease with Dystonia that responds well to Dopamine or Late Onset Dopamine Responsive Dystonia with Parkinsonisms.”

“You got that right,” she replied. She went on to say that they are treated the same way. If, and this is a big if, I wanted to, and had an extra $7,000 to get a DATscan done, we might be able to determine exactly what this is.

Okay, I don't have the money to spend on a DATscan, and I'm not sure I would do it, even if I could. Why? Dr. Hudson understood immediately. She had thought of the same reasons before I even brought them up.

1. There is a large community out there for people with Parkinson's disease (PD) with lots of classes and support. There isn't anything like that for people with Dopamine Responsive Dystonia (DRD).

2. In the PD community, I am considered young. In the DRD community, I'm considered ancient. DRD usually hits in childhood, late teens are considered to be old.

3. I definitely have parkinsonisms. One website maintained that late onset DRD was really a sign of early onset PD. I'm not sure there's enough understood about either disorder to know what is what.

4. Even within the community of people with Dystonia, DRD is rare. According to my doctor, I'd be a community of one.

I'll stick with the diagnosis of Parkinson's, but there's something cool about this. I don't fit easily into any category. Not really. I don't follow the typical pattern of Parkinson's and I'm too old to fit nicely into the DRD group.

I'm unique. My husband didn't bat an eye. He said he'd known this for years. My son just said, “Weird”. I thought he meant the whole situation. Seems he meant me.

I don't know what this means for my future, not really. My doctor is optomistic. She says I must have some sort of unique variation. Maybe something in between the two disorders, who knows? She says, whatever it is, it seems to be a good variation. I'm doing better than I should be doing at this point and I don't seem to be effected cognitively at all. I thanked her for not doing a cognitive test that day. Having rushed to get to the appointment and hitting every single red light on the way, I wasn't exactly in my non-stress mode.

In fact, I was feeling a little more like one of those monsters from the old horror movies.

Uniquely weird.

*Ronald McDonald House... We're on first name basis now.