Thursday, January 21, 2016

My Parkinson's Disease--Current Symptoms

Here are the current symptoms of my Parkinson's Disease:

  • No sense of smell (anosmia). This was the first indicator that occurred a dozen or more years ago.
  • Loss of manual dexterity in my right hand. I have a difficult time buttoning the left cuff button on my dress shirts. Worse, my handwriting, which has never been good (I got a D in handwriting in the 6th grade), is now so illegible that I can't read it myself. I can still type slowly, but often leave letters out and double other letters.
  • Lack of facial expressions. This phenomenon is called blunted affect. I do smile (occasionally) and laugh (pretty often), but my ordinary expression is, um, expressionless. On different occasions, two nurses have said they thought I probably had Parkinson's Disease just by looking at my face.
  • Soft speech. This odd phenomenon is quite common to PD folks, I'm told. To me, my volume sounds normal, but those listening say I speak very softly.
  • Balance issues. I have to be careful when I stand not to start tilting backwards. Occasionally I have to take several, small corrective backward steps to maintain balance.
  • I have difficulty getting out of chairs. Odd as it may seem, I lack the balance and strength (it seems) simply to stand up out of a chair. I have to grab the coffee table in front or else make two or three efforts to get up before I am successful.
  • I read aloud too fast. In my regular speech, I sometimes stumble over what I want to say. Both of these behaviors are new to me, so I attribute them to my PD. 
So far, even though I'm not as sharp now in my sixties as I was in my thirties, my mental acuity doesn't seem to have been affected. Having said that, I do  have more "word finding" difficulty that I used to.

I don't have any tremors, and that is what makes my neurologist think I have a PD-like disease instead of genuine PD.

My Parkinson's Disease

The first thing that turned out later too be a symptom of Parkinson's Disease was that I lost my sense of smell. This was maybe 12 to 15 years ago. Since losing one's sense of smell can mean a brain tumor, my doctor sent me for an MRI, which detected nothing. (Hence the old joke, "We did an MRI of your brain, but couldn't find anything.") Then, and I  realize I'm foggy on this, awhile later I was sent to a specialist who put me on Requip, a medicine used for both PD and restless leg syndrome.  I don't remember a diagnosis at that time. However, I had an episode at work where I almost fainted, so I stopped taking Requip.

A year or two passed. Then I noticed that I was losing dexterity in my right hand. I couldn't button the cuff buttons on my work shirts with my right hand. A visit to a neurologist showed that the electrical signals down my arm were running fine. Conclusion: My brain wasn't generating the commands to the nerves to begin with. In other words, Parkinson's Disease. Soon, I visited another doctor who became my regular neurologist at that time, and he put me on Carbidopa/Levodopa, Mirapex (pramipexole dihydrochloride), and Azilect (rasagiline).

What are these three drugs? Carbidopa/Levidopa is a form of dopamine, a brain chemical needed in the transmission of signals. Basically what's going on in the brains of Parkinson's patients is that the brain cells that manufacture dopamine are dying off so not enough is available for the brain to send the needed nerve signals to the muscles to tell them what to do.

Mirapex, now available as the generic pramipexole dihydrochloride, is a dopamine agonist, which means that it helps dopamine (supplied by the brain and by the Carbidopa/Levodopa pills, work harder.

Azilect (generic name, rasagiline) is a monoamine oxidase inhibitor type B (MAOI-B). As the "inhibitor" name suggests, this medicine slows down the oxidation of dopamine so that it is available to work longer. In other words, it slows down the destruction of dopamine by the brain's ordinary chemical processes. I believe that the "B" in this MAOI means that it works in such a way that the dietary restrictions of other MAOI drugs are not needed. (No cheddar cheese, for example, or anything with tyramine in it.) But check with your doctor.

So, I have been munching on these three guys three times a day for maybe five or more years. My current neurologist says I have a "Parkison's-like" disease that might not be genuine PD. However, my symptoms are increasingly showing that PD is the likely condition.

See the next entry for my current symptoms.

Thursday, January 14, 2016

Aristotle Meets Godzilla

As a boredom reducer for my treadmilling, I started to watch the 1998 Godzilla movie. At one point early in the film, time is of the essence to find out what's going on. So urgent are the authorities that they send a helicopter with a dozen armed men to bring back the earthworm-radioactivity specialist from Chernobyl and put him on the case.

Then comes a scene where he and another principal investigator are racing to the scene of a ship destroyed by this unknown beast. However, the investigators are racing overland in Jeeps--while helicopters accompany them at groundspeed. This makes for interesting spectacle, showing half a dozen vehicles driving along dirt roads, and two black helicopters flying in tandem with them. But Aristotle would have said that plot is more important than spectacle. We are forced to ask the obvious question, "Aside from its cinematic effect, why doesn't the scene show the investigators racing to the site of the shipwreck, arriving not in Jeeps but in the helicopters, while the support personnel come later in the Jeeps?"

Get the book and find out what makes good drama according to Aristotle:

And here's a book just on point--Aristotle for screenwriters: