--------------------------------------------------------------------- The Daily Challenges of Young-Onset Parkinson's Disease: Testimony submitted to the United States Senate Appropriations Sub- Committee on Health, Human Services and Labor: Hearing on Parkinson's Disease. September, 28, 1999 by Ivan M. Suzman, Portland, Maine TABLE OF CONTENTS: 1. Acknowledgments 1. Introducing Myself 2. Early Career 3. Y.O.P.D. Appears 4. Daily Routine 4. Personal Care Attendant Help 5. Problems With Protein and Dehydration 5. Bladder and Bowel 6. Hypothermia 6. Mobility 7. Medications Cause Emergencies 8. Education Needed 9. Impoverishment 9. Underpaid Medical Attendants and Fluctuating Health 10. A Whole Night's Work For Only $9!! 11. No Clinics in Maine, New Hampshire Or Vermont? 12. Dental Health Issues 12. Inconsistent Medical Opinions 13. An Uncertain Outlook for PWP's 14. My Plea To The Committee: Please Fund the Udall Law Fully! 15. Coping and Hoping 1 ---------------------------------------------------------------------- THE DAILY CHALLENGES OF YOUNG-ONSET PARKINSON'S DISEASE by Ivan M. Suzman CHAIRMAN SPECTER, MINORITY CHAIRMAN HARKIN, MEMBERS OF THE COMMITTEE, DISTINGUISHED GUESTS AND PARKINSON'S COMMUNITY: First, my special thanks go to Senator Olympia Snowe of my adopted home state of Maine, and to her staff, for providing the contacts with the staff of Senator Specter of Pennsylvania that have made it possible for my testimony to be included today with those of Dr. Fishbach, Dr. Langston, Mr. Fox, Ms. Samuelson and Mr. Cordy.My thanks also go to Clare Wilson, New Mexico, Hilary Blue, Virginia, Bob Armentrout, Texas and Janet Paterson, Ontario, four "cyber- siblings" from the Parknson's International Exchange List, our on-line Community, for editing help. My thanks also are extended to Kelly Abbett of the Parkinson's Action Network for readying Parkinson's activists for this Hearing, and to Senator Specter, for allowing my testimony to be part of the record today. INTRODUCING MYSELF My name is Ivan Suzman. I am now 49. I have suffered symptoms of Young Onset Parkinson's Disease (YOPD) since 1986. I am now in my 14th year of YOPD. It is wreaking havoc upon me. I have become an advocate for those suffering from all forms of Parkinson's Disease (PD), including children, young adults and older men and women. I founded the Greater Portland, Maine Parkinson's Support Group in 1992. From 1996 through now, I have served all six of Maine's PD support groups as their Legislative Liaison. I have authored large sections of 2 --------------------------------------------------------------------- Maine's 1997, 1998 and 1999 Governor's Resolutions for Parkinson's Awareness Month (April), and its 1998 and 1999 Joint House - Senate Resolutions Recognizing Parkinson's Awareness Month. I traveled to the U.S. Capitol in June, 1998, for the Parkinson's Action Network Forum. I held meetings with Senator Snowe, Senator Reed of Rhode Island, the staff of Senator Collins of Maine, and Representative Baldacci of Maine. I am the initial contact person in Maine for the Parkinson's Action Network. I am an active participant in a diverse cyber-community, P.I.E.N., the 1800 member Parkinson's International Exchange Network, an e-mail forum with members from 36 countries. In 1999, I had the tremendous honor of bringing Archbishop Desmond Tutu into contact with the many persons who, like me, share their woes and their hopes through PIEN. I am from the third American generation of a family from Providence, Rhode Island, where I was born on November 25, 1949. I have two married brothers, three nieces, godparents and cousins throughout Rhode Island, and in nearby Massachusetts. I went from high school in Providence to Dartmouth College in New Hampshire to Ph.D studies in Africa. EARLY CAREER By 1986, when my YOPD symptoms made their first appearance, I had ten years of scholarly life behind me. I had been a Lecturer in Human Anatomy in the Medical School in Johannesburg, South Africa. I had spent six years working in Africa's great museums on thrilling, three-million-year-old, pre-human and human skeletal remains from Kenya, Ethiopia, Tanzania and South Africa. I had been an Assistant Professor of Anatomy and Anthropology for three years in Minneapolis, at the University of Minnesota Medical School , spent one year as an Assistant Professor of Anatomy at the University of New England Medical School in Maine, and 3 --------------------------------------------------------------------- gave advanced anthropology and biology courses as a Visiting Lecturer in the faculty at Bowdoin College in Maine. I was publishing, and at the beginnings of a promising career as a researching scientist, teacher and palaeoanthropologist. I was working closely with South African exiles in the United States, and developed an unrivaled collection of films, now housed at Bowdoin College, which documents the resistance movement against South Africa's apartheid government, from 1956 through 1992. I was honored as a 1991 Maine Martin Luther King, Jr. Holiday Committee Award recipient, in recognition