Monday, April 21, 2014

Notes from the Twilight Zone: I am not alone

More Bad News for Boomers

In “Have You Lost Your Mind?” (p. 32 of this weeks New Yorker magazine), Michael Kinsley explores the possible mental effects of Parkinson’s disease, a condition he was diagnosed with twenty years ago. Kinsley writes that following his diagnosis, after several weeks of quietly freaking out, “it occurred to me to wonder whether it would affect my brain.” Kinsley asked his neurologist. “He answered carefully, ‘Well, after a few years you may lose your edge,’ ” Kinsley writes. Kinsley continues, “My edge is how I make a living. More than that: my edge is my claim on the world. It’s why people are my friends, why they invite me over for dinner, perhaps why they marry me.” In the two decades since Kinsley’s diagnosis—during which his physical symptoms have advanced quite slowly—“there has been a revolution in thinking” about Parkinson’s disease. While Parkinson’s has “always been classified as a ‘movement disorder,’ ” neurologists now believe that deficits in cognition and memory can predate the physical symptoms that lead to diagnosis of the disease. Wondering whether he might be experiencing the mental effects without being aware of it, Kinsley signed up for a cognitive assessment. “My motive was part scientific inquiry, part hypochondria, and part the journalist’s reaction to any interesting development—‘This would make a great piece,’ ” Kinsley writes. His results in the test over all were “not bad, but not great.” He’d been “off the charts” when he took a similar assessment, nearly a decade before. “This time, I did poorly in exactly the categories where someone who’s had Parkinson’s for twenty years would be expected to do poorly,” Kinsley writes.  “Parkinson’s is a degenerative disease, so things are not likely to get better.” But, he writes, they’re really not so bad now. “How bad could a symptom be if it takes a five-hour test to find it?” Please see this link: http://nyr.kr/1hTItVtF

For those who follow my blog, my interest in this article will be obvious.  Many of the comments in this article resonate with the message in my new Window of Opportunity book.  

I have been thinking about why I wrote this book, which I have tried to explain previously.  It certainly is not meant to create anxiety for PWP's, care partners or their families.  The fact is that most of them are already aware of PD-related cognition issues, either because they have read about them or have experienced them, and are, I believe, interested in knowing more.  I hope that the book sheds light on this discussion that it will be interesting/helpful.  Additionally, by sharing how Linda and I have chosen to deal with these problems, it will give others ideas about how they can approach their own challenges and see that it is possible to continue a happy, productive, and fulfilling life.

I was grateful to receive the following quote from Dr. Michael Okun, Professor of Neurology at University of Florida regarding my book:

"This book by Kirk Hall with a forward by Benzi Kluger, M.D. offers a real-world honest and helpful window into the life of a Parkinson's disease patient who is experiencing cognitive challenges.  There are many useful tips, and also many great stories that will provide comfort to both Parkinson's disease patients and caregivers.  This is just terrific and a really important contribution to the literature.   I highly recommend the book."






Sunday, April 20, 2014

Clinical Research Forum Announcement

Learn more about the state of Parkinson’s research today, the different types of trials and how your loved ones can participate. Speak with some of the most active Principal Investigators in Colorado about their research. Ask questions of Research Coordinators about their ongoing trials. Talk to others who have participated in trials about their experiences. Decide to participate. Make a difference.Clinical trials and studies play a critical role in the development of new and better medicines. Yet, enrollment of patients is one of the top challenges clinical researchers face. Slow and/or low enrollment hinders the research process and deters potential funders from investing in research. Many clinical trials fail to recruit a single subject. Only one in 100 people with Parkinson’s takes part in a trial. We can do better.

When: May 3, 8:30am-12:300pm

Where: Mile Hi Church, 9077 W. Alameda Ave., Lakewood, CO 80226

What: 

8:30      Registration • Exhibits

9:00      Welcome
                    Cheryl Siefert, MNM, Executive Director, Parkinson Association of the Rockies


9:10      Parkinson’s Research: Where We Are Today
                     Rajeev Kumar, MD, Medical Director, Rocky Mountain Movement Disorders Center


9:25      Panel Discussion of Cutting-Edge Research
                     Curt Freed, MD, Professor, Division of Pharmacology and Toxicology, University 
of Colorado Denver
                     Benzi Kluger, MD, MS, Assistant Professor, Department of Neurology, University of Colorado Denver
                     Rajeev Kumar, MD, Medical Director, Rocky Mountain Movement Disorders Center

10:20      Movement Break
                    Meredith Roberts, PT, DPT, Outpatient Rehab Manager, Life Care Center of Aurora


10:40      Rehabilitation and Integrative Medicine Research
                    John Dean, MS, CCC-SLP, Parkinson’s Program Coordinator, Life Care Centers 

                    of America 
                    Cynthia McRae, PhD, Professor, Morgridge College of Education, University of Denver

