Dear M.Dawn,

you raise important questions around the impact of stress on PD, and by
extension perhaps the impact of stress on the overall rate of progression of
PD.

>I know that stress can definitely make PD symptoms worse.

I came across a recent article where moment to moment variability of
hypokinesia (measured through spontaneous eye blink rate) was clearly impacted
by exernally applied stressors.  It explored this effect in a marital context
which to my way of thinking makes the study more relevant by virtue of looking
at the impact of stress on current functioning in a virtually real life
situation.  An extended value of this study is to draw attention to
variability of presentation of PD across the day AND how stress can impact on
that presentation.  The study looked at interpersonal stress but I think we
could all agree that it is a simple extension to seeing internally generated
stressors (grief, anger, anxiety, etc.) as also contributing to variability of
functioning.  This will happen with most everyone and with PD it has
particularly potent effects.

>Can this work in the opposite way?

Why not?  Or put differently, of course.  The structure of experience is
bipolar.  We often tend to attach to only one end of the polarity and then we
are shocked when something else happens which doesn't fit with our model of
the universe.  (A bit philosophical but nevertheless very real.)  Recently you
posted to the list and mentioned that good things were happening to you over
the past few months.  Why would we not also presume that those experiences had
a cumulative impact on you and also on the status of your PD, and possibly
also on the rate of progression of your PD?  Going back to the article re eye
blink and stress, the key finding was the moment to moment variability of
hypokinesia; if (-) stress contributed to the hypokinesia, could we not also
say that eustress ( + stress) contributes to the presence of movement.  (This
needs to be explored since it is also possible that the absence of negatively
perceived stress may be sufficient to block the hypokinesia, which is a bit
different.)  Now that was just momentary variabilities.  Why not look at that
as all being cumulative - a good cycle in essence feeding on itself.

This raises the whole question of rate of progression of PD.  I am just
starting to explore that in the literature ( and am very receptive to input
from anyone).  This seems to me to be of the essence of your question.  We all
know the mantra which goes "PD is a progressive neurological disease..."
Perhaps the mantra can be alternated with "PD is a neurological disease with
variable rates of development..."  ...the psychological factors affecting rate
of progression are to be discovered by each person in their unique situation.
How do you like those apples?

How about another mantra?  "PD is influenced by the presence or absence of
Dopamine in the brain and as the brain cells in the substantia nigra die off
there is less...."  With "Our brains sit in a soup of neurotransmitters which
interact with one another, one influencing another depending on, among other
things, expectations and mood states, etc."  Perhaps others can add and fine
tune the + and - mantras.

J.R. Bruman drew our attention to a similar line of thinking in his posting of
6/11/98 entitled Depression and PD.  He cites fascinating research which
clearly shows the relationship between behavior and emotional state and level
of available dopamine.  To me this is yet again another way of saying that
there is tremendous potential for exploring
non -pharmacological events and their impact on the presentation of PD in an
individual.

>Being with both of the doctors was a very postive experience for me.

Let me emphasize the words "very positive."  You said that you have the type
of PD characterized by rigidity.  Hypokinesia also?  Weaving my story now, the
backdrop to both visits is a series of postive experiences and presumably a
sense of well being developing over the summer - that's the ground - and the
heightened expectations and sense of ease of being with those two people
-that's the immediate field (+ stress), combined to create a "soup" in your
head/mind/body which was favorable to ease of movement.  The backdrop creates
the general state and if it is positive (favorable) it will help to raise
expectations (of possibilities, of hope, etc.) and also increase our
resiliency.

>Have any of you improved at times which are emotionally very good for you?

I have only seen one response so far (Barbara Rager, 9/4/98 and I totally
agree with her).  Perhaps you have received other responses back channel.
There is such volume on this list that people must pick and choose what they
respond to, but this appears to be a vitally important question.

>a friend who was with me at Mayo has (I believe) misunderstood and now is
rather convinced that I don't have PD.

Perhaps since the both of you are "studiers" you could engage her is a search
to further explore this issue of wellness and its impact on the rate of
progression of PD, etc.

It may be valuable and interesting for you to monitor your level of
rigidity/hypokinesia during the time that you are "under the influence" of
this tension with your friend.  My expectation is that you will become more
rigid, less flexible/creative in your mind, etc.  To resolve this issue is to
move back again into the other positive state you have been in all summer.
Good luck!

Thank you for raising these questions and for giving me the opportunity to
begin to share some of my thinking on these matters.

Tim

*****

Tim Hodgens, Ph.D.
Psychologist
Westborough, MA

--

In a message dated 98-09-04 17:49:40 EDT,

>Subj:        ?improvement in PD
>Date:  98-09-04 17:49:40 EDT
>From:  [log in to unmask] (Mary Legan)
>Sender:        [log in to unmask] (Parkinson's Information Exchange)
>Reply-to:      [log in to unmask] (Parkinson's Information Exchange)
>To:    [log in to unmask] (Multiple recipients of list PARKINSN)
>
>I've had an experience which I need your help to explain.  I was diagnosed
>with PD (the rigidity type) ~ 6 yrs ago, and now take 6 Sinemet 10/100
>tablets
>& 4 Sinemet 25/100 CR throughout the day, plus one or both early am if
>necessary.  I do have rather severe end-dose "offs", no dyskenesias; mornings
>are my best time.
>
>A few months ago, a doctor who was studying people with PD & migraine asked
>if
>I would see her late a.m. without having taken any meds.  I agreed, & did so.
>Then, a couple weeks ago, I saw a movement disorder physician at Mayo, late
>morning.  I had taken morning meds, but was due for a 10/100 while there,
>which I didn't take.  In both cases, I did very well, indeed!  So much so
>that
>I seemed essentially normal during each appointment.
>
>I know that stress can definitely make PD symptoms worse. Can this work in
>the
>opposite way?   Being with both of the doctors I mentioned was a very
>positive
>experience for me.  Have any of you improved at times which are emotionally
>very good for you?
>
>A friend who was with me at Mayo has (I believe) misunderstood & now is
>rather
>convinced that I don't have PD.  Discussions with her are now causing me
>quite
>a bit of stress!
>
>If you have had improvements when life is good, would you send me a note on
>this which I could show her?
>
>Or if you could share some neurochemistry information on this, that would
>really help a lot, too.  She & I are both studiers.
>
>This is more important to me than I can express in this post, & I'll be very
>grateful for whatever you would be willing to contribute.
>
>M.Dawn  56/6
>
>
>