PARKINSON'S  NEWSLETTER [edited to exclude most regional items] of the
Delmarva Chapter, American Parkinson Disease Association
November 1995  -  4049 Oakland School Road  Salisbury, Maryland 21801-2716
1-410-543-0110
FAX (410)749-1034    PRODIGY PNFX85A    AOL  W I L L M M S J
DOMINIC CITRANO: Dominic Citrano of Ocean City, one of our most faithful
members, died October 20 at the Salisbury Nursing and Rehabilitation Center
after a long battle with both Parkinson's disease and diabetes. Many
memorials in his memory have been received by the chapter. This issue of the
Parkinson's Newsletter is being published in Dominic's memory.
VETERANS OF FOREIGN WARS DONATE $1,000.00 -Veterans of Foreign Wars Meuse
Post 194(Salisbury, Maryland, just off Route 50 near the former Dockside
Murphy restaurant) made a thousand dollar contribution to our chapter in
October. This gift to us was the result of groundwork done by Bob and
Kathleen Holland and their friends Tom and Anna Morris. The State of Maryland
requires private clubs with slot machines to donate half of the slot machine
profits to charitable organizations. We will put the money to good use.
FAIRFAX SYMPOSIUM - Video tapes of talks by Parkinson's disease specialists
including Dr. Mahlon DeLong, Emory University's pallidotomy expert, was the
feature portion of the Nov. support group meeting. Dr. DeLong went to Emory
after leaving Johns Hopkins. Lou and Dora Moses were at the Washington Area
symposium held in Fairfax and are supplying tapes made there and sold by the
Washington Area support groups.
The pallidotomy surgical team from Emory has done far fewer pallidotomies
than Dr. Robert Iocono and his Loma Linda team of Primetime Live fame. The
Emory team is reported to be more scientific in their approach and
post-operative follow up and to be less daring in that Emory will make a
lesion on only one side at a time. The Emory approach is the one followed by
Johns Hopkins, University of Virginia, and Graduate in Philadelphia.
There are also other taped presentations covering exercise and physical
therapy, the clinical depression that often may accompany Parkinson's, and
the current thinking in controlling Parkinson's through drug therapy.
IT'S NOT TOO LATE FOR YOUR FLU SHOT! Flu shots do not guarantee that you will
not catch the flu, but they are still recommended. The 1995-96 influenza
virus vaccine contains antigens for the A/Texas, A/Johannesburg, and B/Harbin
flu strains. There are other flu varieties around. Authorities think this
year's vaccine will provide protection against the most likely flu strains
and reduce the severity of other closely related strains.  Side effects of
flu shots are infrequent and usually mild. People who are sensitive to
chicken eggs or with a history of bad side effects from past flu shots should
get expert advice before getting a new flu shot. Getting a flu shot after
contracting the flu is usually too late. The vaccine requires some time in
the body to become effective. Antibiotics are ineffective in fighting viral
influenza or simple colds. The late Dr. Linus Pauling recommended that at the
first symptoms of a cold, one should take 2,000 mg of vitamin
C every two hours. This may abort a cold but not a sore throat.
Pneumonia shots are vital to Parkinson's people. Our death rate from
pneumonia is over three times that of the general population. We have been
told that one pneumonia vaccine shot will provide protection for a lifetime,
but now some authorities say the pneumonia vaccine shot should be repeated
every five years. An extra pneumonia shot every five years is probably a good
idea for us in the high risk category even if we find later that it wasn't
needed.
The best protection against any infectious disease is one's own immune
system. There are three steps to follow to keep your immune system in working
order: Practice good health habits, eat a healthy diet, and take a few years
off your age. If you can't do all three, do the best you can with the other
two.
COMMUNICATION PROBLEM? PUT ON A [WordPerfect 5.1 ctrl v 5,7  or ASCII 1]
Much has been written about the speech problems connected with Parkinson's,
and we have had a speech and swallowing therapist speak to our group.
Non-verbal communication which can be very expressive has been relatively
ignored.
An article titled "Emotional facial imagery, perception, and expression in
Parkinson's disease" by Dr. Daniel H. Jacobs and others in the September
issue of Neurology found that  Parkinson's patients are, on average, less
able
to communicate by facial expression - incoming as well as outgoing - than
other people. The 'outgoing' was expected since we are relatively famous for
the Parkinson's mask - the lack of expression on our faces. Our reduced
ability to perceive or interpret the facial expressions of others was a
surprise to me, but my face probably did not show it.
Parkinson's patients were tested for ability to distinguish one face from
another. They were shown photographs of pairs of faces and asked if the two