11:10      Panel Discussion on Deep Brain Stimulation Research
                    Aviva Abosch, MD, PhD, Director of Research and Professor, Departmentof Neurosurgery, 
University of Colorado Denver
                    Monique L. Giroux, MD, Medical Director and CEO, Movement and Neuroperformance Center of Colorado
                    Olga Klepitskaya, MD, Assistant Professor, Department of Neurology, University of Colorado Denver

12:15      Research Fair • Exhibits


Event is FREE, but registration is required

In Collaboratiaon with:

CNI 541 stacked         Davis Phinney Foundation         UCHS-UCH-2c1

Special Thanks to: 

LCCA logo with web address       medtronic medium        Teva greenlogo grey USE THIS ONE

Location : Mile Hi Church, 9077 W. Alameda Ave., Lakewood, CO 80226

Contact : info@parkinsonrockies.org This email address is being protected from spambots. You need JavaScript enabled to view it. or 303-830-1839

Wednesday, April 16, 2014

Window of Opportunity book now available


Window of Opportunity: Living with the reality of Parkinson's and the threat of dementia is now available as a book.  It can be ordered on the publisher website at pygmybooks.com and will be available soon on amazon.com. Ebook versions are available on smashwords.com, amazon.com, and most other online bookstores. I apologize that the book was not available by the beginning of April as I expected, but the publisher ran into unforeseen problems with the book cover.

A webinar is planned for Wednesday, June 4, 2014 at 2 pm Eastern on Webex.  Registration and access information will be available on the Lewy Body Dementia Association (LBDA) website (www.lbda.org) in May.  The goal of the webinar is to give Lewy body dementia (LBD), Parkinson's patients (PWPs) and their caregivers the opportunity to hear first hand from Alexander Dreier, who has been diagnosed with LBD, and his wife, Olivia, about what is like for them and how they deal with this diagnosis.  My wife, Linda, and I will also participate as representatives of the "PD world" and how we are dealing with my mild cognitive impairment (MCI) diagnosis, as MCI is often a precursor to Lewy body dementia (LBD).  There will be an opportunity to ask questions. 

My book tells in detail of our journey with the cognitive issues that are common with PD, my MCI diagnosis, what I have learned about PD dementia (which most often falls into the LBD category) and plans for the future.  

I had the pleasure of meeting Helen and James Whitworth (Jim was one of the founders of the LBDA), authors of the best seller A Caregivers Guide to Lewy Body Dementia (available on amazon.com) at the recent Keystone PD Conference.  They will be publishing a new book in the near future that sheds additional light on LBD and insights that will be of interest to anyone concerned about LBD, including remarks specifically addressed to PWPs and their caregivers.  They have reviewed my book and made these comments:

"When Jim and I met Kirk Hall at a Parkinson’s conference in Colorado, we were impressed with his obvious intelligence and knowledge. When I read his book, that was confirmed, but most of all, I was impressed with his courage and determination. Like others facing the possibility of dementia, he found himself alone. Even his wife could see only the positives at first. Yet, he motored on, seeking a diagnosis that fit his symptoms. In the meantime, Kirk’s book shows that he did all of the physical things that help to keep dementia at bay—things like exercising, yoga, eating right and decreasing stress. But he did more. He improved his quality of life and made his days worth living. He moved closer to his grandchildren, increased his focus on spirituality and reached out to others, teaching and sharing. And then he started writing, joining that small group of men like Dr. Thomas Graboys, Rick Phelps and Charles Schneider who tell about dementia from the inside out. As caregivers, Jim and I can only write about dementia from the outside in. We join all dementia caregivers in our gratefulness to men like Kirk who give of their very soul as they tell us what it is like to feel dementia encroaching. Thank you, Kirk, for your heartfelt story. We recommend it to not only all PD and LBD caregivers, but to the medical community as well."

Helen & James Whitworth

Sunday, April 13, 2014

ON THE MOVE

ON THE MOVE is the quarterly magazine of the Parkinson's Movement.  It is truly global and has a fantastic range of contributors.  Click on the magazine title to download.



Wednesday, March 5, 2014

Parkinson's Global Community Conference


       
                            Event Logo
This conference, which was held March 2-4 at the scenic Keystone (CO) Conference Center, was a huge success.  It was the first time that a conference of this magnitude has been held in the Denver area. or anywhere else as far as I know.  It was made possible by communication between organizers of the Parkinson's Symposium being held at the same time and place and Parkinson Association of the Rockies (PAR) board member, Barbara Mendel.

The conference featured internationally know Parkinson's doctors, scientists, and researchers speaking on topics of importance to the Parkinson's community of  people with Parkinson's (PWPs) and care partners in attendance. Those topics included updates on the latest research and medication developments, caring for caregivers, cognition and memory issues, deep brain stimulation therapy, and dealing with the challenges of life with PD. There were also interesting and helpful keynote presentations and panel discussions.  There was a great deal of emphasis on the ongoing need for patient participation in clinical research trials, information for which is easily and readily available online at foxtrialfinder.com.

