Parkinson’s “Off” Time: What It Looks Like, and How to Manage It - MJFF

What does it mean when we say that Parkinson’s can go from “off” to “on” and then back to “off” again? Listen to this Michael J. Fox Foundation podcast as experts discuss these “off” periods — those times when medication can wear off between doses, or are not working optimally, and symptoms can return. This episode will share steps you can take to manage “off” time, including how you can communicate with doctors and care partners about what you’re experiencing and ongoing research to decrease or treat these episodes. 

Host and person with Parkinson's Larry Gifford leads a discussion with:

  • Ashley Rawls, MD, movement disorder specialist at the University of Florida Norman Fixel Institute for Neurological Diseases 
  • Soania Mathur, MD, co-chair of MJFF’s Patient Council 
  • Rick Schwartz, person with Parkinson’s and former professional baseball player 
Listen to the panel discussion at The Michael J. Fox Foundation 

GOCOVRI update 1

 It's been a few weekson GOCOVRI, I'd say early results are reduced off times and reduced dyskinesia.  

I don't remember the medication I took prior, too many doctors each with their favorite combination of pills.  GOCOVRI isn't adding C/L but is time released Amantadine, so not hitting me with a double dose of C/L first thing in the morning. Not perfect but the best in a long time.

8/26/2024 Off times reduced and foot dyskinesia slowed down.



Any GOCOVRI success stories?

The last two visits to my movement disorder specialist (MDS) each had a new doctor. Each doctor stopped previous med and started another.  Meds not optimized. Major off times.  

8/12/2024 — The latest doctor thinks a new medication GOCOVRI will help with the off times and dyskinesia. I'm concerned of constipation being a side effect. I’ve already been to the ER with constipation once before and it was no fun.  

8/13/2024 — Feeling pretty good so far after first night of gocovri. Giving it a week before doctor said to double dosage. Overall feeling somewhat better. Still getting two major off times with freezing around 10:30am and 5pm and other minor off times which last 15-30 minutes.

I’m thinking it is related to food in my gut conflicting with the absorption of levodopa. Hard to work around this when I take C/L every two hours.  Not giving up hope, I think back to last time I saw the original doctor I saw at this neurology office who reassured me there are many things to try and new treatments awaiting FDA approval.

8/21/2024 I started to take two GOCOVRI pills a night last night. So far I have a headache, but nothing else.



Wake Up Brain, Wake Up

Sometimes it feels like a part of my brain is asleep. It isn't talking or listening to me. The meds didn't kick in properly or sometimes at all.  

I want to move an arm or leg or my hand to get leverage to pull myself up. Nothing, not even in my finger. 

I break a sweat wrestling with this invisible assailant called PD. Struggling in my mind to make movement. Then, after almost 2 hours, the meds kick in. I move my fingers, wrists. My neurons are medicated and with a sense of innocence, as if nothing is wrong, I stand up and cherish the 'on time'.

Off times are when my meds not working. On time refers to when my medications are on, or working. 

After a good night of sleep I may wake up fully charged, little or no stiffness for an hour or two. Regardless, I take the meds as scheduled.


Neurologist explains symptoms of Parkinson's Disease

The doctor being interviewed explains the hallmark signs of Parkinson's Disease. Also a commenter on the video was really informative - detailing what the "on/off" experience is like, and how unpredictable it is. 

Dr. Tom Pitts, a board-certified neurologist, speaks with NBC's Tom Llamas about questions surrounding President Biden's health. Dr. Pitts has not examined the president, but shares opinions based on video clips of Biden. 



Some common difficulties with speech includes:

  • Speaking softly or in a reduced volume
  • Using a monotone voice
  • Slurring words
  • Mumbling
  • Stuttering or stammering
  • Hoarseness or a strained quality
  • Breathiness
  • Uncertain articulation

Bradykinesia is a clinical term that refers to slowness of movement, or speed hesitations and halts that occur as movements continue. It can affect voluntary motions, like what you tell your body to do, as well as automatic or repetitive motions. Bradykinesia is a common symptom of movement conditions like Parkinson's disease (PD), and can make everyday tasks difficult.

