• Is Patient Centered Care a Myth?

    I have written previously about Patient Centered care, health care that establishes a partnership among practitioners and patients, where the patient is respected and has input into his or her care.  Seems like a fairly simple concept but, as you will see in this post from my friend and fellow PwP Alan Zimmerman, patient involvement was not wanted during his recent hospital stay and any attempts to get involved were discouraged by doctors at the hospital and the VA.

    Alan is a member of the Parkinson’s Foundation Patient Advisory Council, advocates with the Public Policy group at the Michael J Fox Foundation, maintains a couple of Facebook group pages on PD, and somehow finds time to serve as president of the local East Tennessee support group, PK Hope is Alive.  His recent four day stay in a local Knoxville hospital prompted this post on the support group website:

    ———————————-

    “I spent four lonely days in a brown L.A. haze” from “Come Monday” by Jimmy Buffett

    In other words, I was in the hospital for four days and three nights.

    There is good news and bad news.  The good news (from some perspectives including mine) is that i am still alive.  The bad news is that PwP seem to be thrown into the “One size fits all” bag.  Oh! Almost forgot.  There is even more good news:  The nurses were fantastic (with one exception).

    As many of you know, I’m fairly knowledgeable about most things Parkinson’s.  That piece of trivia probably worked in my disfavor. 

    Intellectual curiosity?  None noticed from Dr. Wong.  Did he do any extra reading or look at a few PD studies?  Not that I could tell.  I even asked for a neurological consult but was ignored.  Evidently this doctor already knows everything.

    What gives a mere patient the right to come in here and challenge what we do?  

    Learn anything from the patient – no way. The patient could not possibly know anything because they do not have a MD or DO behind their name.  Only those that do are considered worthy.  At least that is the attitude that came across from one doc.

    Don’t ask me about delivery of medications.  Unless of course you are interested in an illustration why PwP dread hospital and time spent in the ER.  Had my particular form of the disease been different, I could easily have found my way to the “crazy ward.”  Why?  Because I would not have received my meds on time and could have suffered a severe reaction.

    Why?   Because medication delivery was so very hap-hazard.  You will get it when you get it.  You are on our schedule now.  We have you captured.  

    “You can check out any time you like, but you can never leave!”  from “Hotel California” by the Eagles.

    And speaking of meds, Dr. Wong gave me three days worth to last me until I could see my primary care physician.  I got lucky (kind of) in that I was able to make an appointment to see Dr. Mistry at the VA.  Whew!  Or so I thought.  Of course, by the time I get the meds through the VA mail order system, I should be well.

    I even copied research on Blood Pressure and Parkinson’s Disease for Dr. Mistry.  I figured it would help her treat me.  Since some PwP have BP that fluctuates significantly (as does mine), one cannot treat it as high or low except when carefully and frequently monitored.  Dr. Mistry refused to even look at the research I provided.  Intellectual curiosity seemed non-existent.

    I also discussed the “Outcomes Project” sponsored by the Parkinson’s Foundation.  With over 10,000 participants, there is a whole lot of data.  I only told her about a portion which includes developing a treatment plan by three physicians discussing the patient.  The primary care physician, a general neurologist and a Movement Disorder Specialist should all talk to each other in ordser to provide for the best patient outcome.  She was quick say that idea is worthless.

    I’m at a loss.  I have no idea where to start nor how to convince.

    ———————————-
     
    I’m at a loss too,  but it doesn’t seem right that you have to fight with hospital staff or your VA doctor for the right to explain your symptoms and why you need to take your medication on time. 
     
    While it seems that being surrounded by medical professionals would mean no worries about getting your medication timely, a recent study found that three out of four people with Parkinson’s do not receive medications on time when staying in the hospital.  As a result of this study, the free Aware in Care kit was developed with a primary goal of be able to inform the hospital staff that some drugs don’t play well with your PD medication and you need your medication on time, every time.
     
    Alan is well versed in PD and he was proactive in trying to get his medications timely and and explaining his symptoms.  He even had a printout about the effect PD medications have on his blood pressure, yet no one was interested.   I don’t know what the answer is but I think we have to be proactive, make sure your medical care team knows that you expect patient centered care in the office and in the hospital.  As for the timely medication problem, lets spread the word- On Time/Every Time!
     
