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I wrote this about two years ago. I think it is time to print it again. Accident Waiting To Happen by Alan Bonander Reprinted with permission from the Movers & Shakers, newsletter of the Young Parkinson's Support Network of California, Volume 3 Number 5, Fall, 1994. 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 break 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 tail pipe. 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 eye wear 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. Regards, Alan Bonander ([log in to unmask])