In the Denver area, we are fortunate to have many well-respected movement disorder neurologists and neurosurgeons, many of whom were speakers. The sessions held by these doctors focused on information aimed at helping the many patients and caregivers in attendance with improving their daily lives.

I appreciated a presentation by Helen and James Whitworth, co-authors of Caregiver's Guide to Lewy Body Dementia.  Jim created the Lewy Body Dementia Association after he lost his first wife to the disease.  Together, they are committed to helping people understand this disease, which is the second most prevalent form of dementia after Alzheimer's.  Since both types of dementia most often associated with Parkinson's are in the dementia with lewy bodies (DLB) category, this is a subject that anyone touched by PD needs to understand, including risk factors that are different from Alzheimer's.

We were also fortunate to have Dave Iverson, renowned producer of Parkinson's features including My Father, My Brother, & Me who is now a contributing editor for the Michael J. Fox Foundation.  Dave's personal experience, extensive knowledge, and engaging style added greatly to the conference.

Kudos to Barbara Mendel, Cheryl Siefert (PAR executive director), and Cheryl's dedicated staff for planning, organizing, and executing a rewarding experience for all who attended.






Tuesday, March 4, 2014

WINDOW OF OPPORTUNITY UPDATE

One of my earliest posts was written about my experience with Deep Brain Stimulation (DBS) therapy.  Brain surgery is never an easy decision and should not be taken lightly.  I was fortunate that I had almost a year after I was approved for the procedure in early 2010 to "think about it".  During that interim period, something happened that helped me turn a "leap of faith" into a "hop of faith".

During that summer, I learned about a DBS support group in the Denver area.  The purpose of the group was to give prospective DBS patients an opportunity to interact with other patients and caregivers who had already had the procedure.  There was something about input from other people who had faced the same decision that went beyond professional input from doctors.  These people were not shy about sharing the pros and cons as well as how their lives were affected.

A few months after my DBS surgery in 2011, my first PD-related children's book, Carson And His Shaky Paws Grampa, was published.  The book led to unexpected opportunities to speak to PD support groups, first in Denver (where I live) and then in other parts of the U.S.  Very quickly I was pleased to note that fellow People with Parkinson's (PWPs) were clearly listening intently to what I had to say about living with PD and information that I had found to be helpful.  At some of these events I shared the podium with movement disorder doctors.  While the audience clearly valued what they had to say, they seemed to listen to me more intently.  

Now I am in the interesting position of wanting the PD world to know about my new PD book.  It is challenging to try to connect with this audience so that they will be aware of it and understand that the content may be very meaningful to them.  When I am standing in front of them, the connection is palpable, but it is different "from a distance".  If they read the book, they will understand why I wrote it and why completing it became so important to me.  More than anything else, I hope that fellow PWPs, care partners, and the medical/research community will find the book interesting and useful.  If I am really lucky, it will make a difference in people's lives.

When I think back to the response I felt when speaking to support groups, I am encouraged to "push through" the discomfort.  It feels like I am "singing my own praises", which I don't enjoy.

At the same time, like most people, I enjoy and appreciate positive responses.  With that in mind, I am going to share two responses to the book.  The first is written by a PWP friend who Linda and I have gotten to know as a fellow Parkinson Disease Foundation (PDF) Research Advocate (she is on the board).  With her approval, the publisher is using her comments as a synopsis for the book:



"Window of Opportunity" is the story of one person’s journey through the initial signs of cognitive impairment associated with Parkinson’s disease and the uncertainty of a future that includes a significant probability of dementia. Kirk Hall, only 59 at the time he began noticing small signs of mild cognitive impairment, tells his story with directness, candor, sensitivity and humor.  He describes the long and challenging visits to doctors seeking answers to his disturbing symptoms and the confusion caused by conflicting opinions about the nature and progression of his disease. His journal notes allow him to describe in vivid detail his slowly coming to grips with disability and the increasing lifestyle changes required to offset progressive cognitive difficulties. He shares the internal struggle, anxiety and stress that uncertainty causes, not only for himself but for his family as well.

The book is a tribute to someone who is able to maintain a positive orientation despite the threat of something as devastatingly frightening as dementia. It is also a journey of discovery as Kirk transitions into the healing aspects of giving back to the Parkinson’s community through helping others and sharing his story. Indeed the reader will take away important insights into the importance of keeping a patient journal, patient self-advocacy, and shared decision-making. And, perhaps most powerful of all, are the insights into how dealing with the potential for a terminal diagnosis can turn into a “window of opportunity” to contribute in a meaningful way to the body of knowledge about a disease and to help others on a similar path.
Diane Cook

The second is actually the foreword written by my doctor and medical adviser for the book, Benzi Kluger.  I was extraordinarily moved by his comments:


The first time I met Kirk Hall was in November of 2008. In retrospect, I think it is fair to say that this meeting shaped both of our lives in ways that neither of us would have predicted at the time. I think it is also fair to say that it began a relationship that has moved far beyond what I learned about in medical school classes on communication as the "doctor-patient relationship."