    “It does not matter how slowly you go as long as you do not stop.” – Confucius
     
     
     
  • Welcome 2018 – Another Year of Exercise

    YMCA Pedaling Class Parakinsonscyclingcoach.com

    It’s a new year and time to renew my resolution to continue exercising at least 4 -5 times per week.  As 2017 came to a close a new research study was published that shows high intensity interval training (HIIT) delays Parkinson’s progression.  As Daniel Corcos, one of the lead authors of the study states “If you have Parkinson’s disease and you want to delay the progression of your symptoms, you should exercise three times a week with your heart rate between 80 and 85 percent maximum.  It is that simple.”  If you query Google for High Intensity Exercise and Parkinson’s you will find an abundance of articles about this study, here is the link to one of them from Science Daily

    While the need to exercise for PD patients has been shown in many studies, this was one of the first to be conducted for 6 months instead of 12 weeks.  The participants were divided into three groups, HIIT exercise, moderate exercise and no exercise.  All scored about 20 on a PD scale of 0 – 108 before the study.  When scored after the 6 months The HIIT group showed no change while the moderate group got worse by 1.5 points and the no exercise group worsened by 3 points or about a 15% change.

    Although  the primary exercise used during this study was the treadmill, Kathy, our Parkinson’s cycling instructor immediately figured that we can step up our cycling program to include high intensity intervals and start raising our aerobic fitness level.  So, even though many of us thought we were doing high intensity training already (well at least I did), she started pushing us to reach the 80 – 85% heart rate after Thanksgiving.  Almost every workout has incorporated HIIT and I am already starting to see a change in just 6 weeks.  The first few sessions I found I had to lower the gear to finish the workout.  But each time I felt I was getting stronger and this week I was able to increase instead of decrease the gear and still maintain the required 80 – 90 RPM.  I am happy with that progress and I am noticing a reduction in my symptoms after exercise including not feeling ‘off’ a half hour or so before it’s time to take my medicines on the day of exercise.

    But I wondered what is happening to my aerobic fitness?  Then I discovered that my Fitbit app is keeping track of my cardio fitness! The app determined my heart rate zones and then uses those zones and my resting heart rate to compute a cardio fitness score.  As you can see in this screen shot on the left, Fitbit has determined that, for me,  a heart rate greater than 126 is my peak zone and my cardio zone is 104 – 125.  The peak range is approximately 80% of my maximum heart rate so anything above that would be considered high intensity exercise.

    The app also graphs my heart rate for the entire day so I can tell from that graph how long I was in the peak zone.  The screen shot on the left is for 1/2/18 which includes a cycling class. 

    November 16, 2017
    January 2, 2018

    So I was in the ‘zone’ for 9 minutes during the class which corresponds to intervals where we pushed up to 85 or 90 RPM for short periods.

    And here are screen shots showing my cardio fitness as computed by Fitbit on November 16, 2017 and January 2, 2018. So, in theory, I’ve already improved my Cardio Fitness by a point since we started the HIIT.  But just as important is that fact that either score is considered excellent by Fitbit where the average score for men over 60 is 27.2 – 31.0. 

     

     

     

    Between cycling twice a week, playing tennis 2 -3 times a week and the Dance for PD class I am staying fit, slowing the progression of my Parkinson’s and having fun.  We will revisit my cardiac score in a month or so to see if the trend continues or maybe I’m maxed out!

    So my New Year’s resolution this year is the same as last year, keep exercising and keep fighting PD. By the way, if you are interested in Pedaling for Parkinson’s, check out this video from the Sarasota YMCA website of one of Kathy’s classes and watch us having fun doing intervals!

    “It does not matter how slowly you go as long as you do not stop.” – Confucius
     
  • Sarasota Happenings

    We have been busy with exercise, visitors and events since returning from Knoxville after Thanksgiving. 