In Parkinson's disease, hypomimia occurs when a lack of dopamine in the brain prevents facial muscles from working as well as they used to. This can make it difficult to smile, raise your eyebrows, or express your feelings, and can sometimes make it look like you have a blank expression.

In people with Parkinson’s, cognitive deficits may become more severe and impact daily functioning. Similar to slowness of movement (or bradykinesia), people with Parkinson's disease often report slower thinking and information processing (termed “bradyphrenia”)

Fatigue is a non-motor symptom of Parkinson's disease (PD) that can feel like a deep physical tiredness that doesn't improve with rest. It can make it feel impossible to move, as if you have no energy. Fatigue can occur at any point in the course of PD, whether movement symptoms are mild or severe.

SOURCE: https://youtu.be/97ZIHY2QcDI?si=OLA2NXJEep-w9f3-

Congress Passed the National Plan to End Parkinson's Act

Big news just in from Michael J. Fox foundation

The U.S. Senate today unanimously passed the National Plan to End Parkinson’s Act, the first-ever federal legislation dedicated to ending Parkinson’s disease, sending the bill to President Biden’s desk to be signed into law. The bill passed with overwhelming bipartisan support in the U.S. House of Representatives last December. 

Senate Majority Leader Chuck Schumer (D-NY) announces the passage of the National Plan to End Parkinson's Act in the Senate.

On behalf of the 1 million people living with Parkinson’s disease in the U.S. and their families, The Michael J. Fox Foundation for Parkinson’s Research (MJFF) applauds Congress for this historic step forward in search of improved treatments, and ultimately, a cure for every patient impacted by this disease today and in the future.  

The Parkinson’s community — including tens of thousands of Parkinson’s policy advocates, partner organizations and champions in Congress — rallied together to help policymakers understand just how critical this legislation is. From adding your names to MJFF’s petition, calling and writing representatives and senators, pitching op-eds and sharing your stories on social media — advocates in all 50 states sent more than 70,000 messages to Congress urging their support. And nearly 1,000 advocates joined MJFF to meet directly with their members of Congress.  

We’re especially grateful to the bill’s lead sponsors, Senators Shelley Moore Capito (R-WV) and Chris Murphy (D-CT) and Representatives Gus Bilirakis (R-FL) and Paul Tonko (D-NY) for their exceptional bipartisan leadership in getting this bill passed. We also extend our deepest thanks to Senate Majority Leader Chuck Schumer (D-NY), Representative Jennifer Wexton (D-VA), Senator Bernie Sanders (I-VT), Senator Bill Cassidy (R-LA), House Majority Leader Steve Scalise (R-LA), House Minority Leader Hakeem Jeffries (D-NY), Representative Cathy McMorris Rodgers (R-WA), Representative Frank Pallone (D-NJ) and the many cosponsors from around the country for helping to get this bipartisan bill passed.   

A cross-country strategy to end Parkinson’s has the potential to: 

Dramatically increase federal research funding; 

Develop more effective pathways for treatments and cures; 

Improve early diagnosis; 

Spark new and improved models for patient care; 

Create standards and measures to prevent Parkinson’s disease; 

Address health disparities in diagnosis, treatment and clinical trial participation and 

Enhance public awareness of the disease. 

As the bill heads to the president’s desk, we look forward to continuing our work with policymakers to establish the advisory council and bring the National Plan to fruition for every patient and family impacted by this disease. 

Please join us in thanking the 215 representatives and senators who supported this bill in Congress and read the Foundation's press release to find out more about this historic bill.

PD Quick Tip - Falling?

Am I a klutz or is it a PD fall? 

