Last week,Aliza and I attended a 5 day "vacation PD seminar" in Zichron
Yaakov,Israel.We would like to share some of our experiences with the PD list.
The Seminar was organized by The Israel PD Support Group,POB 635,Kiryat
Bialik 27100,Chairman,Mr Yitzchak Mechraz,Vice Chairman,Dr.Dan Nir based
in the Haifa area with branches in Jerusalem,Emek Yizrael,and Tiberias.Tel
Aviv has about 800 members in its support group but they are not active and as
far as we could learn did not participate in this seminar.Dr. Nir Giladi is the
medical advisor to the group,and was instrumental in initiating the group.There
were 80 attendees consisting of PWPs and their CGs.

The program included:
A workshop for PWPs and their CGs,Arts and Crafts,
Exercises with music and games,lectures by the top Israeli Neurologists,
physical Therapy,Diet,Adapting of the home to physical disabilities,
Reflexology,Shiatsu,hydrotherapy,a fashion show,a lecture on the Bedouin
culture and their health folklore,sports,Cosmetics,and Chiropractic therapy.
We met interesting people.There was entertainment every evening.On thursday,
we had a guided tour of Zichron Yaakov,a small coastal town south of Haifa
famous for its Rothschild Winery.We also visited a Diamond Jewelry factory
and showrooms at nearby Tirat Hacarmel which sponsored our tour.

Dr Nir Giladi,head of the Neurology Dept. at Ichilov Hospital in Tel Aviv gave
the lead-off lecture which was attended by Member of the Knesset,Gideon
Ezra,who later queried the PWPs and their CGs regarding ways the Knesset
could help.Dr. Giladi stressed the maintenance of quality of life for the
PWP and
CG working together to enhance the health of the PWP.He touched on new
developments in PD research which included:PD effects on the autonomic
system(e.g.digestion,smell,heart,respiration,urination) and diagnostic
techniques.
He emphasized that PD encompasses a family of syndromes.
As a consequence,treatment choices depend upon PD type.e.g.Transplants are
only good for certain types of PD.Thus MSA(Multi-System Atrophy) which
occurs in about 25% of PD cases can't be treated with fetal transplants.PD may
have genetic correlation,but not MSA.He described PSP(Progressive
Supernuclear Palsy).One of the severely-disabled attendees
in a wheelchair has PSP which was caused by an automobile accident.
He emphasized the importance of walking at least 45min per day,and exercise in
order to keep the body reflexes active,speech degradation and speech
therapy,memory strengthening techniques(if you don't use it,you lose it).

Some of the issues mentioned with Gideon Ezra were:Financial support for care
giving to severely disabled PWPs,a PD hotline,PD research , PWPs in the
workplace,medical insurance and coverage,the establishment of a PD lobby in
the Knesset.

Naomi Klarfeld,the support group physical therapist gave several dynamic
exercise classes.Naomi recently published a PD exercise  book in Hebrew
and a companion videotape for the PD support group.We attended twice and
took pictures.

There was a session on adapting the home for the movement disabled.
The first part was given by a social worker who described the help that the
government and the various health plans can give in the determining specific
needs,consulting services,and financial aid.
The second part was given by lady from a government office which deals with
supplementary help.She got into specifics such as steps,ramps,bannisters,toilet
aids,bathtubs,faucets,doorways,sinks,telephone in bathroom,kitchens.
She illustrated specific modifications.
An action item for us is to obtain a consultation through our local social
worker
and come up with a plan to modify our home in stages as anticipated including
info on costs,materials,and implementation details.We obtained reference
sources
on design solutions and learned where to see actual equpiment and accesories.

There were a number of classes doing arts and crafts which included drawing,
sculpture,and the making of puppets.Some of this work will be exhibited at the
Annual Support group meeting on July 10th at the Carmel Hospital in Haifa.

In the Reflexology lecture we learned about the correlations of different
parts of
the bottom of each foot with different body parts and how the therapy is
performed.
For an introduction,see Inge Dougans,Suzanne Ellis,Reflexology,Foot Massage
for Total Health,ppbk,Element,Inc.1991.

Dr. Honigman ,Head of the Neurology Dept. at Carmel Hospital in Haifa gave
the second lecture.It was a tutorial lecture which reviewed PD treatment
techniques.
1.Pharmacological Treatment
  L-dopa
  Dopamine agonists
  Amantadine
  Anticholinergics
  MAO B Inhibitors
  COMT Inhibitors

2.Surgical Treatment
  Thaladotomy
  Pallidotomy
  Deep Brain Stimulation
  Transplants

3.The Multi-disciplinary Treatment Team
  GP,N,PTs,SG,CG,Nurses

There was a panel discussion on Treatment Algorithms.The panel consisted of
two neurologists,a social worker and a PD nurse from the Carmel Hospital.
They discussed the use of apomorphine shots,relations between L-dopa
treatment and blood pressure,a publication by Yehudit Mechraz on PWP Rights
in Israel,Controlled Release Sinemet,Selegeline vs Pergolide,Is L-dopa
toxic?,Bromocriptine vs Pergolide.