    Right after we returned, our friends Pat and Steve from Colorado arrived for a visit which included a trip to Walt Disney World where we met up with our mutual friends Ted, who also has Parkinson’s, and his wife Jan.  We spent two nice days at Epcot and the Magic Kingdom with light crowds so we actually got to ride the 7 Dwarfs Mine Train with only a 25 minute wait!  (That’s all six of us zipping down the hill) And we got a lot of exercise walking around the parks.

    We finished the visit up with our first trip to the Dali museum in St. Petersburg.   It contains the largest collection of his works outside of Spain, all donated by a couple who started collecting his work in 1940’s.  It was interesting to see his painting style change to surrealism as his career progressed.

     

    This week we also attended Cause 4 Fashion, a lunch and fashion show to benefit the Neuro Challenge Foundation for Parkinson’s.  All of the models were either Parkinson’s patients or care persons and our friend Carolina was ‘on the runway’ again this year.  It was a well attended event and for a great cause.  Neuro Challenge sponsors over 30 monthly education and support programs in four Florida counties including our PD in Motion class and all at no charge.

    As always, we try to exercise at least 5 days a week. We attend  the PD in Motion dance class every week and play tennis at least 3 times a week.  I attend Pedaling for Parkinson’s at the YMCA and Mara does her weight training routine twice a week.   Kathy, our pedaling instructor, continues to push our class with new routines which keeps it interesting.  I am amazed at the improvement in my aerobic base since we returned in September.   I continue to see a reduction in symptoms for up to 24 hours after each class.  If you have a class near you I highly recommend adding it to your exercise routine.

    As you have probably noticed, I continue to play around with the format of the new site along with trying to find all of the broken links and missing photos.  This week I also updated the Resources page to reflect the merger of Parkinson’s Disease Foundation (PDF) and the National Parkinson’s Foundation (NPF) in to Parkinson’s Foundation. I  added a new resource website about hallucinations and delusions caused by PD.  The site is called more to parkinson’s  and is sponsored by Acadia Pharmaceuticals.   

    In case I don’t produce another post this year, I will take this opportunity to wish everyone a Happy Holidays!!  We hope 2018 will be a year of Peace, Joy, Good Health and Good will for us all. 

    “It does not matter how slowly you go as long as you do not stop.” – Confucius

     

Sample Post #2

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Gravida dictum fusce ut placerat. Convallis aenean et tortor at. Mauris sit amet massa vitae. A condimentum vitae sapien pellentesque habitant morbi tristique senectus et. Malesuada nunc vel risus commodo viverra maecenas accumsan lacus. Magnis dis parturient montes nascetur ridiculus. Volutpat sed cras ornare arcu dui vivamus arcu felis. Neque sodales ut etiam sit amet nisl purus in. Elit ut aliquam purus sit amet luctus venenatis lectus. At volutpat diam ut venenatis tellus in metus vulputate.

Fermentum et sollicitudin ac orci phasellus egestas tellus. Amet dictum sit amet justo donec enim. Iaculis nunc sed augue lacus viverra vitae. Pharetra pharetra massa massa ultricies mi quis hendrerit dolor magna. Vel fringilla est ullamcorper eget nulla facilisi etiam dignissim diam. Nisi porta lorem mollis aliquam ut porttitor. Vel turpis nunc eget lorem dolor. Lacinia quis vel eros donec ac odio tempor orci dapibus. Mi sit amet mauris commodo quis imperdiet. Porta nibh venenatis cras sed felis. Phasellus faucibus scelerisque eleifend donec pretium vulputate sapien nec sagittis. Volutpat ac tincidunt vitae semper quis lectus nulla.

At tellus at urna condimentum mattis pellentesque. Arcu non sodales neque sodales. Tincidunt ornare massa eget egestas. Ut tortor pretium viverra suspendisse potenti nullam ac tortor vitae. Vestibulum rhoncus est pellentesque elit ullamcorper dignissim. Donec adipiscing tristique risus nec feugiat in. Ut ornare lectus sit amet. Hendrerit dolor magna eget est lorem. Ipsum suspendisse ultrices gravida dictum fusce. Ultricies leo integer malesuada nunc vel risus commodo viverra. Mauris in aliquam sem fringilla. Fermentum odio eu feugiat pretium.

