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Living Well, Running HardLessons Learned from Living with Parkinson's Disease
By John Ball
iUniverse, Inc.Copyright © 2011 John Ball
All right reserved.
Author's Note on the Second Edition....................ix
Chapter 1 The Discovery....................1
Chapter 2 Getting Back to Work....................19
Chapter 3 Family Secrets....................30
Chapter 4 Learning to Live Well....................41
Chapter 5 On Shaky Ground....................47
Chapter 6 Running Hard....................52
Chapter 7 Building a Team....................59
Chapter 8 My First Marathon....................62
Chapter 9 Returning to the Air....................69
Chapter 10 Getting to Know My Enemy....................75
Chapter 11 The Silent Partner....................83
Chapter 12 Getting Connected....................92
Chapter 13 The Formation of Team Parkinson....................104
Chapter 14 Other Transitions....................121
Chapter 15 Learning to Succeed....................124
Chapter 16 Our First Out-of-Town Event....................137
Chapter 17 One Tough Marathon....................142
Chapter 18 The Catalina Island Marathon!....................149
Chapter 19 Team Parkinson in Norway....................156
Chapter 20 My First Ultra-Marathon....................162
Chapter 21 Dateline: Glasgow, Scotland....................168
Chapter 22 State of the Art in Parkinson's....................174
Chapter 23 Blinding Flashes of the Obvious....................181
Appendix A Organizations and Resources for Parkinson's Disease Patients and Caregivers....................187
Appendix B Bibliography and Selected Reading....................191
About the Author....................193
I remember the night my future got a lot brighter. I was playing catcher on the company softball team one evening after work. The softball diamond was a brightly lit pool of red earth and green grass in the surrounding darkness. The other team was wearing crisp blue baseball uniforms with "Motorola" written boldly across the chest, while we wore an assortment of jeans, shorts, and red, white, and blue T-shirts bearing Honda Race Team logos. We couldn't get the company to spring for real uniforms like Motorola had, but at least we got old race-team shirts for free! In spite of the usual enthusiasm and chatter of men at play, neither team was hitting well, so the game was excruciatingly slow. I was particularly frustrated with my own performance. It doesn't take much to play catcher in slow-pitch softball. I stand behind the plate and wait to catch the ball after it bounces on the mat for a strike or lands off the mat for a ball. Then I retrieve it and throw it back to the pitcher. That's about all there is to the job. Once in a while I may also catch a desperate throw from the outfield and make a diving lunge to tag out a runner barreling in from third base. That happens maybe once or twice in a season. That night, our pitcher, Larry Langley, hadn't found the range yet, and he was putting lots of his pitches in the dirt. Our game was the last of four played that night, so the field was pretty torn up, making the balls bounce off at crazy angles. With each pitch, I had to wait for the ball to stop rolling before I could pick it up; my coordination and balance were so poor that if I leaned over too quickly I would miss it or simply fall over. To be honest, I had been having trouble fielding the ball for several months, even when we had the first game of the evening and the infield was smooth and the grass newly clipped.
I had once been a good athlete, though never a really good ballplayer. But now, in the summer of 1983, I was just a few months from turning forty, and I was losing my ability to control my body. My mind was sending out commands, but my body wasn't listening! While playing on this team for almost eight years, I'd gone from being a respectable outfielder with good range and a strong throwing arm to what I was today, a really lousy catcher—a stumbling, fumbling wannabe who couldn't catch, couldn't hit, and couldn't even run to first base. I had failed as an outfielder, second baseman, and pitcher; catcher was the only spot left. Pitching had been fun, but eventually I could no longer throw strikes. Now, as catcher, I couldn't even throw the ball back to the pitcher without bouncing it! They still let me swing the bat, but I'd lost so much mobility over the last year that someone else had to run for me if I happened to get a hit. The reason the team still let me bat was that they were consistently short of players and would have to forfeit games if they didn't have enough batters. That, and maybe the fact that I had been team manager for several years, was now the only reason I played at all.
But that night, something changed. It was the third inning when Larry walked off the mound and asked, "What the hell is going on with you?"
"What do you mean? I'm trying my best."
"Something's different about you tonight," Larry said. "You just threw the ball back to me three times in a row without bouncing it. That's the first time in months." He stared at me for a minute and then smiled and said, "You almost look like your old self."
I suddenly realized I did feel better, not as stiff or as awkward as usual. I could almost stand up straight. In fact, I felt almost human! Some of the team had come in to see what we were yakking about, and as I looked around at the other players' faces, I saw grins had replaced their usual pained looks of concern. Cranky old Ed Mazenko shouted from first base, "Hey, John, what did you eat today, some magic beans?"