I've fallen down a few times while out walking, five times to be exact. Three of the 5 times happened when I tripped over sidewalk hazards in New York City. Fortunately only one of these falls resulted in broken eyeglasses, multiple cuts and scrapes. I did better on the other falls--just a few scrapes and my pride was bruised.

In two of the incidents the sidewalk hazards were similar. Light poles, either previously stood or were being installed. Regardless, there were bolts set in the concrete sidewalk and sticking up a few inches. If I were the type to run to a lawyer, I'm sure a judge would agree and find the city or property owner at fault.

My PD Quick Tip sounds obvious but there is a lot going on and this is worth repeating: Make sure you watch where you're walking, you might just avoid an unnecessary fall.

I Won't Back Down (song)

I woke up at 4am with this song in my head.

Well, I won't back down, no I won't back down

You can stand me up at the gates of Hell

But I won't back down

Gonna stand my ground, won't be turned around

And I'll keep this world from draggin' me down

Gonna stand my ground and I won't back down

Hey baby, there ain't no easy way out

Hey, I will stand my ground and I won't back down

Well, I know what's right, I got just one life

In a world that keeps on pushin' me around

But I stand my ground and I won't back down

Hey baby, there ain't no easy way out

Hey, I will stand my ground and I won't back down

No, I won't back down

Source: LyricFind

PD Open Message on Facebook

I've been going back and forth whether I wanted to 'go public' with the news of having Parkinson's.  This week, after a lot of thought, I did it. And received so much positive support from Facebook friends. No regrets.   

Here is what I posted to my Facebook timeline.

I'm guilty of posting a vague reference to my health.  Not sure why but for a long time I've avoided telling many people that I was diagnosed with an illness.  I still don't feel comfortable talking about it, mostly because it has gotten negative responses or reactions from the few friends I've told. It seems every time I open up and tell a friend, it's the last time I'll hear from them.  A few wrote to me that people don't want reality contaminating their Facebook fantasy world so I've been hyper-selective about what audience I expose to my postings that don't eude toxic positivity. 

Since I broke character yesterday and posted a vague message seeking a time machine to get a cure, I decided to be authentic and share the news here.  Twelve years ago I was diagnosed with Young Onset Parkinson's Disease. I am not seeking emoticons of support, just letting friends know what's up. Parkinson's Disease has a very long list of symptoms, it's like the menu in a Chinese restaurant when talking about symptoms. One person suffers from B1, B3 and G4 the next person suffers from B3, C1 E22 and p5. And do you want shakes with that? No two people have the same path. If you want to read more, I'll add a blog link in the comments.  I know it is hard to understand that one illness can take so many directions but for now it's all called Parkinson's, maybe it will have sub classifications in the future, who knows. Hopefully this message doesn't make you too uncomfortable. 

One thing to remember, the illness is both chronic and progressive with no cure.

So here it is, now on Facebook. You can click an emoticon, post a GIF or send thoughts and prayers, it's all good. Phone calls or email are welcomed.   I don't like Facebook messenger and try to avoid text messaging when possible.

TGIF and have a great weekend.



Potential Benefits of Samba Drumming for Parkinson's

Researchers at Cardiff University are hoping to launch a study to discover if there is clinical evidence that drumming classes are improving the lives of Parkinson’s disease patients.

A special samba drum class has been a refuge for Parkinson’s disease patients in Wales where they can move and socialise.

Now researchers in neurogenerative diseases are planning a study to see if samba really can help ease people’s symptoms. 
Parkinson's disease is a degenerative disease caused by a loss of nerve cells. Due to a loss of the chemical dopamine, it affects body movement as well as mental health, according to the World Health Organization (WHO).

Parkinson’s patients experience problems with balance, standing, and walking and sudden rigidity as well as cognitive decline from dementia.

The founder of Sparky Samba, Eirwen Malin, is a Parkinson’s patient herself. She says she started the club after her son went to a samba concert.