of my educational and compassionate work. I had also worked with the famous Leakey family of Kenya and Tanzania, in Africa. My world was the exciting world of fossils, discoveries, and research plans. YOPD APPEARS Since 1986, a time bomb has been ticking. It is my YOPD, claimed to be incurable, and of unknown origin. It is likely to cause me great deterioration in the very near future. YOPD is so powerful that I often feel as if I am a marionette, whose strings are being pulled by an invisible, perverse choreographer. By March 21, 1989, at the age of 39, after three years of accumulating symptoms, a near- drowning, and twenty-one visits to physicians, surgeons, physical therapists, and other health care professionals, I received the devastating diagnosis that I had Parkinson's Disease. My early, unidentified symptoms were intractably stiff shoulder blade muscles, foot cramps, toe curls, frozen wrist and hand joints, and an arm that hung when I walked. These were all warning signs. Strangely, I had virtually no tremor. When I started losing control of pens and pencils, and had to quit an evening office job because of unbearable pain in my right arm, in 1989, and my left leg and foot seemed to be strangely weak and kept dragging, I decided to see a local 4 --------------------------------------------------------------------- neurologist, who diagnosed me with "Parkinson's Disease-30 years too soon." DAILY ROUTINE I take four medications in an attempt to reverse paralysis. Without these medications, I cannot move. I am unsafe if unattended. My medications must be taken in varying combinations, at 7:15 AM, 9:30 AM, 12:30 PM, 3:15 PM, 6:00 PM, 9:15 PM, 12:15 AM and 3:45 AM. I never know with any certainty how well each of 28 pills, or partial pills will work. We "PWP's," persons living with Parkinson's Disease, all experience, eventually, this daily uncertainty of our medications. They may or may not prevent the paralysis, tremors, muscle shortening and stiffness, and various combinations of internal problems. We call these failures our "off' periods. My day usually begins with one, which may last anywhere from thirty minutes to three hours. Some days, I struggle to regain movement, during up to six hours of painful immobility. If I have been perspiring during either the previous day or night, often a side-effect of taking 1100 milligrams of a combination drug, Sinemet, which promotes motion, while lessening nausea, someone will have to help me get cleaned up. This means extra laundry, bathing and time lost. PERSONAL CARE ATTENDANT HELP After getting my juice and taking my early-morning medicines, I need help to unlock toes that have curled under my feet. I have to be at first covered to prevent sudden cold, or worse, hypothermia, and then assisted with many aspects of showering, or bathing, and getting dressed. To regain heat, I may need an electric space heater, and one or more microwaved, flexible heating pads, made from double-layered socks filled with uncooked rice. Sometimes, the medicines hit me so hard that either I sway like the proverbial drunken sailor 5 --------------------------------------------------------------------- on a rainy pier, or they do not work, and I am stuck in a low-dopamine state of exhausting muscle pain, with knee and foot joints that arch as if to break my bones, and which will not straighten out and loosen up. The personal care worker is often busy with no let-up for three hours, just to get me to the point of eating breakfast. PROBLEMS WITH PROTEIN AND DEHYDRATION Breakfast is an enormous challenge. It is thought that proteins in our foods block "gates" that the medications must traverse, within the microscopic vascular network at the blood-brain barrier. This blockage, just beneath the surface of the skull, under the membranous, skin-like coverings over the human brain, can cause me to be both paralyzed and to have painful stiffness. I have to be extremely careful to avoid protein and fat. Milk on cereal can be dangerous. To use an extra teaspoonful of cream in coffee or tea or hot chocolate is to invite immobility within twenty minutes. Eggs and cheese portions have to be minimized to be safer breakfast choices. We PWP's have to learn how to eat bran, whole grain breads, fruit and juices. I must drink fluids all day, even when working around the house, because my medicines dehydrate me. I carry a large, covered plastic drinking mug, with a long, bent straw, whenever I leave home. During off-periods, my hands are nearly useless, and will not hold a glass or cup. BLADDER AND BOWEL Going to the bathroom is an ordeal at times. To empty my bladder may not even be possible. Sometimes, I have to wait until I bathe, and that can be hours, so that hot water relaxes the muscles that often refuse to let my waters be emptied. Sexual function is also extremely difficult. Medications can cause urinary incontinence or uncontrollable bowels, in PWP's, or the opposite, severe constipation. Obstructed bowels are common in PWP's, and cause fatalities 6 ---------------------------------------------------------------------