The Resilience and the Fragility of Life

The young robin must have flown into our window. When we arrived home after errands, it was lying on its back, perfectly aligned on the arm of our porch swing as though it had just decided to take a nap. Though I knew it was dead, I sat and held it in my hands, marveling at its perfect beauty and almost willing it to open its eyes again. Of course it didn't and I buried it on the far side of our raspberry patch.

I'm tired. Two funerals in one week have left me and my family physically and emotionally exhausted. Being greeted by a dead robin was not among the list of things I could deal with right then. 

Life can seem, at times, to be oh, so fragile. A little bird still learning how to control its flight, hits the glass at just the right place, just the right angle, just the right speed. A young woman's doctor doesn't realize how severe her infection is. A teacher finds out he has cancer. A man with a heart of gold dies of a massive heart attack. 

All life is a gift.

I've cried and yelled and shook my fist at God many times these past weeks. How dare he let a 32-year-old woman die! How dare he strike good men with good hearts in the prime of their lives! (okay, I think retirement age is prime) And why the robin? I like robins. 

"All life is a gift and it owes us nothing. It doesn't owe us longevity. It doesn't owe us good health or wealth or happiness. It is pure gift." 

I don't know the source of this saying. When I heard it the first time, it sounded almost cold - too objective. The more I read it, I began to see the wisdom in these words. We had the gift of our niece, Dani, for 32 years. In our minds, it's not long enough, but we had 32 years of the gift of her life. Our students had the gift of Mike Baker's teaching, humor, and compassion for many years. I can't begin to tell you how many people were touched by the gift of Dean Stefan's humor and warmth and generosity. To the universe, the universal, the supreme Good: Thank you for the gift of these people in our lives.

After experiencing a time when life seems so fragile, it's good to also remember how resilient life can be. My dad will be 94 in September. He didn't do any of the right things to assure longevity - except for having longevity run in his family. Our friend, Carolyn Osborn is, at 72, one of the few remaining survivors from the era of polio and the iron lung. There have been times she almost left us, but somehow, miraculously, she has come back every time. We've raised orphaned puppies from day 5 weighing a few ounces to wriggling piles of love, puppy kisses, and leaping on our laps. Our grandchildren and our gardens are growing as quickly as the weeds.

And the other night I dreamt of a tree growing at the back of our raspberry patch. As it grew, white blossoms appeared. They didn't turn into flowers, but out of each one, there came a tiny, living bird.

And they started to sing.

In Fits and Starts - Getting things done the PD way

I'm waiting for my next dopamine surge. 

We folks with Parkinson's disease know all about dopamine. We know what happens when we don't have enough and we know what happens when we have too much. We also know there isn't any such thing and having it perfectly balanced. So, when we want to get things done, we play the dopamine game, otherwise known as doing things in fits and starts. 

Wake-up! What kind of day is today? Is it the slow motion, not gonna accomplish much today sort of day or is it the ohmygodIfeelgoodtodayandIamgoingtogeteverythingdoneonmytodolist sort of day? Okay, in general we may tend to be more the tortoise or more the hare, but day to day is a different story. How our dopamine system is doing and how it will all work with the medications can result in a roller coaster ride between dopamine surges and dopamine crashes.

This is because a lot of things affect how our dopamine system works. It's not just the medications. If we don't sleep well or if we're under a lot of stress, the meds are not going to work as well and it's not going to be easy to stay motivated. Did something exciting happen? How much caffeine have we consumed? Sometimes we don't know what the heck is causing our dopamine levels to fluctuate more than the prices of gasoline. 

We do know what this means in a practical way. 

A dopamine crash is easier to understand. We know we're going to feel lousy some days. No energy. No motivation. We'd procrastinate if it didn't take too much work. It's the day when we say, "I have Parkinson's. You can cook." 

A dopamine surge is when we expect everyone to stay out of our way, thank you very much, because we're going to Get It Done. It's kind of like an adrenaline rush, but without the racing heartbeat. It's more of a racing brain: "I think I can I think I can I think I have a plan.... I think I can rewire the light in the bathroom and replace the medicine cabinet  - myself - and then build a patio  - today - now". I like projects anyway, but during a dopamine rush, I like BIG projects.

I suppose it would be better for us to pace ourselves. Working for a shorter time everyday would help us to avoid a few of the hills and dives of the roller coaster. If we'd pace ourselves really well, we'd get things done, maybe, and not wear ourselves out to the point where we crash. I think. 

On the other hand, a dopamine surge can be a lot of fun as well as being productive. I haven't gotten the patio done yet, but I'm pleased to say I rewired the light and put up two cabinets and a new towel rack in Emma's bathroom. It took three days, several trips to Habitat Restore, and a mad dash to the Ace Hardware store where, 20 minutes before closing time, a clerk found what I needed and gave me a crash course in what I needed to do. He made sure I remembered everything so I could repeat these instructions to my husband. Sigh. 

That was 5 days ago. I'm glad it's done because I used up all the energy I had stored up. We're having pot pies for dinner. I haven't accomplished much of anything today, but that's okay. I'll save my next project for my next dopamine surge.

Olly Olly Oxen Free! Is there a Movement Disorders Clinic hiding near me?

They're hiding out there somewhere. As long as you know what you're looking for, some may even be in plain sight. For many patients with Parkinson's, the rare neurologists who truly understand Parkinson's and even rarer Movement Disorder Clinics will continue to elude them. 

We're lucky here. We have a number of sanctuaries where these doctors can remain safe and continue adding to their knowledge. They are rarely seen in the wild, or even outside their sanctuaries, not because they can't handle the freedom, but because they are kept too busy to be much more than captives in their offices. 

Because they are so rare, many people will drive hundreds of miles just to see one. Other people will never have a chance and so they take their chances on being seen and treated by doctors who are general neurologists or family practitioners. It's not always a bad thing. There are some less specialized doctors who either understand Parkinson's or are willing to get the information they need from one of the sanctuaries. 

There are also the other stories - a patient who is told they don't qualify for DBS surgery because they aren't bedridden yet; a doctor who prescribes a large dose of Sinemet in an odd combination (10mg carbidopa/250 mg levadopa) to a new patient who then goes through agonizing nausea and vomiting from their medication dose; a doctor who tells a new patient that if this dose doesn't work, double it. Some doctors think they know enough, but don't. My father's general practitioner gave him the diagnosis of Parkinson's disease, then refused to refer him to a neurologist. My first neurologist told me my symptoms were just like Parkinson's, but that's not what it was. He didn't refer me to the Movement Disorder docs even though they were just down the hall. 

Treating Parkinson's disease, finding the right combination of medicines and other therapies, is an art. I consider my neurologist to be a master artist as well as an amazing doctor when it comes to how she handles my treatment plan. I know I'm privileged.

There are many reasons patients may not be able to see a Parkinson's specialist. Some patients don't have adequate insurance to pay for a specialist. They might live where there are no Movement Disorder Sanctuaries.. I mean Clinics. They might have one close by, but it is so busy, their visit must be scheduled months in advance. 

Movement Disorder Specialists, we need more of you. We think it would be nice for you to have a smaller caseload, fewer patients to keep track of and treat. I'm sure you'd enjoy being in the sunshine now and then. It would be nice to see you out in the wild - as well as in smaller cities and more rural areas.

Some sources say we are facing a shortage of doctors. Others say no, it's not a shortage of doctors, we're just not efficient. We should be using more Nurse Practitioners and Physician's Assistants. A number of sources feel we have too many specialists and not enough general practitioners. Too many specialists? I don't think so. When a specialist has such a high caseload, you have to call at least 4 months in advance to make an appointment, I say there aren't enough. 

When patients live too far away to go to a specialist or, if they go, they drive hours each way, we need to find a better way to serve those people.  Asking in our support group about how far people drive to see their Parkinson's neurologist, the answers ranged anywhere from 20 minutes to 7 hours one way.

We need General Practitioners, too, of course. They need to be the ones who really get to know their patients. As they are seeing patients for all sorts of ailments, they also need to know when to refer them to someone else. How can one person be a specialist in every possible disease and disorder of the human body? It's just not possible. Specialists help with the efficiency of modern medicine. At the very least, we need Nurse Practitioners and Physician's Assistants who can specialize in different areas. 