“A big issue for people with Parkinson's, they sort of lose that sense of rhythm, they lose the rhythm of walking. Some people have this freezing gait thing where they just suddenly can't go anywhere, especially if you're in a doorway or something,” said Malin.

“And I just thought that the samba rhythms would help them. And I put it out on my Twitter network, which isn't huge, but it is international. And they all said, yes, that's a really good idea, give it a go,” Malin added.

Since then, the class has been receiving government grants which have helped establish several more classes around Wales.

Over the past year, the patients here have reported an improvement in their mood and movement.

“Before samba, I was struggling to get out [of] the chair, so at least I am a bit more mobile now. Not quite so stiff, which is part and parcel of Parkinson's, the stiffness in the joints. I tend to still be leaning over to one side, so I've got to try to prop myself up. But I think without samba I would be struggling,” said Brian Dews, one of the participants in Sparky Samba.

Researchers at Cardiff University are hoping to launch a study to discover if there is clinical evidence that these classes are improving the lives of Parkinson’s disease patients.

Cheney Drew, who works on the university’s drug trials, believes evidence is needed to show exactly what helps Parkinson’s disease patients.

She has previously investigated the impact of drumming on people with Huntington’s disease, another neurodegenerative disorder which can also affect movement.

“One of the reasons that we're doing the trial [is] trying to tease out those complex mechanisms and understanding is actually the drumming itself?” said Drew.

“So there's a phenomenon called rhythmic auditory stimulation which has been shown to improve the way the brain talks to itself and the way that messages are relayed around the brain. But also there may be a social component. We don't know that,” said Drew.

She says controlling for the social component carefully will be important in the experiments to understand how Sparky Samba may be helping Parkinson’s disease patients.

The study will measure symptoms such as freezing of gait and quality of life rather than dopamine levels and other biological symptoms.

“We do look at things called biomarkers, which are biological changes that occur as part of the disease. They are often a really good marker of how the disease is progressing,” said Drew.

“However, we don't have really good biomarkers for Parkinson's yet and so all clinical trials are based on a rating of clinical symptoms. And that will include, as I said, quality of life, motor and cognitive symptoms”.

The study is expected to run for 12 to 18 months.

The WHO has said that more people are becoming disabled and dying from Parkinson’s disease globally. The prevalence of the disease has doubled in the 25 years with at least 8.5 million people having it in 2019.

SOURCE euronews

PD Quick Tip - Heavy, sleepy eyelids

Suddenly my eyelids feel so heavy, and at the worst times. It's happened when I am just talking with someone-my eyes are closing, eyelids so heavy, I struggle to keep my eyes open. The person I was talking to thinks I'm bored and am really rude.  Was I hypnotized? It's probably the autonomic nervous system taking a break.

Blinking is usually a natural reflex. Parkinson's Disease can cause a person to stare and the autonomic nervous system forgets it's time to blink.   

I started doing an eye exercise to strengthen my eyes and remind my brain to blink. I'm not sure if my ophthalmologist would endorse this technique, but here it is. 

The exercise is 8 steps. I basically look in each direction, hold it for a second and blink. Look in the next direction and repeat.

  • Look up and left, blink
  • Look up, blink
  • Look up and right, blink
  • Look right, blink
  • Look down and right, blink
  • Look down, blink
  • Look down and left, blink
  • Look left, blink

I repeat this for a minute. Afterwards my eyes feel open and awake.

Blog Name and URL Changing to parkinsons48.blogspot.com

The name of this blog is changing from screwpd to parkinsons48.blogspot.com 

The former name has caused confusion about the blog's content and also caused it to be flagged as not safe for the workplace.  Hopefully the name change to parkinsons48 gets this blog indexed and crawled by the search engines.

Are you wondering, "Is there anything I can do to help?" Yes, you can help and it won't cost you anything but a few minutes of time. Post the new url on a few of your favorite social media sites and to relevant groups. 

Thanks for your help. Like and Share!


