Parkinson's Disease: Ten Tips for Patients

Parkinson's disease is a condition for which available treatments are both wonderful and
inadequate. They're wonderful because they improve the ability of patients to function and
maintain independence. They're inadequate because they don't stop the underlying disease
from worsening over time and they don’t address all the patient's needs. If you have
Parkinson's disease, you need to grab every edge you can. Here are ten tips that your doctor
probably agrees with, but doesn't have time to emphasize at each visit.

The first five points have to do with getting the most benefit from your medication. The next
three have to do with maximizing function. The last two have to do with staying healthy.

1. Put your morning dose of medication and a glass of water on your nightstand.

Many people with Parkinson's disease find that their ability to move around freely is worst in
the morning. This might be because their last dose of medication, taken the previous evening,
is already wearing off. By the time their morning dose has a chance to take effect, they have
already been up and around for a while. The trick here is to plan ahead. Before retiring for the
night, set tomorrow morning's first dose on the nightstand along with a glass of water. In the
morning, take your dose as the first thing you do. Then the medication is already getting into
your system while you're going through your morning routine. You can even set the alarm
clock for an hour before you plan to awaken so you can take the dose and then roll over for
another hour of sleep. By the time you get up for good, the morning dose has already gotten a
head start.

2. Pay attention to whether you take your pills with food.

It's neither wrong nor right to take your pills with food, but there are consequences. In general,
when you take your medication on an empty stomach, more of it is absorbed into your
bloodstream. On the other hand, if your medication makes you queasy, then you can minimize
this by taking it at mealtime.

3. Avoid most anti-nausea medications.

Most anti-nausea medications can worsen the symptoms of Parkinson's disease or interfere
with the benefits of Parkinson medication. Some of the most common anti-nausea drugs, e.g.
metoclopramide (Reglan), promethazine (Phenergan) and prochlorperazine (Compazine)
block the body's chemical dopamine receptors. These are the very receptors that most
Parkinson medications seek to activate. Taking anti-nausea drugs while also taking Parkinson
medications means that you're taking a drug and its antidote at the same time. They cancel
each other out. However, one anti-nausea drug, ondansetron (Zofran), works on a different
chemical receptor and avoids this problem.

4. Be mindful of forgetfulness.

People with Parkinson's disease may already be more prone to forgetfulness because of
either their disease or their age. But certain medications used for Parkinson's disease, e.g.
benztropine (Cogentin) and trihexyphenidyl (Artane), or urinary incontinence, e.g. tolterodine
(Detrol) and oxybutynin (Ditropan), can worsen memory. So if you're having trouble
remembering things, you should tell your doctor. A simple medication adjustment might resolve
the problem.

5. Know the difference between tremors and dyskinesias.

Parkinson's disease often causes tremors, which are rhythmic oscillations of hands or other
parts of the body. However, many Parkinson medications, when dosed high enough, can
produce another kind of excessive, involuntary movements called dyskinesias. These might
involve muscles of the face, neck, trunk, arms or legs, and have the appearance of wiggles
and fidgets rather than of rhythmic oscillations. Distinguishing between these different
movement disorders is important because the presence of one might mean that the dose of
medication should be increased, while the presence of the other might mean that the dose
should be decreased.

6. Swallow your pride and use a walking stick.

As symptoms of Parkinson's disease slowly worsen over the years, imbalance can make
walking less safe and secure. Yet many patients avoid using walking sticks, canes or walkers.
Sometimes they even buy these gait-stabilizing devices, but leave them in the closet, unused. I
hear patients say that they don't like the idea of "giving in" to the disease by using such
devices. I usually reply that wounding one's pride is better than breaking one's hip in a fall.

7. Take advantage of useful gizmos.

When loss of motor skills interferes with getting dressed, eating food or taking a bath, then it's
time to make use of devices designed to make these and other activities of daily living easier.
Objects as low-tech as button-hooks, dressing sticks, fat-handled utensils, large-buttoned
telephones, grab bars and shower chairs can make life simpler and promote independence.

8. Mentally rehearse your next move.

Sometimes getting out of a chair requires multiple attempts. Or, when walking is interrupted by
a "freezing attack," an uncomfortably long period of time is required to get unfrozen and
moving again. In these circumstances, the trick is to mentally rehearse the next move so
thoroughly that you can actually picture yourself accomplishing it. Then, when you actually do
try to move, you're more successful.

9. Maintain body weight.

In patients with advanced Parkinson's disease, the mere act of chewing food can require so
much work and effort that dietary intake plummets. If the patient is overweight to start with, this
might be useful to a point, but continued weight loss can threaten health. In such
circumstances, one should take advantage of food supplements that permit intake of important
nutrients with a minimum of effort. This is a good time to indulge one's love of ice cream and
milk shakes, which are packed with protein and calories, and require a minimum of chewing.
Supplementing one's usual diet with a can or two of pre-packaged products like Ensure or
Sustacal adds missing ingredients that prevent weight loss. Carnation Instant Breakfast
provides many of the same ingredients, but at lower cost.

10. Stay flexible by exercising.

You've heard the expression, "Use it or lose it." As a saying, it's trite and overused, but in
Parkinson's disease it is nonetheless true. By exercising the very movements that Parkinson's
disease affects, one can improve them. The emphasis is on flexibility rather than strength-
building. Although pumping iron can be helpful, too, one should focus on stretching, limbering
and range of motion.

(C) 2006 by Gary Cordingley