Observations

Next Steps (Originally posted April 5, 2011)


My long journey to a Parkinson’s disease diagnosis was often confusing and frustrating, but there was some comfort in having an answer.  After years of wondering what was happening to me, I finally had a label and I could develop a plan of attack.  I was briefly relieved, until reality began to set in.

Dr. Elisabeth Kubler-Ross describes grieving as a five-stage process:  denial, anger, bargaining, depression, and acceptance.  I’ve been in all five of those places, sometimes all on the same day.  It’s not a steady progression, and I’m certainly not finished yet – I’ve really only just begun.  Although Parkinson’s disease tends to shorten expected lifespan slightly, it’s not a fatal disease – many people with Parkinson’s live long lives after diagnosis, with slow progression and years of good function.  Unfortunately, although the speed of progression and the details are different for everyone, the direction and result is always the same.

With what I now know about this disease, I am amazed and awed by PWPs and their care partners, families, and friends who have been fighting back for decades against this slow thief of health and vitality.  Parkinson’s steals not only the ability to move and communicate effectively, but it also damages self-esteem, destroys relationships, halts promising careers in mid-stride, and sentences both the PWP and their ecosystem to a seemingly eternal cycle of medication, daily struggles with the basic activities of living, and a slow decline in spite of heroic efforts to prevent it.  A friend and fellow PWP once told me that Parkinson’s is like,”being stuck on the railroad tracks in front of a slow-moving train – you know it’s coming, but even though it take years to get there, you can’t get out of the way and you can’t make it stop.”

Since my diagnosis, I’ve worked to get the medications right, and fought my way through debilitating side-effects just as every other PWP has at some point.  I’ve lost friends I’ve known for years who just stopped responding to attempts at communication, and I’ve made many new friends in many places, including our AAPSG support groups (if you want to meet some really fascinating people who don’t quit and who usually have a joke or story to tell, come to a support group.  Sometimes the jokes are agonizingly bad, but we’re all forgiving people).  My family and I have also worked (and are working) through the fear, uncertainty, and anxiety that comes with the diagnosis of a progressive, incurable illness.  How long will I be able to continue working?  What happens when I have to stop?  How fast will the disease progress?  How will our family change?  Will we be OK?

The AAPSG, APDA,  and other organizations can provide excellent resources, guidance, and referrals to help families answer these questions, but the answers, like the disease itself, are different for everyone.  In my family, we don’t have these answers yet, and we’re working and struggling to find them.  However, what we do have is mutual love and commitment, and a dedication to finding the answers together.

It’s become apparent over the last two years that I am particularly susceptible to side-effects from PD medications.  I’ve described my problems with nausea (perhaps to the point that you’re saying, “I GET it – stop, already.”).  I also am having significant difficulty with nighttime insomnia and daytime sleepiness, including sleep attacks from the dopamine agonist .  Recently, I’ve begin experiencing some other effects from the agonist (when you see a squirrel run across the living room floor and your dog on the couch doesn’t move, that should tell you something).  I also have the most well-equipped home theater and home automation system in the neighborhood, and I can’t really tell if that’s just because I like electronics and gadgets, or if Requip XL’s notorious “compulsive behavior” side-effect is rearing its head.  And, although it’s a little unusual, I’ve begun having on-off problems and beginning-dose/end-dose dyskinesia from the levodopa.

With this spectrum of side-effects, increasing the dosage of my medications isn’t an option. At this point, I can’t go up in medication without more severe side-effects; I can’t go down without being off most of the time.  According to the advice of my neurologist, my neurosurgeon, and multiple alternate opinions, it’s time to consider deep brain stimulation surgery (DBS).

I’ve only had a PD diagnosis for about two years, and I’m on the young side for having the surgery, so I’ve been resisting the idea for some time.  When my neurologist first recommended that I think about it, I said,  “You’ve got to be kidding – that’s for late-stage Parkinson’s, after everything else stops working, isn’t it?” I apparently have a limitless capacity for being wrong, and I was this time, too – DBS actually works best for people who are still getting some benefit from medication, but perhaps with unacceptable levels of side effects.  It also seems to work best for people who are relatively early in the disease, who don’t have other complications or significant cognitive impacts, and who are not falling often.  Me, in other words.

So, after weighing the risk factors and evaluating the data (did I mention I’m an engineer?), I’ve decided to have DBS surgery in early June.  Between now and then, I have a neuropsychological exam and a full-anesthesia MRI, and a few other things to get organized and put in order.  In the next few months, though, I hope to be able to describe the whole process, both before and after.

Next time – the lead-up and a description of the procedure itself.

© 2011, Corey D. King

2 thoughts on “Next Steps (Originally posted April 5, 2011)

  1. Corey: Love the way you write! Quite the author. Humorous and insightful and very realistic. I will certainly refer our folks to your blog. David and I watched Ali Rezai (premier DBS surgeon at Ohio State University) perform DBS several months ago. As my background includes 15 years of being a private scrub nurse for a neurosurgeon in Columbus, I thought I would not be so Wowed. But David and I were both in awe; quite an incredible procedure. Keep exercising! Hoping your results from this procedure are incredibly positive.

    Jackie Russell, RN, BSN, CNOR
    Delay the Disease

    Like

    • cdk

      Thank you, Jackie – I’m sticking with the exercise (can’t take all the credit, though – behind every married man in an exercise program is a loving wife saying, “get up out of that chair before I turn it over on top of you”), and I’m seeing results. Thank you to you and David for the service you’re providing to the PD community.

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s