Reflection on Studying Parkinson’s Disease

When I started working at Good Samaritan Society in Moscow, I had three patients who suffered from Parkinson’s Disease. At the time I didn’t know much about the disease other than people who do have PD usually suffered from a constant tremor. I knew that I needed to do some more research on this disease because how could I care for my patients if I didn’t even understand their disease? Senior project was the perfect opportunity for me to study Parkinson’s in its entirety. My goals this semester where to learn what Parkinson’s Disease was, learn what causes it, and spend some time with one of my patients who does have PD and get their perspective on what they are going through.

PD is an incurable and progressive disorder of the central nervous system predominantly affecting the dopamine producing neurons, which creates difficulty moving. When most people think of Parkinson's Disease they usually associate it with the elderly but now PD is increasingly affecting younger people. In Parkinson's Disease, certain nerve cells in the brain gradually break down or die. The true cause of PD is still unknown but researchers have found a few key factors that play a role in who gets PD and who doesn't.

Symptoms of Parkinson's Disease typically start on one side of the body and will remain worse on that side, even after it is affecting whole body. Some of the most common symptoms of PD are tremors, slowed movement, joint stiffness, rigid muscles, incontinence, impaired posture/movement, loss of automatic movements (blinking or swallowing), sleep disorders, speech difficulty, and difficulty writing. There are thousands of symptoms for PD but they are not as widely experienced as the previously mentioned symptoms. Many patients will first experience a constant or recurring tremor, then they usually begin to feel muscle and joint stiffness.

Overall there are about 1.5 million Americans who suffer from Parkinson’s disease, and about 4 million people worldwide. PD is 150% more common in men than it is in women, and within the people diagnosed with PD, men’s symptoms progress faster more often than not. Researchers don’t completely know the reasoning behind why so many more men suffer from PD, but it has been hypothesized that toxicant exposure, head trauma, neuroperation by oestrogen, mitochondrial dysfunction, or X linkage of genetic risk factors all make men more likely to be diagnosed with Parkinson's.

There are many kind of treatments available for reducing the severity of the symptoms. These treatment methods include deep brain stimulus, medications, and regular exercise. Deep brain stimulus (DBS) is the option that many patients will only consider after their medications begin to stop working, but this is usually not the first option. DBS is done with the implantation of electrodes deep in the brain, to help with reducing the tremors that patients are experiencing. Medications can help lessen the pain of some of the symptoms of Parkinson’s Disease, often very effectively. In the mid to later stages medications are more commonly used to subdue dyskinesia (involuntary jerking), freezing (the sudden inability to move), and festination (short almost running steps) because they can become much more prevalent. Unlike many other diseases, Parkinson's is a very individualistic and unique disease. The effects of Parkinson’s plays a big role in the physical and mental well-being of a patient and can vary greatly from person to person.

Though complete prevention is not possible, there are things that everyone can do to help reduce the chances of being affected by Parkinson’s disease. Exercise is a very important part of the prevention for PD. After the diagnosis it is highly recommended to get some exercise in order to help loosen up your muscles and your joints. The exercises that are deemed “most effective” by PD patients include: swimming, walking, and yoga. Many believe that vitamin D3, going organic, eating lots of fresh and raw vegetables, green tea, omega 3 fatty acids, and CoQ10 can all help with the prevention of PD. CoQ10 is an enzyme that helps the cells produce more energy, PD drains the cells energy, leaving PD patients feeling tired and unmotivated. After someone is diagnosed with PD it does not mean that their life is over, they are still able to do anything they want but they just have to be more mindful of what and how they are doing things.

As the rapid search to find a cure for Parkinson’s Disease is always on going, many trails and new research are always being brought to the table. One of the more controversial “cures” is using ecstasy/MDMA. Since PD is the loss of dopamine producing cells in the brain it would make sense that ecstasy would help to temporarily get rid of most, if not all, of the physical symptoms of Parkinson’s. Obviously, using ecstasy is not only temporary but also dangerous. British film stuntman Tim Lawrence had been diagnosed with PD when he was 34, his body alternating between rigidity and uncontrollable spasms, almost the only physical recreation left for Lawrence was going out with friends to London clubs. At one of the London clubs is where Tim Lawrence tried the illegal drug ecstasy, for the first time in years he was able to control his body, his twitching was gone. After believing it was some kind of freak accident or coincidence because PD is unpredictable, he tried it again a few days later.

