July 30, 2015

Where Should I Live in My Final Years? Option Two: Age in Place

Most seniors would prefer to age in place -- that is, remain in their own homes as long as possible. In fact, 90 percent of adults 65+ report that's just what they'd prefer.

Aging in place has been -- and will remain -- my choice for as long as possible. But the situation for an 86-year-old man with Parkinson's could suddenly change. If I fell and sustained serious injuries, I could require assisted living care at a senior residence tomorrow.

Here is the place where I'm aging... and have been aging since the fall of 1965. Maybe I should start planning a 50th anniversary party.

5023 Eskridge
Beloved backyard
Old Rocking Chair's Got Me
I spend as much time as possible sitting in the rocking chair on my screened-in back porch looking out on this scene. But I've remained inside for nearly a week, as Washington's heat and humidity have been especially bad. The older I get, the more the humidity wipes me out.

My Housemates Are My Second Family
I've often discussed the role serendipity has played in my life. In 2001, as I planned my first visit to India, my mountain-climbing son said, "If you're going to India, you really should go to Nepal, too." Since then, I've made a dozen trips to Nepal, and now several Nepali families living here in the Washington area are treasured friends.

July 29, 2015

Where Should I Live in My Final Years? Option One: Move to a Senior Residence

When I was first diagnosed with Parkinson's six years ago, I experienced an unusual side effect -- temporary insanity. I became convinced I needed to sell the house I love and move out of the neighborhood I love and into a senior residence. I shudder every time I think about how close I came to doing just that.

Late last year, I had a recurrence of my Parkinsonian insanity… at least I hope it proves to be insanity. I became convinced that 2015 was likely to be my last year on earth. That notion was likely a side effect of the struggle I was having with blood pressure (BP) spikes that drove my systolic (top) numbers above 180… occasionally above 200 -- definitely stroke and heart attack territory.

The BP struggle that continued through the first half of this year is now resolved. Click here for the first in a series of posts about this positive turn around.

The idea that I might be around in 2016 and beyond was further bolstered when my neurologist remarked during a recent consultation that the rate at which one's Parkinson's progresses at the outset is unlikely to change. My disease has been progressing relatively slowly.

So, I'm looking at my future through new rose-colored glasses. As a result, I’m taking a fresh look at what is probably the number one question for seniors like me who are still hanging on: Should I move into a senior residence or should I age in place?

I know what my answer is for today: age in place. But I know my situation could change. A sudden fall could send me quickly into a senior residence – the option we’ll consider today.

Choosing an Assisted Living Residence
The Washington metropolitan area has dozens of senior residences. Most of them are designed so residents can choose independent living and later move into assisted living. Some places also add a nursing care option or a facility for people with dementia.

Here are some examples of the choices available in the Washington area that appeal to me.

July 28, 2015

STIMband: Will a Simple Headband Reduce Parkinson's Symptoms with Controlled Electrical Impulses?

Will people with Parkinson’s (PWPs) soon have access to a headband-like contraption that administers carefully controlled electrical impulses to the brain, thereby relieving some of the disease’s most common motor symptoms?

A team of five graduate students from Johns Hopkins University think the answer is YES, in the form of a product called STIMband.

For six years, this blog has included many commentaries about treating Parkinson’s disease (PD).
  • Many posts concern the attempts of science to replace the dopamine – a key neurotransmitter – that the disease destroys, thereby compromising the brain’s ability to direct the body’s actions.
  • Many posts concern new drugs being developed to target just-identified biomarkers of PD, like a specific type of protein or plaque. 
  • Many posts pass along (I learned early in my blog experience NOT to recommend anything) information about over-the-counter (OTC) products that have worked for me… like the serotonin booster 5-HTP, which has been a great help in treating (or keeping at bay) common non-motor symptoms of PD, like depression, insomnia, and constipation.
  • Many posts concern information about botanical products that have been proven to support health generally and to reduce the risk of certain diseases. A prime example is curcumin, the active ingredient in the Indian curry spice turmeric. It has been used medicinally for millennia and subjected to rigorous testing. Based on the science, I’m a believer.
  • Some posts concern the importance of exercise in mitigating PD’s symptoms. There are many different kinds of exercise that reportedly bring great benefits -- like dancing, singing, boxing, and tai chi. If it involves movement, it’s probably been shown to be helpful.
  • A few posts have covered the latest news about invasive surgical procedures, like deep brain stimulation (DBS). This surgery is considered a “last resort” for people with advanced PD who no longer are benefiting from standard therapies.

