If you have recently been diagnosed with Parkinson’s disease (PD), choosing your physician is an important decision. Unfortunately, in the current health care environment, you may be limited to doctors who are in your insurance network. You may also want to know if the physician is affiliated with your hospital. But the most important thing to consider when making your choice is finding a physician with whom you can develop a good relationship—hopefully one that will be enduring.

Scientific data suggests that you will get the best care if you choose someone specializing in your condition. Movement disorders specialists (neurologists specializing in PD) are best at diagnosing and managing Parkinson’s disease but, depending on where you live, that may not be feasible or easy.

Integrative care: the team approach

Scientific literature demonstrates that “integrative care” is beneficial (Van der Marck 2014). While the best approach would be to get all of your physicians in a room together with you to plan treatment, this is probably not going to happen except in special circumstances or as part of a clinical trial. The next best thing, however, is to ensure that all of your physicians and therapists communicate. They are your “team” and your internist is the “captain of the ship,” primarily responsible for ensuring that all specialists involved in your care work together. Be certain that each physician involved in your care is sharing your information with the other physicians. You should insist that we work together to give you the best care possible.

Be actively involved in your care in these ways:

  • Bring a medication list to each visit with all of your physicians.
  • Bring a contact list (with fax numbers) to all of your physicians.
  • Remind physicians and therapists to send notes to each other.
  • When hospitalized, arrange to have hospital records sent to all of your physicians.
  • Bring a list of discussion topics when you visit your physicians, but try to limit topics to no more than two or three per visit.

The choice of your physician and your involvement in your medical care and treatment are very important elements in your successful medical outcome. I encourage my patients to be involved and informed in their care.

Van der Marck MA, Bloem BR (2014) How to Organize Multispecialty Care for Patients with Parkinson’s Disease. Parkinsonism and Related Disorders, S167-173

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parkinsons.chartThe shaded area (figure, above) indicates a range of how you might progress with PD. By making the right decisions, you can modify your progression and increase the probability that you remain in the “impaired” region rather than progressing more quickly to either being handicapped or disabled.

Answers and Advice
from a Specialist
Diagnosis with a chronic progressive disease such as Parkinson’s disease (PD) can be very scary and may come as a shock. Those newly diagnosed wonder what the future holds for them. Questions like: Will I end up in a wheel chair? Answer: Very rarely. Should I make funeral arrangements or get my affairs in order? Answer: People with Parkinson’s usually live a normal life span.

Parkinson’s disease is a slowly progressive disease that requires medical treatment, physical therapies and some modification in lifestyle. If you have been diagnosed with PD, there are ways you can increase the likelihood of maintaining your highest level of functional capacity—your ability to perform daily activities physically, socially and psychologically.

An important thing to remember is that evidence shows that people with PD who exercise regularly, maintain a healthy lifestyle and do not take unnecessary risks increase the likelihood of living a full and active life. Your brain controls your body in order to carry out your daily activities. The brain does the math and the messages it sends to your muscles must take into account how tall you are, how much you weigh and how strong you are. It is much easier, mathematically, for the brain to control a body that is in good shape and strong, than one that is debilitated.

First Steps After Diagnosis

  • First and foremost, educate yourself about PD.
  • Be a compliant but savvy patient and choose the right physician.
  • Choose a healthy lifestyle and don’t take inappropriate risks.
  • Learn about new drugs and treatments.

Seeking information about your disease is better than simply wishing you didn’t have PD. Scientific literature demonstrates that people with PD have a higher quality of life when they are informed about their disease (Shimbo et al 2004). You should understand:

  • How your medications work and why you are on them.
  • The role of exercise and how it can help you maintain a high level of function.
  • Where to get information that is specific to your situation. Your neurologist is probably the best source because he or she understands the stage of your disease and the most effective treatment strategies.

Information Sources
Various foundations are a good source of information, including the Parkinson Foundation of the National Capital Area, The Michael J. Fox Foundation, the National Parkinson Foundation and the American Parkinson Disease Association.

Howard County Support Groups:

  • Early Onset/Newly Diagnosed Support Group: Meets first Saturday, monthly, 10:30 a.m.-1 p.m. Bain Center, 5470 Ruth Keeton Way, Columbia. Contact: Deb Bergstrom, 301-712-5381 or dfbergstrom@comcast.net.
  • Howard County/Columbia Group: Meets third Monday, monthly, 7-8:30 p.m. Parkinson’s and Movement Disorders Center of Maryland, 8180 Lark Brown Rd, #101, Elkridge. Contact Kathleen Dougherty, pdgroup2@yahoo.com.
  • Howard County Carepartner Group: Meets second Tuesday, monthly, 10 a.m. Vantage House, 5400 Vantage Point Rd, Columbia. Contact Lynada Johnson, 410-992-1120.

Local Education Opportunities
Symposia are held throughout the Baltimore-Washington Area by local academic centers (Johns Hopkins, University of Maryland, Georgetown University) and by the Parkinson Foundation of the National Capital Area.