The third lecture was given by Dr Yehudit Aaron,Neurologist from Rambam
hospital,Haifa.

She talked about the effects of PD on Cognition including:
Ability to learn new material
Short-term and long-term memory
Ability to concentrate
Associative memory
Memory of independent events and information
Recall and recognition
Ability to access stored information
Ability to jump quickly from one topic to another
Response slowness
Difficulties in planning ahead
Difficulties in planning complex tasks
Effects of tranquilizers,e.g.causing confusion
She referred to two books:
The Rain Man
The Man who Thought His wife was a Hat

There was a presentation by a two young Chiropractors from the U.S.
They discussed the role of the vertebra in health and "Dis-ease".
They used the term "Subluxation"in connection with misalignments of the
bones.They referred to displacement of the "Medulla Obligata"as causing
reduction of Dopamine in the brain.I missed the part where they dealt with PD
therapy.

The fourth lecture was by Prof Rabai,Director of the Neurology Dept. At Asaph
Harofe Hospital since 1995.He has been involved in neurochemistry research at
NPF,NYU and in Tennesee.
He talked about drug side-effects;e.g.cold and clasping fingers as a side
effect of
Dopamine Agonists such as Pergolide.He referred to 50% PWPs having ON-OFF
effects within 5 years.

Meds reduce OFF but don't improve ON.e.g. use of Carborgaline,which will be
available within a year in Israel.He also spoke of Ropinerol,Pramipexole,and
Raselegiline.The latter is being developed in Israel and will be available in
about two years.It is an MAO inhibitor which delays the operation of the
Dopamine so that it lasts longer.An advantage of Raselegiline is
that it does not cause the generation of Amphetamines which are addictive as
does selegiline.He referred to the development of Liquid Levadopa by an Israel
 team at Beilenson,Rambam and Ichilov Hospitals.
He referred to Motillium for reducing nausea side-effects.
He mentioned Nomiphensine,a new drug whose trials are scheduled to begin in a
year,which acts like cocaine as a Dopamine blocker.
He defined a YPD(young PWP) as a PWP younger than 70.
He talked about pallidotomies.He doesn't favor two sided pallidotomies.He
talked of successes with fetal transplants showing Dopamine concentration
increase after three years,based on PET scan measuremnts.
He pointed out that 8 embryos are needed for each transplant.
There is research on artificially generated embryos.He pointed out that
transplants are not done after a pallidotomy.

Interacting With other PWPs and CGs

Dr. Dan Nir is a Physicist with PWP and follows recent PD research.He had a
number of interesting papers and books with him.I copied chapters on PD
from the following references:

1. R.L.Adams,O.A.Parsons,J.L.Culbertson,S.J.Nixon,Neuropsychology for
Clinical Practice,Etiology,Assessment,and Treatment of Common Neurological
Disorders,American Psychological Association,Wash.,D.C.1996.ISBN 1-55798-
298-8,Chap.9,pp 243-267.
Chap.9 deals with PD.It reviews diagnosis criteria,classification of
Parkinsonism,epidemiology,and Etiological
Concerns,Genetics,PathophysiologyImaging
Techniques,Symptom Presentation,
 Prognosis,Neuropsychological Studies,dementia,Neuropsychological
Assesment,Rating scales for assessing level of disability,Treatment.

2.Neurological Rehabilitation,D.A.Umphred,Editor,3rd Edition,Mosby-Year
Book, 1995.ISBN 0-8016-7925-7,Chapter 21,Basal Ganglia Disorders,pp 615-640.
Chap.21 discusses PD Symptoms:Bradykinesia and
Akinesia,Rigidity,Tremor,Postural Instability, Gait,Attentional and Cognitive
Deficits,Pharmacologocal Considerations,,Medical Management,
PWP Evaluation,Treatment Goals,and Procedures.

A lady in her early fifties(I guess) was diagnosed with PD 9.5 years ago and is
doing well with only selegiline twice a day and no levadopa.She swims and
exercises regularly and from her appearance one would not know she is a
PWP.She traveled to Baden,Switzerland a few years ago where the Dopamine
loss in her brain was estimated as 70%.She is a patient of Dr. Giladi.

A man in his 70s diagnosed 9 years ago takes Dopicar and sinemet every hour
and one half and is in a much more advanced stage.

A lady in her 40s is in a wheel  a wheel chair.She was diagnosed two years
ago.A
photo of her at last year's seminar showed a very different person dancing with
her husband.

A tall thin man in his early fifties is on crutches. He has a severe balance
problem.

A tall grey-haired lady in her middle 40s is always smiling and very active.
She has a high freqency tremor in both hands.

A man in his late 70s is cared for by his blind wife and helped at the
Seminar by
their pretty blonde daughter.

A man in his mid-60s diagnosed 9 years ago had a pallidotomy 9 months ago in
Sweden.He is disappointed with the results.He is on heavy frequent medication
which was just marginally reduced after the operation.He has serious
rigidity.His
ON-OFF has been improved by the operation.

We did not find it depressing.Almost everyone had a very positive attitude and
an optimistic approach to their PD.We were very impressed.

Gil Lieberman,74,CG for Aliza 73,PD 2+
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