May 16, 2018 // Perspective

Parkinson’s affects 1 million people in North America

Dr. David Kaminskas

The Catholic Doctor Is In

Although you can’t describe it to your family or friends, there is a feeling that there is something inside of you that is not quite right. It is a weird sensation of internal shaking. Months later, while you are sitting quietly, you notice a slight tremor in one of your hands. During a visit from a grandson you go outside to throw the football around, and you notice some stiffness in your movement. Uncharacteristically, you are dropping more passes than usual. Then weeks later your spouse tells you that you look a little different and asks if you feel OK. A trip to your family physician leads to a referral to a neurologist. After a thorough neurological exam, she tells you that there are signs of Parkinson’s disease. Your mind races as you try to understand what all this means.

You would not be alone. One million people in North America are affected by Parkinson’s disease, one of the most common neurological diseases that affects mankind. Muhammad Ali died from complications of parkinsonism. Two celebrities currently battling this affliction are Michael J. Fox and Linda Ronstadt.

The pathophysiology is quite complicated. It is well-known that there is a loss of neurons in the basal ganglia of the brain with depletion of dopamine — a key player in brain function. There are three key manifestations of Parkinson’s disease, which are tremor, rigidity and bradykinesia, or slowing of movement. The tremor is just about always described as a “pill rolling tremor”: Place a pill between your thumb and first and second finger and roll it back and forth. The tremor is typically more prominent at rest.

Tremors in other conditions usually get worse during purposeful activities, where in Parkinson’s they get better. Rigidity is best defined by increased resistance to passive movement. Very commonly it is described as cogwheel rigidity: Taking the flexed arm of a Parkinson’s patient and trying to straighten it out is manifested by a ratchety pattern of resistance.

Bradykinesia is like moving in slow motion. It is described by those afflicted as incoordination, weakness or tiredness. Simple tasks such as tying shoes or buttoning clothes becomes challenging.

Walking is eventually affected, and is best described as a shuffling gait. There is a feeling of unsteadiness and a high risk of falling, with injury. James Parkinson, who first described the disease that bears his name in 1817, wrote a famous medical monograph, “An Essay on the Shaking Palsy,” and defined a new medical term called “festination.”  It is “an irresistible impulse to take quicker steps, and thereby to adopt unwillingly a running pace.” Flashback to Tim Conway on the Carol Burnett Show. (Sorry millennials, way before your time.)

Other features of parkinsonism include hypomimia, or reduced facial expression), speech impairment, stooped posture and many different other movement disorders. Unfortunately, this complex disorder may include neuropsychiatric manifestations such as hallucinations, psychosis, depression and sleep disturbances. After years of battling this disease some people will go on to develop dementia.

The mainstay of treatment remains a medicine called levodopa, and this has not changed for years. There is no cure currently, but there is great hope for new treatment modalities that may be curative. Adult stem cell research, the type blessed by the Catholic Church, is a very exciting area of investigation that may pay huge dividends in the future. Please do not despair if you or a loved one has recently been diagnosed with Parkinson’s disease. You can still live an active, productive life for many years. Exercise is proving to be very valuable in slowing the progression. Specific protocols using a stationary bike have been shown to be very helpful. Physical therapists recommend a type of treatment that is called LSVT Big, which involves practicing large, repetitive movements.

There are many very interesting observations when looking at risk and prevention in Parkinson’s disease. Maybe the most surprising is the fact that smokers have a very low incidence of this affliction. Studies support that it is the nicotine that seems to be the protective chemical. Even those that have had significant exposure to second-hand smoke have a statistically lower incidence of parkinsonism. Millions of people die each year from complications from smoking, so no one would promote tobacco use to prevent this disease. But, what can we potentially learn from all this?

Some healthy foods have small amounts of nicotine in them. The winner is bell peppers, but there is also some natural nicotine in tomatoes too. It has yet to be proven to be an effective treatment plan, but I can’t see any harm in eating these healthy foods.

There is actually proof that regular coffee drinkers have a lower incidence of Parkinson’s disease — one more reason I will continue to enjoy my morning cup of joe. Finally, there is quite a bit of information that indicates blueberries may be the super fruit for the brain. In a Harvard study published in the major journal of neurology, it was reported that researchers found that eating blueberries, strawberries and apples are probably protective. Blueberries seem to be the winner of that one.

My personal plan is to continue to exercise and begin to eat more stuffed peppers drenched in tomato sauce, followed by a bowl of blueberries for desert. Live life and enjoy the fruits of the earth given to you by your heavenly Father.