We don't have the answers yet. Like most people in the US, I'm dreaming of the day when we have health care for everyone, the day when income inequality isn't so completely off balance, the day when college tuition and medical school tuition is not so prohibitive and school loan repayment doesn't threaten to bankrupt average people and become one more reason for the high cost of health care.

Until then, keep your binoculars handy just in case a shy, elusive movement disorder specialist happens to be spotted in your area. 

And here is a handy guide for locating them:

Movement Disorder Specialist Finder    

Wisdom and Strength and Love Shall Grow

Having a sympathetic young police officer NOT give me a speeding ticket is one of the perks of being an elder, but being an elder also means learning how to let go. We have to let go of bits of ourselves, what we used to do, who we used to be. With any progressive neurological disorder, letting go starts a lot sooner.  What happens when we get to the point where there are things we can't do anymore? 

Okay. Stop right here. I know what you're thinking. I've heard it before, many times. Please don't send me the quotes and memes saying, "Stay positive! Don't ever say you can't do something!"  I don't want to see the videos of 99-year-olds riding skateboards, climbing mountains, or running marathons or the videos of 99-year-olds with Parkinson's riding skateboards, climbing mountains, and running marathons. I get the point. If they can do it, so can I.

Right.  

The message in these memes and videos? Running marathons = awesome, walking with a walker = not cool.   Climbing mountains = awesome, needing help to climb stairs = not cool. Riding on a skateboard = awesome, riding a mobility scooter* = not cool. If we must have Parkinson's or if we must get old, be like the awesome ones. I know it's all meant to be inspiring, but too often it's discouraging. Nope. I obviously can't be awesome because, try as I might, I'm not going to climb mountains or run marathons or ride skateboards.

Stop again. Breathe out. All those memes and videos? Hit the delete button.

Now, a reality check. Giving up the awesomeness of climbing mountains, running marathons and skateboarding isn't difficult for me. I don't do those anyway and, if I'm truly honest, I don't want to. It's when I have to give up things I love to do, that's my true test.  

Because of fatigue issues, I've had to give up a few things - working full time or  even part time, volunteering regularly, doing more than one major activity per day and not more than three per week. I've been very lucky. What I've had to give up, I've been able to replace with other activities like naps...and, well, other things... like naps.. and... Okay, instead of felting intricate pictures and figures, I'm knitting little animals for my grandchildren.  I can join my husband on his daily walks if I adapt and use my cool scooter*. I can, occasionally, be in a clinical study and once in awhile, I even get paid for it.

We all respond differently when we are faced with chronic health challenges and the challenge of growing older. Some will choose to not go gentle into that good night, but will, as Dylan Thomas' poem advises, rage, rage against the dying of the light. Some will pretend their challenges don't exist and try to pass as a younger person in perfect health. Some will be convinced their challenges will go away if they are just positive enough. Some will climb mountains and ride skateboards till the day they die. 

I don't want to spend the rest of my life raging or feeling guilty because I'm not climbing mountains.

My mentor is Dr. Paul Zeiger, engineer, scientist, university professor, yoga teacher, poet, and PWP (person with Parkinson's). He says we are given many opportunities to reconfigure our lives according to the resources we have available to us. He knows. He and his wife, Carolyn, have had to do this time after time. Paul says that growing old is the most difficult work a person will ever do. For some of us, a marathon is also known as getting through each day.

There is a verse which is said by the first and second graders at the Waldorf school at the end of each day. It allows the children to put their academic work aside, let it rest.

“All my doing now has ended.
What I have learned shall rest.
When I have done my very best,
wisdom and strength and love shall grow
and I will bless all those I know.”

We tend to identify ourselves by what we do and when we lose the ability to do something, it can be like losing a part of ourselves. We have to reconfigure ourselves and find out what this new.... or older body can still do. If we get stuck trying to hold on to who we were once upon a time, we're not leaving room to discover who we are now. The time for doing some things may have ended, but we can let them rest and trust in what we have learned from our doing.

We have to grieve and maybe even rage a little. But what if we take Paul's advice? What if we could let go of those lost parts of ourselves and let them  go gentle into the good night? If Paul and Carolyn's lives are an example, we know if we can let go and let those things rest, our lives are not empty, but will include wisdom, strength, love, and the capacity to bless those around us.

Skateboarding is optional.