Tellus in metus vulputate eu scelerisque felis imperdiet proin. Eu ultrices vitae auctor eu augue ut lectus. Enim sed faucibus turpis in eu. Hac habitasse platea dictumst quisque sagittis purus. Justo laoreet sit amet cursus. Lobortis mattis aliquam faucibus purus in massa tempor nec feugiat. Mauris pharetra et ultrices neque ornare aenean euismod elementum nisi. Lectus sit amet est placerat. Vulputate enim nulla aliquet porttitor lacus luctus accumsan. Odio pellentesque diam volutpat commodo sed egestas. Sapien eget mi proin sed libero. Ut placerat orci nulla pellentesque. Mi quis hendrerit dolor magna eget est. Nunc scelerisque viverra mauris in aliquam. Sapien faucibus et molestie ac feugiat sed lectus vestibulum mattis. Odio ut enim blandit volutpat maecenas volutpat blandit. Cras sed felis eget velit aliquet sagittis id consectetur purus. Porta nibh venenatis cras sed felis eget velit. Imperdiet proin fermentum leo vel. Tempus egestas sed sed risus pretium quam vulputate dignissim suspendisse.

Lorem ipsum dolor sit amet consectetur adipiscing elit duis tristique. Nunc consequat interdum varius sit amet mattis vulputate enim. Faucibus et molestie ac feugiat sed lectus vestibulum mattis. Massa sed elementum tempus egestas sed sed. Nunc consequat interdum varius sit amet. Neque vitae tempus quam pellentesque nec. Cursus metus aliquam eleifend mi. Eu scelerisque felis imperdiet proin fermentum leo vel orci. Quam elementum pulvinar etiam non quam lacus suspendisse faucibus interdum. Non enim praesent elementum facilisis leo vel fringilla. Nisi vitae suscipit tellus mauris a diam maecenas sed. Lorem sed risus ultricies tristique nulla. Elementum facilisis leo vel fringilla. Ut tortor pretium viverra suspendisse potenti. Diam in arcu cursus euismod quis viverra. Mattis vulputate enim nulla aliquet porttitor. Lorem ipsum dolor sit amet consectetur adipiscing. Libero id faucibus nisl tincidunt eget nullam non. Libero nunc consequat interdum varius.

Sample Post #2

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Gravida dictum fusce ut placerat. Convallis aenean et tortor at. Mauris sit amet massa vitae. A condimentum vitae sapien pellentesque habitant morbi tristique senectus et. Malesuada nunc vel risus commodo viverra maecenas accumsan lacus. Magnis dis parturient montes nascetur ridiculus. Volutpat sed cras ornare arcu dui vivamus arcu felis. Neque sodales ut etiam sit amet nisl purus in. Elit ut aliquam purus sit amet luctus venenatis lectus. At volutpat diam ut venenatis tellus in metus vulputate.

Fermentum et sollicitudin ac orci phasellus egestas tellus. Amet dictum sit amet justo donec enim. Iaculis nunc sed augue lacus viverra vitae. Pharetra pharetra massa massa ultricies mi quis hendrerit dolor magna. Vel fringilla est ullamcorper eget nulla facilisi etiam dignissim diam. Nisi porta lorem mollis aliquam ut porttitor. Vel turpis nunc eget lorem dolor. Lacinia quis vel eros donec ac odio tempor orci dapibus. Mi sit amet mauris commodo quis imperdiet. Porta nibh venenatis cras sed felis. Phasellus faucibus scelerisque eleifend donec pretium vulputate sapien nec sagittis. Volutpat ac tincidunt vitae semper quis lectus nulla.

At tellus at urna condimentum mattis pellentesque. Arcu non sodales neque sodales. Tincidunt ornare massa eget egestas. Ut tortor pretium viverra suspendisse potenti nullam ac tortor vitae. Vestibulum rhoncus est pellentesque elit ullamcorper dignissim. Donec adipiscing tristique risus nec feugiat in. Ut ornare lectus sit amet. Hendrerit dolor magna eget est lorem. Ipsum suspendisse ultrices gravida dictum fusce. Ultricies leo integer malesuada nunc vel risus commodo viverra. Mauris in aliquam sem fringilla. Fermentum odio eu feugiat pretium.

