Parkinson’s disease is a condition for which the available treatments are both wonderful and inadequate. They are wonderful because they improve patients’ ability to function and maintain independence. They are inadequate because they do not prevent the underlying disease from worsening over time and do not address all of the patient’s needs. If you have Parkinson’s disease, you need to grab every edge you can. Here are ten tips your doctor probably agrees with but doesn’t have time to stress at every visit.
The first five points are all about getting the most benefit from your medicine. The next three have to do with maximizing the 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 freely is worse in the morning. This could be because your last dose of medicine, taken the night before, is already wearing off. By the time your morning dose has a chance to kick in, you’ve already been up for a while. The trick here is to plan ahead. Before going to sleep, place the first dose tomorrow morning on the nightstand along with a glass of water. In the morning, take your dose first thing. Then the medicine is already entering your system as you go about your morning routine. You can even set your alarm clock for an hour before you plan to wake up so you can take your dose and then roll over to sleep for another hour. By the time you finally get up, the morning dose has already started.
2. Pay attention to whether you take your pills with food.
It is not right or wrong to take the pills with food, but there are consequences. In general, when you take your medicine on an empty stomach, more of it is absorbed into your bloodstream. On the other hand, if your medication causes nausea, you can minimize it by taking it with food.
3. Avoid most anti-nausea medications.
Most anti-nausea medications can worsen Parkinson’s disease symptoms or interfere with the benefits of Parkinson’s disease medications. Some of the most common anti-nausea medications, for example, metoclopramide (Reglan), promethazine (Phenergan), and prochlorperazine (Compazine) block the body’s chemical dopamine receptors. These are the same receptors that most Parkinson’s medications seek to activate. Taking anti-nausea medication while taking Parkinson’s medications means that you are taking a medication and its antidote at the same time. They cancel each other out. However, an anti-nausea drug, ondansetron (Zofran), acts on a different chemical receptor and prevents this problem.
4. Beware of forgetfulness.
People with Parkinson’s disease may already be more prone to forgetfulness due to their illness or age. But certain medications used for Parkinson’s disease, such as benztropine (Cogentin) and trihexyphenidyl (Artane), or urinary incontinence, such as tolterodine (Detrol) and oxybutynin (Ditropan), can worsen memory. So if you have trouble remembering things, you should tell your doctor. A simple adjustment of the medication could solve the problem.
5. Know the difference between tremors and dyskinesias.
Parkinson’s disease often causes tremors, which are rhythmic oscillations of the hands or other parts of the body. However, many Parkinson’s medications, when dosed high enough, can cause another type of excessive involuntary movements called dyskinesias. These may involve the muscles of the face, neck, trunk, arms, or legs, and have the appearance of wiggling and fidgeting rather than rhythmic oscillations. It is important to distinguish between these different movement disorders because the presence of one may mean that the dose of the drug should be increased, while the presence of the other may mean that the dose should be decreased.
6. Swallow your pride and use a cane.
As the symptoms of Parkinson’s disease slowly worsen over the years, the imbalance can make walking less safe. However, many patients avoid using canes, canes, or walkers. Sometimes they even buy these gait stabilizer devices, but leave them in the closet, unused. I hear patients say they don’t like the idea of ”giving in” to disease through the use of such devices. I usually answer that it is better to hurt pride than to break your hip in a fall.
7. Take advantage of useful gadgets.
When loss of motor skills interferes with dressing, eating, or bathing, then it is time to use devices designed to facilitate these and other activities of daily living. Items as low-tech as button hooks, dressing sticks, thick-handled utensils, large-button phones, grab bars, and shower chairs can simplify life and promote independence.
8. Mentally rehearse your next move.
Sometimes getting up from a chair takes several tries. Or, when walking is interrupted by a “freeze attack,” it takes an uncomfortably long period of time to thaw out and get moving again. In these circumstances, the trick is to mentally rehearse the next move so thoroughly that you can imagine yourself doing it. So when you really try to move, you have more success.
9. Maintain body weight.
In patients with advanced Parkinson’s disease, the maternal act of chewing food can require so much work and effort that dietary intake plummets. If the patient is overweight to begin with, this might be helpful to some extent, but continued weight loss can threaten health. In such circumstances, one should take advantage of food supplements that allow the intake of important nutrients with a minimum of effort. This is a great time to indulge in your love of ice cream and shakes, which are packed with protein and calories, and require minimal chewing. Supplementing the usual diet with a can or two of pre-packaged products like Guarantee or Sustacal adds the missing ingredients that prevent weight loss. Carnation Instant Breakfast provides many of the same ingredients, but at a lower cost.
10. Stay flexible by exercising.
You’ve heard the expression “use it or lose it.” As said, it is hackneyed and overused, but in Parkinson’s disease it is true. By exercising the same movements that Parkinson’s disease affects, one can improve them. The emphasis is on flexibility rather than strength development. Although lifting weights can also be helpful, one must focus on stretching, flexibility, and range of motion.
(C) 2006 by Gary Cordingley