*My mobility scooter IS cool. Some 12 year old boys told me so. It is a TravelScoot, the best little scooter ever. Thank you, Roger, again and again, for blessing me with this gift and the bigger gift of a connection with our family in Luxembourg.

The Privileges of Being An Elder

Last night I drove our daughter to her play rehearsal. We made good time, but as we approached the turn into the parking lot, I glanced in my rear view mirror and saw flashing lights behind us. A police car. With flashing lights. Maybe he needed to get around us? I turned and he turned right behind me. I parked and he pulled up and stopped, blocking my car.

Emma got out, saying "Bye! Good luck!"

Apparently, I had made better time than I'd thought and the nice young policeman seemed to think I could've gone a wee bit slower. He asked to see my ID, registration, and proof of insurance. I resisted the urge to give him my Medicare card. He took the info and disappeared into his patrol car, which was still blocking me from going anywhere. 

Several thoughts went through my mind. Would there, could there be any chance of getting off with just a warning?  Yeah, right. I told myself there was no way in hell I'd be that lucky. You see, I remember very well which friends got warnings and which of us got tickets. The ones who were let off the hook were almost always very attractive females. Never happened to me. I sat, waiting and wondering how I was going to tell my husband about this and how much mileage he'd get out of it. And how were we going to pay the fine? Another fine mess I've gotten myself into, Ollie. 

The policeman (did I tell you he was young?) eventually came back and, miracle of miracles! he gave me a warning! It was a very gentle warning, too. He understood. It was the hill. It was so easy to get going too fast. He said it knowingly as if he was admitting it had happened to him more than once. But, just be careful, he said, because the fine is pretty steep. 

I realized how privileged I was in that moment. Not only am I white, and female (occasionally it's a help), but I don't think he expected to see a grandmother when he pulled me over. All the way home, I basked in the wonder and privilege of being an elder. I didn't even have to be gorgeous. I just had to be grandma. 

And today, I went to the thrift store and got my senior discount, without even asking. Life is good!

Wetting Yourself and Other Fun Things to do with Parkinson's Disease

..or How to have your tea and drink it, too.

I was trying not to panic this morning. I was out with a friend and had a large cup of spicy Chai tea as we sat outside and enjoyed a beautiful spring morning. Then the wind came. It wasn't a nice spring breeze, it was a Wyoming wind that had lost its way, found itself in the middle of Denver, and was pissed off. My knitting went flying off the table and as my friend bravely attempted to return our mugs to the kitchen, I wondered how far it was to Oz and whether the wizard would help us get home.

Soon after we left, a new problem arose. The wind had picked up every bit of pollen, dust, and other allergens it could find. Revenge. I don't know why this particular wind was out for revenge. I mean, really. It was its own fault if it took a wrong turn at Laramie and went South instead of North, but it was and it sandblasted us with the ingredients for a major allergy attack. I started to sneeze.

I started to sneeze and I couldn't stop. Problem number 3 - I spent the rest of the trip in the car trying to hold a pleasant conversation while sneezing every few seconds and praying frantically that I wouldn't pee in my friend's car. 

Any woman who has had babies knows the difficulty in controlling dribbles while sneezing or coughing. Parkinson's just makes it worse, much worse. I talked with my doctor about this a few years ago. She recommended exercises and a small dietary change.

"Are you drinking tea? Tea is a diuretic and it will make the problem worse. Don't drink tea."

Don't drink tea? Tea? I sat with my mouth open, totally baffled. Give up tea? That's like asking me to give up water... or air... or knitting. I have Chai running through my veins. Fortunately, there's another possible way of dealing with this which doesn't require giving up anything. Urinary incontinence pads. Like large menstrual pads, only much more absorbent. Sounds insulting, you say? YOU wouldn't want to admit to wearing these? Hey, if it's that or give up my tea, I'll do it. 

I'm done with being embarrassed about wearing pads. It's better than the embarrassment of soaking my pants, which I did last week when my husband had to do the Heimlich on me one more time. I changed clothes and put "Grandma diapers" on the grocery list. My husband does the shopping as I tend to wear out before making it to the produce section. He's very happy to purchase anything I might need, even if it comes from what some consider to be the embarrassing part of the store. 