Tellus in metus vulputate eu scelerisque felis imperdiet proin. Eu ultrices vitae auctor eu augue ut lectus. Enim sed faucibus turpis in eu. Hac habitasse platea dictumst quisque sagittis purus. Justo laoreet sit amet cursus. Lobortis mattis aliquam faucibus purus in massa tempor nec feugiat. Mauris pharetra et ultrices neque ornare aenean euismod elementum nisi. Lectus sit amet est placerat. Vulputate enim nulla aliquet porttitor lacus luctus accumsan. Odio pellentesque diam volutpat commodo sed egestas. Sapien eget mi proin sed libero. Ut placerat orci nulla pellentesque. Mi quis hendrerit dolor magna eget est. Nunc scelerisque viverra mauris in aliquam. Sapien faucibus et molestie ac feugiat sed lectus vestibulum mattis. Odio ut enim blandit volutpat maecenas volutpat blandit. Cras sed felis eget velit aliquet sagittis id consectetur purus. Porta nibh venenatis cras sed felis eget velit. Imperdiet proin fermentum leo vel. Tempus egestas sed sed risus pretium quam vulputate dignissim suspendisse.

Lorem ipsum dolor sit amet consectetur adipiscing elit duis tristique. Nunc consequat interdum varius sit amet mattis vulputate enim. Faucibus et molestie ac feugiat sed lectus vestibulum mattis. Massa sed elementum tempus egestas sed sed. Nunc consequat interdum varius sit amet. Neque vitae tempus quam pellentesque nec. Cursus metus aliquam eleifend mi. Eu scelerisque felis imperdiet proin fermentum leo vel orci. Quam elementum pulvinar etiam non quam lacus suspendisse faucibus interdum. Non enim praesent elementum facilisis leo vel fringilla. Nisi vitae suscipit tellus mauris a diam maecenas sed. Lorem sed risus ultricies tristique nulla. Elementum facilisis leo vel fringilla. Ut tortor pretium viverra suspendisse potenti. Diam in arcu cursus euismod quis viverra. Mattis vulputate enim nulla aliquet porttitor. Lorem ipsum dolor sit amet consectetur adipiscing. Libero id faucibus nisl tincidunt eget nullam non. Libero nunc consequat interdum varius.

Year: 2020

  • Sample Post #2

    Sample Post #2

    Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Gravida dictum fusce ut placerat. Convallis aenean et tortor at. Mauris sit amet massa vitae. A condimentum vitae sapien pellentesque habitant morbi tristique senectus et. Malesuada nunc vel risus commodo viverra maecenas accumsan lacus. Magnis dis parturient montes nascetur ridiculus. Volutpat sed cras ornare arcu dui vivamus arcu felis. Neque sodales ut etiam sit amet nisl purus in. Elit ut aliquam purus sit amet luctus venenatis lectus. At volutpat diam ut venenatis tellus in metus vulputate.

    Fermentum et sollicitudin ac orci phasellus egestas tellus. Amet dictum sit amet justo donec enim. Iaculis nunc sed augue lacus viverra vitae. Pharetra pharetra massa massa ultricies mi quis hendrerit dolor magna. Vel fringilla est ullamcorper eget nulla facilisi etiam dignissim diam. Nisi porta lorem mollis aliquam ut porttitor. Vel turpis nunc eget lorem dolor. Lacinia quis vel eros donec ac odio tempor orci dapibus. Mi sit amet mauris commodo quis imperdiet. Porta nibh venenatis cras sed felis. Phasellus faucibus scelerisque eleifend donec pretium vulputate sapien nec sagittis. Volutpat ac tincidunt vitae semper quis lectus nulla.

    At tellus at urna condimentum mattis pellentesque. Arcu non sodales neque sodales. Tincidunt ornare massa eget egestas. Ut tortor pretium viverra suspendisse potenti nullam ac tortor vitae. Vestibulum rhoncus est pellentesque elit ullamcorper dignissim. Donec adipiscing tristique risus nec feugiat in. Ut ornare lectus sit amet. Hendrerit dolor magna eget est lorem. Ipsum suspendisse ultrices gravida dictum fusce. Ultricies leo integer malesuada nunc vel risus commodo viverra. Mauris in aliquam sem fringilla. Fermentum odio eu feugiat pretium.