I reached into my jeans pocket and took out the little packet of yellow tablets Dr. Beck had given me that morning. He had said, "Try these: one every four to six hours for a couple of days. If they do any good, then maybe we'll know what you've got." No further explanation; nothing about what the pills might do or how I might react to them. Just take these and see what happens—a little bit like Alice in Wonderland! I had left his office in a bad mood. I didn't like being used as a guinea pig. It wasn't the first time some doctor had tried that approach, and the first time had made me temporarily crazy—really bonkers, with terror and tears and feelings of hopelessness. I thought it was a poor way to make a diagnosis—like a mechanic just replacing parts until something finally works. I'd stuffed the pills into my pocket and stalked out of the office. I waited until the end of the day to take the first tablet; I didn't want to risk going out of control at work like the first time. Now I looked again at the packet. What were these things, anyway? The label said "Sinemet 25/100." I had no idea what that meant, but from where I was standing—with my head up and my shoulders back for the first time in months—they might as well have been labeled "magic beans." In the glare of that red-earth infield, surrounded by the bright green outfield, the rest of the world didn't seem so dark anymore. At home that night, I pulled out my guide to prescription drugs and looked up Sinemet. That's how I found out I had Parkinson's disease.
I was thirty-nine years old, had been married nearly ten years, and had two kids—David, five, and Sarah, three. When I read that Parkinson's disease affects more than a million Americans, I wondered why the doctors I'd been seeing for over ten years had never even considered it. Then I saw why: people with Parkinson's are usually diagnosed in their sixties or later. Looking back over the years, I figured I'd shown symptoms of Parkinson's since I was about twenty-seven. Still, if someone had asked me how I felt at the moment I knew I had Parkinson's, I would have said I was a happy man. You may think that's an odd response to the diagnosis of an incurable, degenerative neurological disease! Yet for me it was such a relief to put a name to the problems I'd had all those years; I was no longer facing the unknown. There had been so many bad possibilities: a terminal brain tumor, or chorea athetosis or myasthenia gravis—that word, gravis, has too much of the word grave in it. Finding out it was Parkinson's the way I did was also a relief because Sinemet, that miraculous little yellow tablet, relieved many of my worst symptoms.
When I went to work the next morning, I told my boss about my discovery. "Hey, Tom, I've figured out what my problems with my left leg are all about. I've got Parkinson's disease."
His response was, "I suppose it's good to have a name for it; now let's get back to work."
I didn't know much about Parkinson's, so I researched it during the next few weeks. A Scottish doctor named James Parkinson first described its characteristics in 1817. Before that it had been called simply "shaking palsy." Not until 1960 did Austrian researchers Ehringer and Hornykiewicz discover that the primary cause of Parkinson's was the loss of dopamine-producing cells in the area of the brain called the substantia nigra. Why those cells die is still unknown more than fifty years later. Dopamine is a neurotransmitter that enables signals to be sent back and forth through nerves between the brain and the body. It has to be in balance with another neurotransmitter, acetylcholine, for the brain to communicate effectively. Dopamine and acetylcholine are created in the brain and in other parts of the body, where they serve other functions. In Parkinson's disease, the dopamine-producing cells of the substantia nigra die out, eventually causing a severe communications breakdown. The cells that produce acetylcholine and other brain chemicals like GABA, norepinephrine, and serotonin may suffer only minor damage but add to the wide array of Parkinson's symptoms. The brain is left unable to communicate effectively with the rest of the body. That's what caused me to lose my mobility, to wake up stiff and sore every morning, and to stand there, frozen in place, watching the softball slowly roll away.
Since dopamine is not difficult to manufacture, some doctors thought they might make up for any shortage in the brain by injecting it directly into the bloodstream or giving it orally as a pill.
But the brain is practically isolated from the larger molecules in the bloodstream. The cells in the walls of the brain's tiny blood vessels are packed so tightly that only very small molecules like glucose, oxygen, and water can get through; dopamine molecules are much too large. This blood-brain barrier is actually a good thing, because it maintains the right balance of chemicals for proper nerve function. It also shields the brain from bacteria, viruses, and most toxic substances, as well as hormones the brain puts into the bloodstream to control other parts of the body. So the brain must have sub-manufacturing units like the substantia nigra for everything it needs that can't get through the barrier.