 

April is Parkinson's Awareness Month

 


April is Parkinson's Disease Awareness Month, chosen because it is the birth month of James Parkinson, who first identified the symptoms of Parkinson's disease more than 200 years ago.

Parkinson's Disease, or PD, progresses and affects everyone differently, and symptoms vary from person to person. It can be a mix and match when you go to a PD support group meeting.

The most commonly visible symptoms are tremors or shaking, but the condition can also manifest in many other forms, such as slowness of movement, muscle rigidity, speech changes, fatigue, sleep disturbances and mood disorders.

There is currently no cure, however researchers are working to find a cure, as well as better treatments and support for people living with the condition.


PD Apathy is very real

I brought up Parkinson's Apathy to a group last week and was surprised I received a lot more response than I expected. Just knowing 5 or 10 other people also struggle with PD apathy is reassuring and helps me to not feel so alone with my long list of symptoms.

PD apathy is very real. I struggle to accomplish even the smallest tasks and I beat myself up because I have a ton of things that need to get done, all with a high priority. But I freeze up mentally when I think about it. The list grows and months go by on the calendar.

In an ideal world there would be a person who can help someone who's cognitively challenged to do things. Like a "task rabbit" but they are also trained in psychiatry or psychology. Someone who understands we're not being lazy. The neurons just don't connect to accomplish the things we need to do.

I try making lists, then lists of lists and it's not helping.

By the way, I'm calling this apathy but the inability to accomplish things might be another issue. The days pile up, turn into months and years.

How do you deal with the apathy–feeling of being stuck in quicksand, surrounded by a brick wall?

A few suggestions from the group were: 

  • Reduce clutter, make neat piles
  • Set realistic goals
  • Break tasks down into smaller tasks
    • ie: Clean Kitchen becomes wash dishes, put dishes away, mop floor, clean cabinets. 
  • Remember to take time off! If you're having a bad day, unplug and relax. Don't struggle to accomplish something every day.

I know, It could always be worse.

Parkinson's Unity Walk 2024

Parkinson's Unity Walk

Saturday April 27th 2024 • 8:30am - 1pm, Central Park, New York, NY

The Michael J. Fox Foundation (MJFF) is thrilled to bring you the 2024 Parkinson’s Unity Walk on Saturday, April 27th, in New York City’s Central Park. Enjoy programming at the Bandshell, explore informational booths featuring industry representatives, national and local groups, and participate in a 1.2-mile walk. Families and friends of all ages and abilities are welcome for all portions of the event!

Let’s come together and walk to end Parkinson’s!

This year, the Parkinson's Unity Walk will be celebrating 30 years of joining as a community and walking together to end Parkinson's disease!

Location:
Central Park, NYC - Naumburg Bandshell
Entrance at East 72nd Street. & Fifth Avenue

Unity Walk Route Map


Cognitive and Non-motor Symptoms

This presentation feels like it is talking for me.  Joanne Hamilton talks about some non-motor an cognitive issues that I have trouble expressing.

Some of the first symptoms people with Parkinson’s may experience are not visible to others. As Parkinson’s progresses, cognitive and other non-motor symptoms continue to be a significant aspect of living with Parkinson’s. Joanne Hamilton, PhD, ABPP-CN, of Advanced Neurobehavioral Health of Southern California in Poway, CA, explains what to expect and how to distinguish symptoms caused by Parkinson’s from those caused by medications. Her presentation for the Davis Phinney Foundation audience offers hope and practical strategies for understanding and managing cognitive and non-motor challenges.

PD Quick Tip - Freezing

If you get "stuck" walking, brushing teeth, in the shower scrubbing shampoo, etc. Try looking at the task from another angle. 

Walking around in apartment. Sometimes I'm heading into a room and can't make the left turn to go in. Back up and try doing the task in reverse.  I turn right three times and I'm facing left.