    Tellus in metus vulputate eu scelerisque felis imperdiet proin. Eu ultrices vitae auctor eu augue ut lectus. Enim sed faucibus turpis in eu. Hac habitasse platea dictumst quisque sagittis purus. Justo laoreet sit amet cursus. Lobortis mattis aliquam faucibus purus in massa tempor nec feugiat. Mauris pharetra et ultrices neque ornare aenean euismod elementum nisi. Lectus sit amet est placerat. Vulputate enim nulla aliquet porttitor lacus luctus accumsan. Odio pellentesque diam volutpat commodo sed egestas. Sapien eget mi proin sed libero. Ut placerat orci nulla pellentesque. Mi quis hendrerit dolor magna eget est. Nunc scelerisque viverra mauris in aliquam. Sapien faucibus et molestie ac feugiat sed lectus vestibulum mattis. Odio ut enim blandit volutpat maecenas volutpat blandit. Cras sed felis eget velit aliquet sagittis id consectetur purus. Porta nibh venenatis cras sed felis eget velit. Imperdiet proin fermentum leo vel. Tempus egestas sed sed risus pretium quam vulputate dignissim suspendisse.

    Lorem ipsum dolor sit amet consectetur adipiscing elit duis tristique. Nunc consequat interdum varius sit amet mattis vulputate enim. Faucibus et molestie ac feugiat sed lectus vestibulum mattis. Massa sed elementum tempus egestas sed sed. Nunc consequat interdum varius sit amet. Neque vitae tempus quam pellentesque nec. Cursus metus aliquam eleifend mi. Eu scelerisque felis imperdiet proin fermentum leo vel orci. Quam elementum pulvinar etiam non quam lacus suspendisse faucibus interdum. Non enim praesent elementum facilisis leo vel fringilla. Nisi vitae suscipit tellus mauris a diam maecenas sed. Lorem sed risus ultricies tristique nulla. Elementum facilisis leo vel fringilla. Ut tortor pretium viverra suspendisse potenti. Diam in arcu cursus euismod quis viverra. Mattis vulputate enim nulla aliquet porttitor. Lorem ipsum dolor sit amet consectetur adipiscing. Libero id faucibus nisl tincidunt eget nullam non. Libero nunc consequat interdum varius.

  • Sample Post #1

    Sample Post #1

    Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Gravida dictum fusce ut placerat. Convallis aenean et tortor at. Mauris sit amet massa vitae. A condimentum vitae sapien pellentesque habitant morbi tristique senectus et. Malesuada nunc vel risus commodo viverra maecenas accumsan lacus. Magnis dis parturient montes nascetur ridiculus. Volutpat sed cras ornare arcu dui vivamus arcu felis. Neque sodales ut etiam sit amet nisl purus in. Elit ut aliquam purus sit amet luctus venenatis lectus. At volutpat diam ut venenatis tellus in metus vulputate.

    Fermentum et sollicitudin ac orci phasellus egestas tellus. Amet dictum sit amet justo donec enim. Iaculis nunc sed augue lacus viverra vitae. Pharetra pharetra massa massa ultricies mi quis hendrerit dolor magna. Vel fringilla est ullamcorper eget nulla facilisi etiam dignissim diam. Nisi porta lorem mollis aliquam ut porttitor. Vel turpis nunc eget lorem dolor. Lacinia quis vel eros donec ac odio tempor orci dapibus. Mi sit amet mauris commodo quis imperdiet. Porta nibh venenatis cras sed felis. Phasellus faucibus scelerisque eleifend donec pretium vulputate sapien nec sagittis. Volutpat ac tincidunt vitae semper quis lectus nulla.