When those dopamine-producing cells in the substantia nigra die out, they aren't replaced by new ones. Until very recently, researchers thought that the brain stops creating new cells after infancy, that adult brain cells never divide, and that the brain can't regenerate them. Now they're not so sure. But without healthy living cells in the substantia nigra, there is no mechanism for keeping dopamine at the proper level in the brain. At least for now, once those cells are dead, you've got Parkinson's disease for life. Postmortem examinations have shown that most patients diagnosed with Parkinson's had lost 75 to 80 percent of their dopamine-producing brain cells by the time they were diagnosed.
Even if one could continuously feed exactly the right amount of dopamine directly into the brain, the patient might be symptom-free for a while, but they would still have Parkinson's. After all, those brain cells are dead, and the minute they stopped injecting the dopamine, or used too much, their symptoms would return. And it's not the same as hooking up an insulin pump to your body to regulate the level of sugar in your blood. Without some way of getting dopamine to cross the blood-brain barrier, a pump would be useless.
In the early 1960s, Dr. George Cotzias of the Brookhaven National Laboratory in Long Island, New York, discovered that levodopa, a chemical precursor of dopamine, can pass through the blood-brain barrier; once in the brain, an enzyme (dopadecarboxylase) converts it into useable dopamine. Although the levodopa (L-dopa in chemical shorthand) does get past the blood-brain barrier, it doesn't do it very efficiently. Dr. Cotzias found he had to give large oral doses of L-dopa to get even a small amount into the brain because most of it was being broken down while in the bloodstream. And any L-dopa that wasn't broken down caused significant side effects, such as dyskinesia (involuntary random movements).
In 1969, Dr. Cotzias suggested that the levodopa needed a "partner compound" that could keep it from breaking down so quickly in the bloodstream. That led to the creation of a new molecule called carbidopa, a decarboxylase inhibitor that does the job. Fortunately, the carbidopa can't get past the blood-brain barrier, where it could interfere with the conversion of levodopa to dopamine in the brain. So by reducing levodopa breakdown in the body, but not getting into the brain, carbidopa significantly increases the efficiency of levodopa and reduces the dose required to get good results. This also reduces levodopa's unwanted side effects.
In the mid-1970s, levodopa and carbidopa were combined in a yellow, oval-shaped tablet called Sinemet that reached the market a few years later. When I was diagnosed with Parkinson's in1983, Sinemet had been on the market for fewer than ten years. After I began taking it, I could once again do all the physical activities I'd been missing. The diagnosis of Parkinson's and a prescription for Sinemet had given me back my life.
What now? I was at the midpoint of my life. Before going on with the second half, I wanted to take stock of the first. After a rocky start, I'd lived up to most of my parents' expectations and hit many of the early targets I'd set for myself. After high school I managed to qualify for a Navy Hollowell scholarship to the University of Washington. It was a great opportunity for me to get away from my parents and the constant comparisons to my older brother. It was that constant comparison and competition with my brother that sent me in the direction of the Navy scholarship. He had applied for the Hollowell program but failed the eye test during the physical exam. I was more fortunate on the physical. My scholarship may have come as a surprise to some because I was somewhat lazy and immature, a prototype of the classic underachiever, although the term wasn't invented until a few years later. I hated doing my homework in high school but enjoyed showing off my test-taking skills. Teachers disliked my attitude, and my grades suffered. High-school track and cross-country running were my salvation, because everyone could see that I was willing to do the really hard work in training. My teammates might be faster at the meets, but I was always challenging them in the workouts. That tenacity and competitiveness eventually carried over into my schoolwork; I realized I could just do the same thing in class that I did on the track. I had to be willing to do the busywork, not for the love of learning, but simply because my teachers expected it.
At the university, I ran on the cross-country and track teams, but not under the scholarship program that supported the elite athletes. I was a typical "walk-on"—someone who really loved the sport but wasn't good enough to recruit at a Division I school. I couldn't be counted on to bring in points in the big meets. In the winter of my sophomore year, what I thought were shin splints turned out to be a stress fracture in my left leg that went undiagnosed for several weeks. A blood clot formed around the fracture, which pinched off blood flow to my lower leg, and the calf muscle atrophied. The harder I trained, the worse it got. Once the coaching staff noticed my shrinking calf, they sent me to a specialist, who found the clot and identified the stress fracture. I red-shirted my track season that spring. Red-shirting was a way to practice with the team without competing in the track meets, thus preserving my eligibility for another year.
I got hurt a few other times and failed to make the traveling squad as a junior or senior.
Excerpted from Living Well, Running Hard by John Ball Copyright © 2011 by John Ball. Excerpted by permission.
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