When I'm having trouble with my arms and hands and it's difficult to move the toothbrush, it seems to be the toothpaste jamming me up. When I try it without toothpaste and rinse with mouthwash it works.  I don't know if a dentist would be on board with this method.

When I'm walking outside I focus on the sidewalk and try to follow the lines so I'm not swerving all over. 

Occasionally I'll think of something I do that seems counter intuitive or just strange but it works for me and my PD and maybe it can help another struggling person too.




Blog Construction: Frequent Design Changes

A brief interruption. Most of you come to this blog to read the posts related to Parkinson's Disease.  

I've been experimenting with various settings on this blog in an attempt to get it listed in popular search engines, trying to remove whatever is preventing the blog from appearing in search results.

You may see the appearance radically change a few times a day as I experiment with setting but the blog content is not changing.  All the postings about YOPD and PD are still there.

We will control the vertical. We can roll the image; make it flutter. We can change the focus to a soft blur or sharpen it to crystal clarity. 

For a few hours last week the entire blog was unreadable on mobile devices and a couple of you asked what is going on. So in the spirit of transparency, that's what's going on. Do not adjust your set.

And now back to the blog posts, already in progress.



Help me change a light bulb?

So I could blame a lot of things for the nearly impossible task of changing a light bulb, but I'm pretty sure it's 75% shitty product design and 25% user fault, meaning my diminishing fine motor skills related to Parkinson's.

About 5 years ago a light bulb burnt out in the hallway. No big deal I thought. I dragged out the ladder and stared at the cheap made in China fixture.  No way could this be as complicated as I'm making it. Yes, it was that complicated.  I posted a photo of the fixture with a plea for help to a few message boards. Someone who went through the demoralizing hell I'm going through replied.  Sent me a PDF with step-by-step directions how to change a light bulb in this fixture. Over the years I've experienced other poor product designs from computers to television remotes to poor user design on software. 

Oh sorry, I was drifting. Changing a light bulb. Yes that is what I'm doing today. The meds kicked in so I'm changing burnt out bulbs. Two bulbs broken and $18 down the drain. A few hours pass, off time, next dosage of meds. I've tried every method posted on YouTube an the bulb won't twist into the socket.

I had five new bulbs, broke two. Not able to get bulbs to stay in the cheap track lighting fixtures.  The reason I mentioned the bad product design is for my own sanity.  Knowing what passes as acceptable quality products, I'm fairly confident the sockets in the track lighting are cheap not designed to last a "simple" light bulb change. I refuse to blame my inability to change a bulb on PD. $40 on light bulbs and kitchen is dark. At least I didn't fall off the ladder and bust my ass.  Time to find a handyman and pay him some large amount to change 5 bulbs. 

PD sucks but things could be worse.

Keep Me In Your Heart (song)

The music is not specific to PD. I'm a music fan and some mornings I share a few songs.

This morning I'm just feeling invisible, misunderstood and missing. Friends have moved on with their lives,

With a look of ease drawn on my face, it's easy to misread my feelings as lack of concern. I do worry and I do care. Stuck inside myself. 

Stiffness and pain. Frozen. 

I miss me. 
 

New C/L Delivery System Sounds Promising

My gut has issues absorbing medications. Sometimes it doesn't seem to get absorbed, other times it can take hours then suddenly the medicine works. 

My doctor has been telling me about a new deivery system for carbidopa/levadopa that works like diabetes meds, with a tiny prick into fatty tissue, not only bypassing the gut but instead of spikes of medication every time I take a pill, this should have a steady flow.

Two subcutaneous preparations, ND0612 and ABBV-951, have been shown to improve OFF time/motor activity or dyskinesis in advanced Parkinson's disease. One advantage of ABBV-951, over ND061, is that it can be used alone as l-dopa therapy, whereas ND061 must be used with oral l-dopa.

Awaiting FDA approval.

I'm not giving medical advice. Everyone's PD is different and responds differently to the medications. Work with your movement disorder specialist to figure out what's best for you.