Now we find another challenge. Where do you find incontinence pads and how do you tell the difference between those and menstrual pads? They're not labeled! Look at the boxes when you're at the store next time. Okay, some are, but it's in the small print. What you see are words like "overnight protection", "ultimate absorbency", or "thin and light". What you usually don't see are the words "menstrual" or "incontinence". It's not easy for most guys to know which is which and, trust me, menstrual pads aren't enough to cope with a large mug of chai tea and an allergy attack. 

Okay, most women know these by the brand names, but our husbands might not, and of course, there are many men who also have Parkinson's and have problems with incontinence. Hey, companies, could you please label these products properly? I don't want to make it a guessing game for my husband when he goes shopping. "Menstrual" and "Incontinence" are not dirty words.

We're pretty weird in our culture about these things. If it's a normal bodily function, we invent ways of talking around them. I grew up learning to call my menstrual period, "my friend", as in, "my friend came today". Even that was said in a whisper and only to another female. One woman I knew described her period as "an angel of God coming down to say 'not this time, honey'".  We certainly don't want to admit we can't always control our bladders. Even though a lot of people go through this (though most would only admit to little dribbles) wetting ourselves is equated with getting old and senile. Nice words for getting old don't work when you're talking about peeing your pants. Senile, decrepit, doddery, feeble, in one's dotage. 

I made it through the morning without mishap, even though I had run out of incontinence pads and my husband had brought home the wrong ones from the store. Hopefully the wind will die down, too, or at least find its way back to Wyoming, where they're used to that sort of wind. 

I sneezed. I peed. I changed. All in a day's journey with Parkinson's and Dystonia.

Dentist Phobia

My husband recently went to the dentist. He came home with instructions to get an electric toothbrush, a waterpik, special toothpaste, and a gel for dry mouth. He's taking care of his teeth, though he complains about how long the routine takes. "I'll see you in an hour or so," he moans as he closes the door and starts up the toothbrush. 

Now he's telling me I should go in for a dental check-up. 

That's like gently suggesting I make a visit to the local torture chamber. "It'll be fine, honey, just think of the nice back stretch you'll get on the rack." Right. With Parkinson's and Dystonia (or vise versa), there's enough torture without adding to it. 

I do need to go in. I know I do. Dental health is important to our overall health. The other day I took my parents in to see the dentist. They both have dentures. Dad got his before he was 30. I don't exactly have good DNA when it comes to teeth. Seeing my parents struggling now with dentures that don't always fit properly (though that is probably due to using too much dental adhesive) and sores on their gums, I figured it's time for me to think about getting my teeth checked. First, however, I will talk with my neurologist.

There are a few things I know: 

~ I can use an electric toothbrush only if my meds are working well and my dystonia is not acting up. Otherwise I run the risk of forcefully cleaning out one of my nostrils.

~ Some of us are at high risk for choking. While dentists have helpers who suction out the saliva from our mouths, they either can't get it all or they ask you to close your mouth around the suction tube. The latter will set off my dystonia quicker than just about anything. I get tired of having to explain this. They don't always believe me. One dental assistant physically closed my lips around the tube. I feel about suction machines like many dogs feel about vacuum cleaners.

~ Epinephrine, which is in most dental local anesthetics, can interact with our Parkinson's meds. What does this mean? At one visit, the dentist accidentally injected the local anesthesia into a vein. I started to shake uncontrollably. My heart was racing. I started going into a dystonic storm. A reaction like this should have prompted the staff to call 911, but they didn't. They let me shake and twist with a racing heart for what seemed like hours. I'm not sure how long it really was... maybe 20 minutes? It was terrifying.

~ Don't take Ibuprofen before a visit to the dentist. It can make your gums bleed, which then makes it easier for the dentist to inject into a vein. 

~ Don't go to a budget dentist. In all the articles I read about Parkinson's and dentistry, they all agree that our visits should be shorter so our medication doesn't wear off during the visit. It won't happen during the assembly line dental work at a budget clinic. 

Which brings me to another challenge. When people talk about Universal Health Care (Medicare for All, etc), there's never a mention about dentistry. Medicare does not pay for dentistry at all. You have to purchase a separate policy for dental coverage. I have a dental policy which covers basic check-ups and basic cleanings. Nothing else. The local dental college sees patients at about the same cost as the budget clinics. The dental college is on the other side of town, which means up to an hour to drive each way. Both the dental college and the budget dentists require either payment up front each visit or a contract with monthly payments. Dentists take one look inside my mouth and plan their next overseas holiday. There are programs to bring dental health care to children, but no programs for adults.