Once more he was in total control of his body and was still not twitching. For awhile he kept quiet about his new groundbreaking discovery since using ecstasy is a criminal offense, but much later he saw documentary about two PD researchers who were trying to understand why ecstacy has such an impact on Parkinson's Disease sufferers. He immediately come forward and began helping in anyway he could. Professor Alan R. Crossman and Dr. Jonathan M. Brotchie of the University of Manchester, were the researchers that Tim Lawrence began working with. Not too long later they believe that they can modify the drug to eliminate the bad such as brain cell death, memory loss, and depression yet still allow the good parts of the drug to work. This temporary “cure” is still highly controversial and not completely understood.

Many people do say the ecstacy can help people with PD, but others are also saying that long term use of ecstasy can actually cause Parkinson’s Disease. At John Hopkins University, George Ricaurte tested this theory on rat’s brains in 2002. He injected three consecutive doses to rats, much like all night clubbers use the drug. A few weeks later Ricaurte examined the animal’s brains and found evidence of severe damage to the dopamine producing neurons. The damage to the dopamine producing neurons is exactly the same as the effect on the brain as Parkinson’s Disease. The use of ecstasy made the brain overproduce dopamine and certain “transporter” proteins, but after the drugs wore off the brain was now being deprived both dopamine and certain. The animals brains also had some severe inflammation causing brain cell death. “The damaging effect of MDMA, together with the decline in dopaminergic function known to occur with age, may put individuals at increased risk of developing Parkinsonism and other neuropsychiatric diseases either as young adults or later in life,” the researchers write in the journal, Science. All of this permanent brain damage and brain cell death all happened within one night and three doses of the drug, so when long use ecstasy users are older their brains are so deprived of dopamine and certain proteins, resulting in Parkinson’s Disease.

Many of my patients do suffer from Parkinson’s Disease but one specific patient told me that she would love to help me with my project by sharing her story and telling me what all she has gone through. Pat was diagnosed in 2010 with Parkinson’s Disease and after she received her diagnosis she immediately felt crushed. She was quickly convinced that her life was over and she could never leave her house because she wouldn’t be able to do anything anymore. When she was done having a “pity party” for herself Pat decided to do some more research on her new debilitating disease. She learned how the disease itself works but she also scared herself because she learned about all the side effects and what will inevitably happen to her body. She was scared and disappointed that her body has “let her down” but soon realized that she still had plenty of time to do everything she wanted to do, her friends an family all came besides her and supported her. Pat and her supportive husband, soon joined a support group with other people who are also suffering from the same disease.

Years after her diagnosis Pat decided that her constant tremor was not only annoying but a reminder of her illness that had consumed her, she quickly consulted a neurosurgeon in Spokane Washington and he told her that deep brain stimulation (DBS) would be a great fit for her. Brain surgery is scary but she decided to go through with it anyways. Her surgery was conveniently scheduled 5 years after her diagnosis, to the day. Pat’s surgery was a success and she came out remarkably well, but during all of her tests and scans the doctors learned that she needs a hip replacement. Pat decided to go through with the surgery almost a year later and the doctors recommended for her to come Good Samaritan Society to recover fully and regain mobility with her new joint.

When Pat moved to Good Sam I was the CNA on floor that day and I got to know her and care for her. As of now she has been on my hall for about 5 months, but everyday she makes a special point to tell all the staff “thank you” for everything. Pat has gained so much of her independence back and not to mention an incredible range of mobility in just 5 months. Some people think that 5 months is a long recovery time but for a 92 year old woman, 5 months is an incredible turnaround time for really any older person to lean how to walk and to relearn how to do almost everything. About 10 years after her diagnosis Pat stil attends her PD support group and swears that she wouldn’t have made it this far without them. Pat is an incredibly strong woman who I admire greatly, she is the type of woman who everyone wishes they could be when they are older. This is a just a short glimpse in her brain after she was diagnosed and what her body has gone through over time.

Thankfully senior project gave me the perfect opportunity to study all angles and aspects of Parkinson’s Disease. I was able to reach all three of my goals and now I can use my new knowledge to better my care of my patients with PD.