I was just four months into my grown-up job as an assistant professor of neurology at the University of Colorado following more than ten years of school, residency, and fellowships. Despite all this preparatory work, I was still very much in the midst of figuring out what I was doing with my career. Still, I was not totally without direction. Having done fellowships in behavioral neurology (the neurology of problems with thinking, memory, and behavior, particularly dementia) and movement disorders (the neurology of problems with motor control, including tremor and Parkinson's disease), I was committed to doing work at the crossroads of these two fields. Being done with training meant that it was now up to me to determine what that further work would look like. I had just started doing research on non-motor symptoms in Parkinson's disease. Although this may sound focused, non-motor symptoms refers to any and all symptoms other than shaking, slowness, and stiffness (e.g., thinking and memory problems, hallucinations, depression, anxiety, constipation, pain, fatigue, insomnia, etc.).

Kirk was also at a crossroads in his life. He too was at the beginning of a journey that would involve the meeting of behavioral neurology and movement disorders. And despite the fact that he did not choose the medical conditions that led to our meeting, he too was faced with the dilemma of how he was going to live his life with them. Kirk was referred to me by the movement disorder neurologists who were taking care of his tremor to deal with his non-motor symptoms, which at that time included changes in thinking and memory, fatigue, and depression. Although I'm sure my notes from that visit contained a wealth of medical information, including his physical examination and neuropsychological test results, I don't think those notes (or most medical records, for that matter) captured what was really important in our interaction as people.

To begin with, the notes imply that I (the physician) am the expert and Kirk (the patient) is the beneficiary and subject of my knowledge. I think one of the many values of this book is that it turns this common wisdom on its head. Kirk lives with the symptoms I read and write about. He is an expert on this subject because he is the subject.

I remember that Kirk was anxious, and that his anxiety was centered around the changes he noticed in his thinking and memory. Scared may be an even better word for what he felt, as it implies a normal reaction to something scary rather than an abnormal reaction to something that should be easy to accept. For many people, the prospect of losing one's memory, of someday not recognizing your spouse and children, is more frightening even than death. Kirk was not afraid to be vulnerable and share his fears with me then, and he was equally candid when I invited him to speak as part of a patient roundtable discussion in front of 60 doctors and other health care providers. This vulnerability has been one of his many gifts to me and the Parkinson's community, a gift that was a driving force for this book: to take those parts of Parkinson's that are scariest and talk about them openly.

I remember reassuring him at that time that he did not have dementia and that I expected he would have many good years ahead of him. I think it was during this discussion that he first brought up the idea of writing a few books and that I first encouraged him to do so. I could tell him he had a window of opportunity that he could choose to use, but neither of us could know how long it would last. Kirk didn't just take the opportunity, he ran with it. Since that meeting he has led two Parkinson's support groups; written three books; and become an advocate for Parkinson's research, a blogger, an advocate for patients, and a national speaker. This book is important not just for the messages it contains, but as a message itself: an inspiring example of opportunities seized from a place where many would have given up hope.

Kirk is a deeply spiritual man who values his faith and draws upon it as a source of strength and inspiration. To talk about such things in our secular age seems taboo, particularly in a book on a medical topic. But despite the increasing use of technology in medicine, doctors ultimately take care of people, not diseases. When dealing with serious, progressive, and life-altering illnesses, caring means asking people about their hopes and fears, understanding their beliefs, and helping them reconnect with their sources of strength and meaning. This type of work is not currently well supported in our medical system, as it (of course) takes time, has no insurance billing category, and is not for the weak of heart.

Since my first meeting with Kirk, I have gone on to obtain grant funding to better understand the causes of dementia in Parkinson's disease, with the goal of developing improved treatments, and have started one of the first team-based palliative care clinics for Parkinson's disease in the United States. Kirk has become a local and national leader as a patient advocate. I am proud to write the foreword to this book and hope that Kirk inspires you as much as he has me.
Benzi Kluger, MD, MS
Associate Professor of Neurology and Psychiatry
Director, Movement Disorders Center
University of Colorado, Denver
August 2013

Window of Opportunity: Living with the reality of Parkinson's and the threat of dementia is now available in ebook formats at smashwords.com and most other major online retailers for $5.99.  It is not yet available at amazon.
Pygmy Books is taking preorders at pygmybooks.com for shipment in late March.  The book price is $14.99.