Transcription:
Parkinson’s Disease Signs and Symptoms: Before the Diagnosis

Deborah Howell (Host):   Hello, and welcome to the show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Mindy Bixby. Dr. Bixby is a neurologist with the Parkinson's and Movement Disorder Institute at Orange Coast Memorial Medical Center. She received her medical degree is Osteopathic Medicine at Touro University in California. She completed her neurology residency and fellowship training in movement disorders and neurorehabilitation from the Georgetown University National Rehabilitation Hospital. Dr. Bixby is a three-time recipient of the String of Pearls Award from Georgetown University Medical School for exhibiting humanism and excellence in teaching. She is involved in research, developing new therapies for Parkinson's disease and other movement disorders, and has a special interest in exploring neurorehabilitated modalities to help patients improve functional independence. Welcome to you, Dr. Bixby.

Dr. Mindy Bixby (Guest): Hello. Thank you so much for having me.

Deborah: Today we're going to be talking about Parkinson's disease, signs and symptoms before the diagnosis. So from the get go, let's start at the beginning, what is Parkinson's disease?

Dr. Bixby:   Well, Parkinson's disease is a progressive disease of the nervous system chiefly affecting middle-aged and elderly people. However, there are a percentage of people who have an earlier onset of the disease. It is associated with degeneration of neurons in the deep structure of the brain called the basal ganglia. An area of the basal ganglia makes the neural transmitter called dopamine. Parkinson's disease occurs when you are dopamine deficient.

Deborah: I see. We all know dopamine is a very good thing. What benefits does it give us?

Dr. Bixby: It allows us to control our movements. If it's lacking quite a bit, you can actually notice that you may have some emotional changes within you or cognitive changes. Your thinking processes may be a little bit less.

Deborah: Okay. That leads me to my next question about the initial signs and symptoms someone might experience when they have early onset of Parkinson's.

Dr. Bixby: Yes. Disease often manifests itself with either tremor, which are movements of the hands or feet at rest; slowness of movements; balance problems; changes in walking, falls, decreased arm swing on one side of the body, a feeling of instability, or walking slower with smaller steps; or they may even experience stiffness which can be sensed as tightness in the arms or legs, or heaviness or a feeling of weakness.

Deborah: Does it affect your personality in any way?

Dr. Bixby: It can over time. That's actually known as something called the non-motor symptoms of the disease. Individuals can usually seek medical attention when they start seeing the motor fluctuations of the disease. However, many non-motor symptoms can be present for many, many years prior to the motor manifestations of the disease.

Deborah: Okay. Did you describe most of the non-motor, or are there more non-motor symptoms?

Dr. Bixby: There's many more, and they can be very subtle and be confused with other disease processes not related to Parkinson's disease, such as constipation; lack of smell or a low ability to smell, can't smell things that you used to; sleep disturbances, such as acting out in your dreams or more vivid dreams or difficulty falling asleep or maintaining sleep; also, excessive need to go to the bathroom, such as urgency, frequency; or changes in mood or thought processes, like we talked about before.

Deborah: Amazing that the little ganglions in the brain control all of that.

Dr. Bixby: Absolutely.

Deborah: I'm sure it's not the most pleasant disease to encounter both in yourself and those you love. What are the other symptoms that Parkinson's can be confused with?

Dr. Bixby: Well, constipation, you can think that you just have constipation. A lot of people have constipation out there. They don't drink enough water or enough fiber or not taking care of their diet. That could be one of the manifestations 10, 15 years before you ever have the motor symptoms.

Deborah: Really?

Dr. Bixby: People may think that they have a nasal infection because they're not able to smell the garlic that they're used to smelling before. Mood changes, just feeling like they have anxiety just simply because their life has been hard or there are things that are changing in their body and they're not really thinking about that and maybe thinking that maybe it's just they're getting slow or they're getting older. Those are some of the things you think about.

Deborah: I'm so glad we're getting better at diagnosing this because that must be so incredibly frustrating.

Dr. Bixby: Absolutely.

Deborah: So at what point would you recommend someone see a physician for a referral to a neurologist specializing in movement disorders?

Dr. Bixby: Well, at the onset of the movement disorder, symptoms would be one. Or if the patient or loved one feels that the treatments they are receiving are not adequately controlling their symptoms, or if the patient simply feels that they need a second opinion on their diagnosis.