I know I'm not the only one out there with dentist-phobia, but before I embark on this adventure, I'm going to do some more research and talk to my neurologist. 

The Hare is Back

My kitchen needs rearranging. Currently, the baking supplies can be found in any one of four different cupboards, the pantry down the hall, or on the shelves in the laundry room. Generally, I don't pay much attention to my lack of efficient organizing. It's like when my son learned how to type. He never caught on how to do it the right way, but he was still able to pass the speed test at school. I'm not trying to pass a speed test on baking or even on getting everything ready to bake, but I would have liked to be a wee bit more together when my friend came over to bake with me this morning. 

First of all, the reason she offered to come over and help bake is because I had to use up some of the 3 1/2 gallons of buttermilk in my refrigerator. I didn't want it to go to waste. Why did I have 3 1/2 gallons of buttermilk in my refrigerator? Because I didn't want it to go to waste. The community pantry had about 15 gallons of buttermilk and, at the end, workers told me, "Take it! Take it!" I should be commended for not taking all of it.

What was I talking about? Oh yeah, the kitchen. I'm ready to sit and ponder how I might redo the cupboards. While I ponder, I'll knit. Knitting is cool and it helps  me think. I wonder if I should make a sweater or a poncho for the little kitty I made. A sweater would look nice, but a poncho would be easier. Maybe I'll go look up a few patterns on the computer.

My desk is a mess. I need to reorganize this area, too. Since I watch movies on this computer and knit at the same time, I have my yarn basket under the desk. Brilliant move, methinks. The knitting needles I used on my last project are sticking out of the pencil holder and the pattern I'm working from is.. where? back in the dining room. My other knitting supplies are in my work room, which I have been rearranging and reorganizing. This is why there are boxes filled with odds and ends, piles of books, and dog toys all over the floor.

But I digress....

I should be making dinner. 

Leftovers. I'm cool. Pizza doesn't take long to warm up so I have time to get something else done first.

Distractible? Yeah, but I don't mind. It’s kind of nice for a change. For the last six months, I’d found myself dragging more and more. I thought I’d learned to appreciate the Way of the Tortoise, but the Tortoise wasn’t moving much anymore. I wasn’t ready to learn the Way of the Potted Plant.

The worst of it was, I didn’t care and I knew I didn’t care. I didn’t want to not care. It was depressing. I had gone four whole months without going to coffee with a friend. I hadn’t prepared for the holidays. No baking. No cards. No shopping for gifts. This was not acceptable. I figured it was related to my medication and decided I would definitely bring it up with my neurologist.

Then, right before Christmas, I realized I had run out of the drug which happened to be the one that had introduced me to the Way of the Tortoise. I ordered it, but I knew it would be a week or more before it would arrive. Unintentionally, I took on the experiment of going off this drug for a week. 

This is where I'm supposed to say we're really not supposed to do this and warn you all to not do what I did. It's still good advice. I probably should have called my doctor, but it wouldn't have gotten the meds to me any faster. No lectures, please, or if you must, at least don't shout. My startle reflex is drinking espressos again. I’m a wee bit jumpy. I'm back to the Way of the Hare.

After a week off the drug, I wondered why the heck I was taking it. Granted, I was having a lot more dystonia. I also had a lot of nervous energy, but the upside was I got more sleep - good deep sleep - than I'd had in a long time. I had energy. I didn't care if I was a bit scattered. Dystonia can be painful, but as things go, I’d rather feel pain than not feel anything.

My neurologist agreed with me and said I could and should stay off the drug. She then explained something else. I am now 60 years old. I am no longer a young Parkinson's patient. We have to look at drugs differently now, she said. Because I'm old, I said. My doctor smiled. Older folks' bodies respond differently to medications. Usually, it means there's more of those non-marketable effects we're all so very not fond of. My body tends to respond to drugs in rather weird ways at the best of times.

I'll take that. I'm just happy to have some energy again... even if it means it means more dystonia. It's a matter of what's harder to put up with and, well... how normal do I have to be anyway?