Stephen Grill, MD, PhD., is a physician with the Parkinson’s & Movement Disorders Center of Maryland.






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exercise and sleep“There is a reciprocal relationship between sleep and exercise,” said Charlene Gamaldo, M.D., medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital. “Most of us recognize the fact that when we sleep well we feel better and have more energy during the day, which includes feeling more motivated and having more energy to exercise. Those who sleep well tend to lead a more active lifestyle.”

On the flip side, studies show that the average person who exercises regularly has a tendency to fall asleep more quickly and go into deeper sleep stages. “These individuals also appear to prime their body and brain to be better and more efficient sleepers, which results in waking up feeling more rested and restored,” noted Dr. Gamaldo.

Exercise and insomnia
People suffering from insomnia are unable to fall asleep or struggle with staying asleep. For those who don’t respond to treatment, recent data suggests that exercise may help.

In one study, participants suffering with long-standing insomnia exercised moderately (with an increase in heart rate) for 50 minutes, three times a week, for six months,” said Dr. Gamaldo. “The results showed a significant improvement in their insomnia. This was not just a subjective measurement on how they felt, but also based on their sleep quality as measured in a sleep lab. This is exciting news, and there is no downside of exercise, no bad side effects. Patients also reap the health benefits that come with increased physical activity along with better sleep.”

Exercise when you can!
Although this study showed that the time of day that people exercised didn’t negatively impact the participant’s sleep, Dr. Gamaldo warns that everyone is different.  “I encourage my patients to exercise and, if they can fit it in more practically in the evening without hampering their sleep, then they should do so. For a long time we felt you shouldn’t exercise in the evening before sleep, and for some people that may still be the case. Listen to your body and try to incorporate physical activity at some point in your day that works for you.”

Charlene Gamaldo, M.D., is the medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital and associate professor of neurology at Johns Hopkins Medicine. For an appointments, call 800-937-5337.

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5892760393_1666c64567_zOne of the major factors contributing to different forms of stress, bodily afflictions, mental illnesses, high anxiety levels, and general dissatisfaction with modern life can be found in the lifestyles we have voluntarily chosen. For example, our inability (or unwillingness) to bring about an appropriate balance among the various components of what should be a “well balanced life” exacts a heavy toll on our body and psyche. For many people, undue, excessive emphasis on any one aspect of life—such as –office work, career, climbing the corporate ladder, pursuit of wealth, etc. leads inevitably to wanton neglect of other important ingredients of a well-balanced life. This type of personal choice leads to various ailments, imbalances and misalignments. In consequence, anxiety, worry, stress, and mental tension ensue.

Our sedentary lifestyles, with its emphasis on income producing activities, and neglect of other important aspects of living, (such as rest, recreation, exercise, relaxation, and adequate sleep), can and does result in irritability, fatigue and poor physical health. Some of us seem to have no time for anything other than the economic aspects of living. Consequently, we become victims of such an unbalanced life style. The neglected areas of life cry out for attention. They manifest themselves in many warning signs – many physical and mental ailments—and we tend to ignore them at our peril.

So the obvious question is: what should be done? What is the remedy? How do we correct this obvious imbalance? Fortunately, the answer is not far to seek!

thriveVarious aspects of daily life, such as: earning and spending; work and career aspirations; family responsibilities; social obligations; activities that promote physical and mental well being—these must be properly balanced—to produce good health and peace of mind. The resulting improvement in life satisfaction will be immeasurable. Whenever we lose sight of this balancing principle, and ignore the vital contribution that each of these components contribute to our sense of life fulfillment, the result is: physical and emotional distress. Happiness and contentment elude us. Life seems empty—filled with worry, anxiety, tension and stress.

The paradox of our unbalanced lifestyle is this: What we think of as enhancing the quality of life—money, power, position, prestige and recognition (all good things in themselves)- can be pursued to excess, to the detriment of our overall quality of life. This is a trap that should be avoided.

So, it is up to each one of us to recognize the importance of balance in life. Engage yourself in a variety of activities—physical, mental, spiritual, and whatever else you want—but do it NOW. Make it a habit. This would be a wise and welcome choice we can and should make; the benefits would be immeasurable.

Dr. Gopal C. Dorai is an author, economist, statistician, and Professor Emeritus at William Paterson University.

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pregnancy and exercises


You’re expecting a baby and you want to stay fit and healthy. But you probably have some questions about what kind of exercise and how much is safe for you and your baby. Lahaina Hall, M.D., an obstetrician on staff at Howard County General Hospital, has some answers for you.

Q: Can I exercise when pregnant?
You can exercise while pregnant, as long as you do not have any medical or obstetrical issues that put your health at risk. Some conditions that would limit exercise are vaginal bleeding, premature rupture of membranes, incompetent cervix, low placenta or risk factors of preterm labor. You should always speak with your doctor first before starting any exercise regimen.