    At tellus at urna condimentum mattis pellentesque. Arcu non sodales neque sodales. Tincidunt ornare massa eget egestas. Ut tortor pretium viverra suspendisse potenti nullam ac tortor vitae. Vestibulum rhoncus est pellentesque elit ullamcorper dignissim. Donec adipiscing tristique risus nec feugiat in. Ut ornare lectus sit amet. Hendrerit dolor magna eget est lorem. Ipsum suspendisse ultrices gravida dictum fusce. Ultricies leo integer malesuada nunc vel risus commodo viverra. Mauris in aliquam sem fringilla. Fermentum odio eu feugiat pretium.

    Tellus in metus vulputate eu scelerisque felis imperdiet proin. Eu ultrices vitae auctor eu augue ut lectus. Enim sed faucibus turpis in eu. Hac habitasse platea dictumst quisque sagittis purus. Justo laoreet sit amet cursus. Lobortis mattis aliquam faucibus purus in massa tempor nec feugiat. Mauris pharetra et ultrices neque ornare aenean euismod elementum nisi. Lectus sit amet est placerat. Vulputate enim nulla aliquet porttitor lacus luctus accumsan. Odio pellentesque diam volutpat commodo sed egestas. Sapien eget mi proin sed libero. Ut placerat orci nulla pellentesque. Mi quis hendrerit dolor magna eget est. Nunc scelerisque viverra mauris in aliquam. Sapien faucibus et molestie ac feugiat sed lectus vestibulum mattis. Odio ut enim blandit volutpat maecenas volutpat blandit. Cras sed felis eget velit aliquet sagittis id consectetur purus. Porta nibh venenatis cras sed felis eget velit. Imperdiet proin fermentum leo vel. Tempus egestas sed sed risus pretium quam vulputate dignissim suspendisse.

    Lorem ipsum dolor sit amet consectetur adipiscing elit duis tristique. Nunc consequat interdum varius sit amet mattis vulputate enim. Faucibus et molestie ac feugiat sed lectus vestibulum mattis. Massa sed elementum tempus egestas sed sed. Nunc consequat interdum varius sit amet. Neque vitae tempus quam pellentesque nec. Cursus metus aliquam eleifend mi. Eu scelerisque felis imperdiet proin fermentum leo vel orci. Quam elementum pulvinar etiam non quam lacus suspendisse faucibus interdum. Non enim praesent elementum facilisis leo vel fringilla. Nisi vitae suscipit tellus mauris a diam maecenas sed. Lorem sed risus ultricies tristique nulla. Elementum facilisis leo vel fringilla. Ut tortor pretium viverra suspendisse potenti. Diam in arcu cursus euismod quis viverra. Mattis vulputate enim nulla aliquet porttitor. Lorem ipsum dolor sit amet consectetur adipiscing. Libero id faucibus nisl tincidunt eget nullam non. Libero nunc consequat interdum varius.

  • Lessons…Learned

    Lessons…Learned

    I know this is my second post in less than 30 days! I think I have too much free time on my hands while practicing this social distancing routine! Today I will catch up with what’s happening in PD School 2020 and talk a bit about how I have implemented what I’ve learned so far. If you aren’t aware of Dr. Mischley’s PD School 2020 you can read more about it my posts here and here. And check out the coupon offer at the end of this post!

    The last lesson I covered was lesson 3 so I will quickly catch you up on lessons 4, 5, 6 & 7 just touching on highlights and things I found interesting. Lessons 4 and 5 cover the topics of food and nutrition. Lesson 4 discusses what to eat and lesson 5 discusses when and how to eat. In lesson 4 Dr Mischley covers foods that are “Good” for PwP and also foods that are “Bad” for PwP. The data to support the designation comes from the ongoing longitudinal research trial she runs at Bastyr University.

    The good foods below are listed in order of decreasing impact, that is fresh vegetables had a greater impact than fresh fruit and so on.

    • Fresh vegetables
    • Fresh fruit
    • Nuts and seeds
    • Fish (not fried)
    • Wine (yessssssssssssssss!)
    • Olive oil
    • Coconut oil
    • Fresh herbs

    The bad foods below are listed in order of greatest negative impact.

    • Canned fruit
    • Diet soda
    • Fried foods
    • Ice cream (noooooooooooo!)
    • Canned vegetables
    • Beef
    • Pasta
    • Soda

    She also discusses how eating can impact medication absorption particularly when you eat protein just before or just after taking your meds.  Various diets are discussed and her recommendation is go as vegan as you can and follow the Mediterranean diet.

