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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