Q: What is a healthy amount to exercise?
If you don’t already exercise regularly and you are beginning an exercise regimen during pregnancy, start slowly and work up to a goal of at least 30 minutes a day. This can have significant health benefits and help with the process of labor.

Q: Is there a time when I should stop exercising?
There is no set time to stop exercising if your pregnancy remains uncomplicated. Certain exercises may be more challenging as the pregnancy progresses, and those exercises will need some modification. Avoid excessive exercise in hot, humid weather. Stay hydrated. Stop exercising if you experience pain, vaginal bleeding, contractions, leakage of fluid, chest pain, shortness of breath, headache, decreased fetal movement, muscle weakness or are feeling faint or dizzy.

Q: Why should I exercise while pregnant?
Exercise during pregnancy has many benefits. It helps build muscle, bone and stamina; improves energy, mood, sleep and posture; promotes strength and endurance; relieves stress; and may possibly help to prevent and treat gestational diabetes.

Q: Which exercises are best for pregnant women?
The best exercises for pregnant women include swimming, walking (if you don’t exercise, walking is a good way to start and build endurance over time), cycling, low impact aerobics and running, especially if you were a runner before pregnancy.

Q: Are there any exercises I should avoid?
You should avoid exercises with an increased risk of falling and contact sports.  Skiing, horseback riding, gymnastics, hockey, soccer, football, basketball, volleyball and boxing are not recommended. After the first trimester, you should avoid exercises requiring you to lie on your back.

Q: How can I avoid injury?
Always warm up before exercising. Stretching is particularly important. This can help avoid stiffness and injury. Hormones during pregnancy cause ligaments to become more relaxed, enabling joints to be more mobile and at risk of injury. Always cool down after exercising by slowly reducing activity and then stretch.

As pregnancy progresses, be aware that your center of gravity will shift with your growing abdomen; this can make you less stable and more likely to lose balance and fall.

STAY HYDRATED!!!!! Make sure to drink water before, during and after exercise.

Lahaina Hall, M.D., is an OB/GYN with Signature OB/GYN in Columbia. For an appointment, call 410-884-8000.





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anti-aging, exercise

According to a Johns Hopkins study, “Most experts recommend exercise as the single most important anti-aging measure anyone can follow, regardless of age, disability or general level of fitness. A sedentary lifestyle accelerates nearly every unwanted aspect of aging.” [JackF]/[iStock]/Thinkstock

Exercise has long-term physical and mental benefits, even reducing arthritis symptoms in older adults

Physical Benefits of Exercise
A lack of physical activity can put you at higher risk for health problems such as diabetes and osteoporosis. In fact, according to Dianne Braun, P.T., a clinical program manager and physical therapist with Howard County General Hospital, “It is not only healthy for seniors to exercise, it can also be dangerous to not exercise. Not being physically active can be risky, as seniors can lose up to 75 percent of their strength from inactivity, making them prone to falls. Current statistics show that one in three people over the age of 65 fall every year and that number increases to one in two by age 80.”

Mental Benefits of Exercise
Not only does exercise help seniors physically, it can also have a positive effect mentally. Physical activity can help manage stress and reduce feelings of depression. “Depression is a big issue for seniors, and just five minutes of exercise a day has been shown to reduce the incidence of depression,” said Braun. Some studies also suggest that regular physical activity can increase various aspects of cognitive function.

How Much Exercise is Enough?
“General exercise recommendations for seniors include 30 minutes of exercise with strength training two times per week,” said Braun. “If you have a fear of increasing pain, or have a heart or medical condition, check with your physician for exercise guidelines. The important thing is to start exercising and make it a part of your daily routine.”

Studies show that exercising regularly and staying active have long-term benefits and improve the health of older adults. According to a Johns Hopkins study, “Most experts recommend exercise as the single most important anti-aging measure anyone can follow, regardless of age, disability or general level of fitness. A sedentary lifestyle accelerates nearly every unwanted aspect of aging.”

The Arthritis Antidote 
Though exercise may seem like the last thing you want to do when suffering from arthritis, exercise is very important to increase strength and flexibility, reduce joint pain and help with fatigue. Physical activity does not have to be at a high-intensity level, but studies indicate that a moderate level of exercise can help with the pain as well as help maintain a healthy weight.

“Strength training and aerobic activity (walking or other) are good for the joints. Many studies have shown a reduction in pain with regular strength training and aerobic conditioning,” said Braun.

Exercise Examples: 

  • Aerobic conditioning activities such as walking, biking, swimming, raking leaves
  • Strengthening activities for lower body: squats, single-leg stance, step-ups and sit to stand from a chair (try not to use your arms and upper body)
  • Strengthening for upper body that incorporates some weight lifting, such as arm raises, overhead raises and biceps curls.
Dianne Braun is a clinical program manager and physical therapist with Howard County General Hospital.

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