    Lesson 6 discussed the laboratory tests she requests for her patients. Several of the tests are not normally requested by your neurologist or PCP and some are not covered by insurance or Medicare. She notes at the end of the lesson that she is working on trying to set something up to provide the test to any PwP at a reduced rate (she hopes around $500 instead of $2000).

    I was interested in this lesson because she pointed out that most PwP’s are low in both vitamins D and B12. A B12 deficiency can result in neuropathy, cognitive decline and loss of sense of smell. In addition tremor, trouble walking and balance may also be effected. Vitamin D deficiency can result in constipation, falls and balance issues, depression and cognitive decline.

    I have been taking both B12 (120mg) and D (2000 iu) supplements for the last several years. My PCP tested me for both vitamins this year and I was within range as far as the lab was concerned. Dr Mischley provides her recommended reference range for the tests and I am below her recommended range in both. I was particularly surprised at the vitamin D result with all the sunshine I get here playing tennis, etc. Looks like I need to increase my supplement amounts of both vitamins.

    She covers several other lab tests she conducts and why and I think you will find this lesson very interesting.

    Lesson 7 discusses gut and intestinal health. This lesson includes a presentation by Dr Samantha Evans who practices with Dr Mischely in Seattle. Dr Mischely provides the introduction and overview pointing out that 50% of the dopamine neurons are located in your intestinal tract. She also discusses the need for gastric acid to breakdown food and medications. She points out as we get older the gastric juice becomes less acidic and recommended taking our medication with a glass of water mixed with 500 mg powered vitamin C to increase the acid level.

    Dr Evans discusses how much of what happens in the intestinal tract impacts PwP’s. She discusses SIBO (Small Intestine Bacteria Overgrowth) and Leaky Gut and how it impacts PwP, particularly medication absorption issues.

    So there are a few highlights from lessons 4,5,6, and 7. The next class is Do I need to take supplements? and will be available on the 28th of the month.

    Quick timeout for some fine print! Before I discuss how I have implemented parts of these classes I just want to remind everyone I am not a medical practitioner and you shouldn’t rely on the information below as an alternative to medical advice from your doctor or other professional healthcare providers. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on It Is What It Is .

    And we are back.

    I have enjoyed these classes and have started trying to put some of what I have learned in to practice. In lesson 2, Dr Mischley discusses the success she has had with treating dyskinesia with high doses of DHA fish oil for 30 days and then adding CDP Citicoline twice a day to improve absorption of Levadopa. Since we eat salmon 4-6 days a week, I decided to test taking the CDP Citicoline as she recommended (2 250 mg capsules twice a day).

    I began the test on February 2 and tracked the effects daily through April 4. As she mentioned in the lesson, my dyskinesia actually started getting worse because the supplement was improving the uptake of the medication and after 3 weeks I started to slowly reduce the amount of Sinement,Rytary and Mirapex over the next two months. My goal was to reduce my levadopa intake, reduce dyskinesia and not increase off periods.

    By April 4 I had reduced the Mirapex from 1.5 mg to .5 mg (67%) and my Sinement from 2.5 tablets 3 times a day to 2 tablets 3 times a day (20% reduction). My dyskinesia is barely noticeable and off episodes are unchanged. I believe I could stop taking the Mirapex completely except the .5 mg helps reduce my restless leg syndrome which I had before my PD diagnoses but went away with the Mirapex which is also prescribed for restless leg.

    I have also tried to do a better job of not taking meds too close to mealtime particularly high protein meals. And I have reduced my dairy intake, even ice cream! I’ve ordered some powered vitamin C which should arrive next week and I will test out taking medications with water mixed with vitamin C. Now if I could just figure out how to get Dr Mischely to remove ice cream from the bad food list!!

    Just In!! It’s Parkinson’s Awareness Month and Dr Mischley is offering a coupon for $50 off the PC School for this month (All 24 courses for $100). If you haven’t signed up or have friends or relatives that might find this program useful, please send them this link to the course and the coupon code: AWARENESS. http://pd-school.teachable.com/