Our support group has been discussing vision and because of the
interest shown follwing my post here on PIEN re vision and contrast, I
dredged up the following from my files.jmr

Posted to PIEN, February 1996...

An Accident Waiting To Happen - by Alan Bonander
        Recently I accompanied Tom Riess on a speaking trip to Phoenix and
Tucson. I took advantage of the trip to see Dr. Matt Kurth at Barrow
Neurological Institute in Phoenix. I was a participant over three years
earlier in a study on duodenal infusion therapy conducted by Dr. Kurth.
I had three problems plaguing me and I hoped Dr. Kurth had some answers
for me.

My First Fall
        The first problem was really a scare. I missed a step and fell as I
exited the front door of my house. I was carrying an electric shaver. I
landed on my elbows on cement holding the shaver high. This was the
first time I had fallen where I knowingly made no attempt to break my
fall. I recall the fall clearly. In the short time that I was falling, I
recall wondering why did I not try to catch myself. Afterwards, all I
could think about was that this was my first PD related fall. Was
this the beginning of a PD balance problem? Had my PD progressed one
more step? Dr. Kurth looked at me and said, "First, Alan, your lack of
response was normal."  He went on to say that from early childhood we
are taught that should we ever lose our balance while carrying
something, we should fall in such a way as to not spill, drop or break
what is in our arms. How we land is unimportant. Our body easily
absorbed any shock in those days. I was protecting a measly shaver using
a  learned-from-childhood response. As we grow older our bodies cannot
absorb the impact when we fall. My new response needs to be - drop what
I am holding and use my arms to break my fall. I need to make these
changes before PD seriously enters the picture.
Teaching this old dog new tricks will not be easy.

Kissing Tailpipes
        The second problem happens when I am driving my car. The scenario goes
something like this: I have just exited the freeway and a stop sign
exists at the end of the long exit ramp. There are about eight cars
ahead of me. The car at the stop sign goes and each car waiting moves
one car length closer to the stop sign. When the car in front of me
moves up a car length, I will move up one car length also. However, on a
number of occasions, the car in front of me moves up and I move up and
fail to stop. I try to occupy the same space as the car ahead of me.  I
am going only 3 - 4 miles per hour and no damage has resulted to either
car. It is embarrassing to say the least.
        The answer to why this happens may lie in the work Tom Riess is doing
on visual problems in PD. I remove my foot from the brake and slowly the
car moves forward. Because the motion is so slow, the visual system does
not perceive the motion until I come to a jerking halt on the tailpipe
of the car ahead of me.
        Motion is detected by the peripheral vision system.  The visual system
is rich in dopaminergic neurons. Researchers are saying there is a
dopamine deficiency in our vision. Thus, my eyes may detect the motion
but are slow to inform the brain. At 2 to 3 miles per hour everything in
my visual environment is almost motionless.  Not until I hit the car
ahead of me do I get the motion message. By that time it is too late.
The next picture I have is either that of hitting the car in front of me
or my front bumper is about to kiss his tailpipe.
        This problem seems to happen more often when I am under-medicated or
just starting to come "on". I initially thought my eyes were going in
and out of focus. Even when my eyes are out of focus I am aware of
motion.
        Changing prescription eyewear has little or no effect on this problem.
There is no quick fix to the problem, just a realization that slow
movement can be a problem. Others have mentioned that they have similar
problems. Their solution is usually to increase the distance between
their car and the vehicle ahead of them. I hate to think what might
happen should I hit the car ahead a second time.

Dreamland on Wheels
        The third problem is very serious - a potential killer. Simply stated,
I can become extremely sleepy while driving. I become so sleepy that my
eyelids feel like heavy garage doors and I cannot keep them open.
Eventually the eyelids cover the eyes and I fall asleep. It may be just
a fraction of a second or maybe longer. At 70 miles an hour in the
center lane of a busy freeway, any amount of time my eyelids are closed
is too long. Once this happened as I was driving on a freeway in the
right lane. Suddenly there was the sound of truck horns and car horns. I
had fallen asleep, crossed the left lane and was driving on the shoulder
between the highway and one of the California aqueducts. I pulled over
to the side of the road and stopped. I
offered a short prayer. When my wits returned I started driving again -
this time wide awake.
        Dr. Kurth stated that falling asleep at the wheel is far too common a
cause for fatal accidents. Parkinson's disease and other diseases are
known to have the adverse side effect of sleep deprivation.  Dr. Kurth
said there is one point in the medication cycle when I am very
vulnerable to falling asleep. That point is when I cross from an “off”
state to an “on” state. In the “off” state my muscles are tight,
movement is slowed and there may be pain. As I cross to the "on" state,
there is a rush of relaxation. The muscles relax, movement becomes
normal, even pain
disappears. This euphoric state must send a message to the sleep center
because it is at this time that sleep seems to dominate my life. This
rush feels so good that the next event I remember is waking up.
Obviously driving a car during this relaxation rush could be fatal.
        Overcoming this problem is not easy. I need to make sure my medication
level does not change significantly while driving. It is preferable to
do all my driving in an “on” state. That way the need to sleep due to
coming “on” should not happen. Better yet, leave the driving to a
non-parkinsonian whenever possible. I am very serious.  Ever since I
started telling others about this problem, people are reluctant to ride
with me. They should have been reluctant to ride with me before I knew
the cause of my problem. I must admit that since the meeting with Dr.
Kurth I
have significantly reduced this problem. I try never to start driving
the car in an “off” state. Should I feel a drowsiness state coming on I
pull off the road and stop. I will switch driving with a
non-parkinsonian whenever possible. First, sleep is always welcome and I
want to enjoy every moment. And second I want to wake up in this world.
A special thanks to Dr. Matt Kurth for his sound advice.

(Alan Bonander, a past president of the Young Onset Parkinson's group in
California, was born May 14, 1940, and died August 1, 1996. He had PD,
diagnosed 12 years ago, but it was asthma that caused his death. Alan
had a pallidotomy in Sweden in 1993.)

        Wherever you are, Alan, God Bless....and thank you.
Judith

--
All information is intended for your general knowledge only and is not a
substitute for medical advice or treatment for specific medical
conditions.

Judith Richards, London, Ontario, Canada
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