Deborah: So this is pretty much after they've been diagnosed with Parkinson's that they would go to a neurologist?

Dr. Bixby: Not necessarily. It just depends. We have a lot of general neurologists that do diagnose Parkinson's, and some of the primary care doctors are able to diagnose it. But sometimes they actually send a referral to us to actually really hone in on the diagnosis before they give the patient this information. So it really just depends on how comfortable the primary care doctor or the neurologist is with diagnosing this with the patient.

Deborah: Okay. Once we have a diagnosis confirmed, what are some of the treatments to help manage the symptoms in the early stages and even in the more advanced stages?

Dr. Bixby: The nice thing about it -- and hopefully everyone out there doing this is having a multi-disciplinary approach to this patient. These include neurologists, neurosurgeons, neuropsychologists, as well as other healthcare professionals such as physical, occupational, and speech therapists. We all work together to find the right combination of therapies and treatments that help tailor the individual needs of the patient. Again, like we talked about before, Parkinson's disease is a dopamine deficiency, and so the idea is we use medications that help supplement the dopamine in the brain, whether that be a synthetic form called Sinemet (carbidopa-levodopa), an enzyme inhibitor that stops the breakdown of the dopamine, or maybe a lookalike drug.

Deborah: Okay.

Dr. Bixby: If the modes of fluctuations are not being controlled or the medication is no longer optimally controlling their system, we may discuss a surgical option known as the brain stimulation for our patient.

Deborah: Okay.

Dr. Bixby: Deep brain stimulation is the surgically implanted device called a neurostimulator, kind of like a heart pacemaker that delivers electrical stimulation to the targeted area to control movements, of which we call electrical dopamine, which has been amazing for a lot of our patients.

Deborah: It just sounds like a revelation.

Dr. Bixby: It's fantastic. It's amazing and I've been very lucky to be a part of this revelation. It's been around for about 15 years in the United States, and it's amazing how much it helps patients.

Deborah: It used to be used for depression, right?

Dr. Bixby: No. It's been used for essential tremor. They're looking at depression as being one of the targets for DBS, but that is not FDA approved.

Deborah: I see. Okay.

Dr. Bixby: And at this point, it's approved for dystonia, essential tremor, and Parkinson's disease.

Deborah: Okay. Well, it's a whole new frontier, and we can see the big elephant in the room is always Michael J. Fox when we're talking about Parkinson's disease. You can see that there can be life and humor and work and family and love.

Dr. Bixby: Absolutely.

Deborah: And I know that MemorialCare has various support groups and exercise programs for a Parkinson's patient and their caregivers. Maybe you could explain the importance of group support and exercise, not only for the patients but also for their caregivers and their spouses.

Dr. Bixby: Absolutely. It's an amazing thing that MemorialCare has. The groups are open to patients, their families, and their caregivers, and the goal is to inform them, educate them, and support individuals with Parkinson's and their families. The beauty of these groups allows for a sense of community with each other and the importance of stressing that the patient is not alone in his/her disease. It absolutely takes a village for the success of these patients, and we want to be there for them, and these support groups are amazing. I believe knowledge is definitely power. We also have exercise, which I think are a huge benefit for our patients. It does give them a chance to move their bodies and create friendships and engage in the community. It also provides a social environment. Some of the patient feedbacks that I have received an overall feeling of well being in a controlled environment. I'm a huge advocate of exercise, especially in patients with Parkinson's, and research has shown that exercise may slow the progression of the disease and overall improves stamina, cardiovascular health, and improvement of the quality of life. There is the old saying, "If you don't use it, you lose it."

Deborah: You lose it.

Dr. Bixby: That's true for the population of people.

Deborah: Well, it sounds like a really wonderful time to be involved in the work that you're doing with your patients and their families, and I want to thank you so much, Dr. Bixby, for taking the time to talk to us today about Parkinson's disease and what's on the horizon.

Dr. Bixby: Thank you. I really appreciate your call. Thank you.

Deborah: It's been wonderful to have you on this show. I am Deborah Howell. Please join us again next time. We're going to be exploring a wide variety of topics this fall. Next week, it's another Weekly Dose of Wellness brought to you by MemorialCare Health System. In the meantime, have yourself a fantastic day. Get some exercise, be with those you love, and thank you so, so much for tuning in. Bye-bye.