What are some of the effects of Parkinson's disease?
At one time in my life, I was blessed with seemingly endless energy. I enjoyed challenging problems and relied upon my limitless
energy to help solve them. However, living with Parkinson's disease for the past 15 years has forced me to adjust my priorities.
I still enjoy challenges, but I have learned to accept the fact that my energy has definite limits. At somewhat unpredictable
times during each day, my energy level falls, forcing me to take a break. That is partly related to the fact that, as a result
of Parkinson's disease, all voluntary muscle movements require more effort than normal. It is frequently difficult for people
with Parkinson's disease to get a restful night of sleep. As the effects of medications wear off during the night, muscle
stiffness, muscle cramps and distracting paresthesia occur. I liken the sensation associated with paresthesia to the burning
sensation you feel in your hands and feet after they are exposed to extreme cold or to the sensation of stepping on cactus
thorns with your bare feet. As you might expect, a sleepless night tends to reduce one's productivity during the day.
Unfortunately, the medication I am taking (carbidopa-levodopa — also known by the trade name Sinemet [Merck & Co]; Sin means without and emet means vomiting) no longer works smoothly or consistently, even though I take it approximately every two hours. The medication
is associated with troublesome side effects that typically occur when the drug is at therapeutic levels and include periods
of jerky, involuntary movements (collectively called dyskinesia) that interfere with my normal gait. These side effects usually develop after taking the medication for several years and
progressively interfere with mobility. They cause exaggerated muscle movements that also consume more energy than normal and
sometimes result in muscle pain due to overuse.
Every muscle in an afflicted person's body may be affected to varying degrees. For example, when the beneficial effects of
my medication are wearing off, the muscles involved in my speech are at times affected, and my voice sometimes becomes weaker
and higher-pitched, which is sometimes misinterpreted as a sign of anxiety. This likely occurs because of weakness of my intercostal
muscles and diaphragm. Simply put, I have not inspired enough air into my lungs to exhale and complete the sentence. Also,
at times, I may not clearly enunciate words (slurred speech). When this pattern of altered speech occurs, I ask those participating
in a discussion to ask me to repeat the words that were muffled or slurred. Unfortunately, some individuals avoid talking
with me, apparently because engaging in conversation is too difficult.
Sometimes my facial muscles are also affected inasmuch as they don't function automatically (neurologists call this facial masking). Unless I remember to tell myself to smile, it may appear that I am uninterested or in a bad mood. But if and when an opportune
moment occurs, I explain my situation to those who have an interest and let them know that I still enjoy taking part in conversations.
Also, I tell them that I am smiling on the inside.
Can endurance help you?
Perhaps you or a family member are faced with problems that will become progressively more severe with time. What can you
do? How can you keep a positive outlook? What can you do to sustain a reasonable quality of life? The quotations presented
on page 10S about endurance have helped me to keep smiling inside and out. By so doing, I tend to block out Mr. Parkinson
and find that my endurance and quality of life increase. I share these quotations with you with the hope that they may bring
some comfort to you, your family and your friends.
If we are guided by the enduring principle that there is greater happiness in giving than in receiving, then it is apparent
that our greatest reward for doing is the opportunity to do more. In this context, happiness is a byproduct of doing things
for others and not an end in itself.
In reflecting on the activities and accomplishments of colleagues, friends and family whom I have known during my lifetime,
it is my conclusion that what we do for ourselves dies with us. In contrast, what we do for others lives on. Therefore, until
the day arrives when our lamps of service are extinguished, let us continue to give of our talents, our empathy and energies
on behalf of the welfare of others.
Dr. Osborne, a diplomate of the American College of Veterinary Internal Medicine, is professor of medicine in the Department of Small
Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota.
For a complete list of articles by Dr. Osborne, visit