faces belonged to the same person. They performed a little worse than
non-Parkinson's patients, but they could still recognize faces pretty well.
In the next test Parkinson's patients were tested for the ability to detect
emotions (happy, sad, angry, frightened, or neutral) in faces in pictures.
They were shown photographs of two faces and were asked if the two faces
showed the same emotion. They did poorly.
Then the Parkinson's patients were given a picture of a face and asked to
choose among five other pictures to find the one expressing the same
emotion. They performed worse than the control group.
In the next test Parkinson's patients were asked yes-or-no questions about
facial characteristics shown in various emotions (such as 'Are the lips
curled up?'  'Are the eyebrows drawn together?') with the proviso that they
could not make faces to figure out the answer. They performed sub-stantially
worse than the non-Parkinson control group. The next test involved the
identification from memory of objects instead of faces and emotions, and they
out performed the non-Parkinson's group, but the difference was not
statistically significant.
In the next test Parkinson's patients were asked to make faces themselves,
reflecting different emotions.The faces were videotaped and judged on the
basis of correctness and intensity by graduate student judges. There was a
trend toward fewer correctly expressed emotions by the Parkinson's patients,
and they performed much worse than the control group in intensity of emotion
expressed. Their greatest deficits were in sad faces and angry faces rather
than in happy or frightened faces. There was no test of intensity of neutral
facial expression where they might have excelled.
Women are typically stereotyped as being better able to express and interpret
facial emotions, but this study found no difference between men and women.
The severity or progress of Parkinson's disease logically should make a
difference in the ability to make faces, but this study found no significant
differences based upon the Unified Parkinson's Disease Rating Scale. Time
since latest medication or type of medication used by the patients was not
considered in the study. Most testing was done during morning ~office hours,~
and it took about two hours to complete the tests for each patient. Over a
two hour period, a Parkinson's patient could well go from an extreme
~on~ to an extreme ~off,~ particularly with the stress that accompanies
almost any testing. A good friend who is a professional linguist can readily
detect changes in my voice as I progress from "on" to "off" and back to "on."
I have learned through experience to detect "on" or "off" in Parkinson
friends from their voices, particularly over the telephone. A study similar
to this one using Parkinson's patients when "on" as the control group for
testing the same group when ~off~ could be an interesting study.
The 5+ page article and its reference citations is tough reading and not
recommended for the casual or recreational reader.
The purpose of the article was primarily to show that the source of expressed
facial emotion imagery is partially in the basal ganglia (where there is a
shortage of dopamine for us) and therefore not limited exclusively to the
right side of the brain.
The article also suggested that incoming and outgoing communication may be
closely related. Perhaps a person who does not frown or cannot remember the
look of a frown cannot easily recognize a frown on another's face, and
vice-versa.
Although this research seems esoteric (determining whether or not emotional
facial imagery is confinedto the right side of the brain), there are some
useful ideas for us and our friends and families.
 At least part of the stoicism attributed to the Parkinson's personality may
be an inability to express emotion rather than a lack of emotion.
 Insensitivity to the feelings of others may be a problem of not knowing
instead of not caring.
 Failure to understand what is meant may not mean that the words used were
not understood. It may come from failure to comprehend from the speaker's
face how they were intended to be understood.
 Intentionally over-emoting by the Parkinson's patient may convey a
relatively normal level of emotion understandable to family and friends.
 Intentionally over-emoting or putting one's feelings into words can help the
Parkinson's patient to not miss the intent of visual cues that facial imagery
normally conveys.
In a phone conversation, Dr. Jacobs said that plans are being made to use
this series of tests pre and post pallidotomy to see if pallidotomies have an
effect on expression or recognition of emotions.
 
No [WordPerfect 5.1 ctrl v 5,26]. [ctrl v 5,7]] Yes!
 
LOWER DELAWARE GROUP MEETS DEC 3 - The Lower Delaware Support Group will meet
Sunday December 3 in the Harrington Senior Center in Harrington at 2 pm. The
program will feature musical selections by Michelle Oswell and Rob Tilton to
introduce the Christmas season. For more information, call Mrs. John (Mary)
Rohland at 202-698-0302.
 
Will Johnston