There are risks involved with all these treatments. Drugs often bring negative, unintended consequences, like the bodily jerks and tics of dyskinesia. OTC products are frequently mislabeled or can cause serious adverse interactions with other drugs or supplements or just do not provide the overhyped benefit. DBS is serious surgery with risks of infection and stroke. Even exercise – the “treatment” that seems to make everyone’s “do THIS” list – can cause falls and injuries.

Back to those Hopkins Students and their STIMband
Guided by Yousef Salimpour, a research associate neuroscientist at Hopkins, the students created a comfortable, snug, easy-to-use headband – it goes on like a baseball cap -- that positions electrodes over the part of the brain that controls movement. In the comfort of home, the PWP presses a large red button, easy for a shaky hand to operate. The device then delivers a pre-programmed amount of painless electrical impulses -- for about twenty minutes a day -- at the intensity prescribed by the PWP’s doctor.

July 24, 2015

Consultation with My Neurologist: From Rytary to the Rest of My Life

If you have Parkinson's disease, you typically see your neurologist every three or four months for a checkup to see how you're doing, or -- more likely -- how you're deteriorating. After most of these meetings, I usually grouse to family and friends about not being able to have a nice chat about things on my agenda, since the neurologist is spending all his time entering data into his computer during our brief time together.

I recently mentioned my frustration about this issue, and the neurologist suggested, "Why don't you just schedule a separate consultation meeting?"

What a brilliant idea! I did, and we met last week.

I brought a list of questions and got answers to them all in less than half an hour. There was no chatter about families, vacations or books, like there was for years with a former internist. But I got good information, which I'll share here.

Rytary: Off to a Slow Start
Rytary was approved by the FDA in January as a new form of levodopa, the gold standard medication for Parkinson's disease. I'd heard that it can provide longer-lasting benefits and less "off" time than existing levodopa meds, both regular and extended release (ER).

July 23, 2015

Lincoln's Cottage: A Perfect Setting for Allen Weinstein's Memorial Service

On Wednesday evening, I attended a lovely memorial service for my pal Allen Weinstein. It was held on this lawn in front of Lincoln's Cottage.

Lincoln's Cottage: the Summer White House
I've lived in Washington since 1955 and thought I'd seen all its major historic sites. But I'd never been to Lincoln's cottage and only vaguely remember hearing about it.

The Cottage is on the grounds of the Soldiers' Home, about four miles north of the White House. During the Civil War, President Lincoln lived there from June into November to escape the city and the distractions of life at the White House. From my visit Wednesday night, the heat and humidity there seemed about the same as anyplace else in this swamp we call the nation's capital.

Lincoln journeyed on horseback between White House and Cottage, morning and night, usually unguarded. Today, the president travels by car in a heavily armored Cadillac. But he travels mostly by air. I can tell when he's flying to Camp David because I hear and see three helicopters in a row flying noisily over my back porch. (Obama, thankfully, uses Camp David much less than his predecessors.)

At the Cottage, Lincoln made several momentous decisions that defined his presidency. While there, he formulated his thoughts on freedom that became the Emancipation Proclamation... and mourned the death from typhoid of his 12-year-old son Willie. In July 1864, he and his family were evacuated from the grounds when nearby Fort Stevens came under Confederate attack.

In July 2000, the Cottage was designated a national monument and opened to the public. I've made a note to take one of the tours in the fall.

About Allen Weinstein 
The Cottage was perfect for Allen's memorial service. He was a history professor, author of history books, and our National Archivist until he retired in 2008 because of his Parkinson's disease.