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Davis Phinney Foundation | Parkinson’s Q&A with Monique Giroux, MD

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During February and March 2013, the Davis Phinney Foundation collected questions submitted by people with Parkinson’s disease via our social media networks. Monique Giroux, MD, co-author of the Every Victory Counts® manual for living well with Parkinson’s, responded:

Q: What supplements, vitamins, etc. are TRULY necessary? I’m terrible about taking vitamins and what not, but am sure that I should be!

Vitamins are not usually needed unless there is a deficiency. Some people take vitamins to substitute for a health diet. Remember that nutrients from your diet are much better than that ingested from a pill. Vitamin D may be low in Parkinson’s disease. A simple blood test can determine if this is the case. Recommend reviewing your vitamin needs if any with your healthcare provider especially if you are pregnant, malnourished, losing weight, a vegetarian, have celiac disease or other intestinal problem.

Q: How can I maximize protein while taking levodopa?

Levodopa is chemically similar to amino acids (protein breakdown products). Therefore, levodopa and proteins compete for absorption into the bloodstream via the small bowel. Eating protein an hour before or after taking this medicine can speed absorption into the bloodstream. This is most important is your symptoms are more advanced or if you are requiring more frequent doses to reduce motor off periods. The following additional tips can help:

  • Start with healthy sources of protein. Vegetable protein (beans, nuts, seeds, soy, whole grains) is more easily absorbed and processed by the body so may have less interference with levodopa.
  • Enhance food transit through the bowel by adding fiber to diet with grains, whole fruits and vegetables. Drink plenty of water. This will also help reduce problems of bloating and constipation.
  • Eat more protein at the end of the day or time when you are less physically active.

Q: Since my Parkinson’s diagnosis, I find I’m losing weight. I don’t want to get below a normal weight. Suggestions?

Be sure that you are getting enough calories and protein. This is sometimes hard to determine without careful documentation of exactly what you are eating and how much each day. Keeping a food diary can help with this task. A consult with a dietitian can help you determine your needs.

  • Make certain that you are getting enough protein for strength, immune health, and energy. Adults of normal weight and activity require 0.8g/kg daily
  • Add resistance training (weight training) to your exercise routine to increase muscle mass
  • If a calorie boost is needed, certain caloric dense foods but healthy foods include nuts, seeds, dried fruit

Q: Just having any chronic illness can be depressing. What do you find helps you deal best when you don’t feel like you are getting things done?

Talk to your healthcare provider about this concern. This will help determine if you are suffering from depression or anxiety both of which can occur in Parkinson’s disease. Avoid the depression of chronic illness by staying physically active, socially engaged and being mindful of how your symptoms are affecting you. The following tips may help

  • Join a class (i.e., exercise, book club, dance, creative writing, panting)
  • Consider attending a support group
  • Focus on the positive things you can do not just the negative things you can’t do.
  • Plan things with a ‘buddy’ or family to help keep you motivated and on track
  • Set goals and establish a plan for the things you would like to accomplish. An occupational therapist can help you with this task.
  • Consider attending a class on mindfulness, chronic illness management to learn the skills, and techniques that can help you live your best with a chronic disease in mind, attitude and health. Many hospitals or clinics offer these classes for their community.

Q: I rarely get depressed, but anxiety usually happens when I’m trying to get ready to get out on the bike in time for the start of the group ride or gran fondo, etc. It really slows me down. How do I deal with this?

The first thing to do, which you have already done, is simply to be aware of anxiety, identify the trigger so that you can respond to the situation in a way that reduces anxiety.

  • Rushing can worsen anxiety this can worsen PD symptoms further exacerbating the problem.
  • Be sure your medicine dosing is the right amount for your symptoms and activity level Optimize medication timing and the
  • Start early – plan to be ready an hour before you would normally get going
  • If the ride requires a lot of preparation – be ready the night before
  • Nutrition is important – make sure your body is fueled for the upcoming ride so you have the energy
  • An occupational therapist can help you with day planning, tips and strategies for efficient use of time, or performance of daily activities
  • Discuss this concern with your group. They may be very supportive and help you feel less anxious about this.
  • Change how you respond to this concern. Be prepared to tell yourself you are doing the best you can, do not have to compare yourself to others and are doing the ride for your health and enjoyment. Remind yourself of the great thing you are doing before each event. Be careful not to judge yourself.

Q: Explain the difference between generalized anxiety and anxiety due to “wearing off” of Parkinson medication? How does the neurologist (Movement Disorder Physician) know if one is displaying an episode due to a history of depression or depression caused by dopamine deficiency due to Parkinson’s?

Anxiety attributed to wearing off will generally occur predictably when Parkinson’s medicines for movement are wearing off. This is not typically a problem early in disease but can be a problem later in disease. Anxiety before your next dose of medicine is due or first thing in the morning may be a clue.

Generalized anxiety does not occur with a strict timing to medicine dosing. Specific triggers such as social outings, shopping, riding in a car, loss of sleep, and other stressors can ignite an anxiety attack with progression to a panic attack in untreated anxiety.

Keep a calendar of times of day you feel most anxious, when you took your medicines and what you are doing. This will help you and your doctor determine triggers and whether there is a relationship to medication.

Q: My leg will go stiff and my toes curl (on the same side). I can hardly move it or drive. It lasts from two to five hours; any suggestions?

Persistent muscle contraction or cramps is called dystonia. Dystonia can be a symptom of Parkinson’s disease. This is especially noted in young onset people. Dystonia can occur when medications are low or during times of activities. Discuss the symptom, time of day or activity that causes this symptom with your healthcare provider. This will help you tailor your medicine regimen to your symptoms. If activities worsen the muscle contractions, a change in medication or botulinum toxin (Botox) injection into the muscle can reduce the overactive muscle contractions.

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About Dr. Giroux
Dr. Monique Giroux is Medical Director and co-founder of the Movement & Neuroperformance Center of Colorado in Englewood, CO. Dr. Giroux received her medical degree from Ohio State University, completed her neurology residency at Yale and her Movement Disorders fellowship at Emory University, and completed a fellowship in holistic health and Integrative Medicine at the University of Arizona. She is board-certified in Neurology and specializes in comprehensive care for people with movement and cognitive disorders, integrating non-medical approaches with traditional medical and surgical treatment, including deep brain stimulation and neurorehabilitation programs, which she developed.

Dr. Giroux is the co-author of the Davis Phinney Foundation Parkinson’s self-care manual, Every Victory Counts®. In addition to her clinical care, Dr. Giroux is advancing quality care and wellness for Parkinson’s in her positions as Medical Director of the Northwest Parkinson’s Foundation wellness center, Medical Faculty for the National Parkinson’s Foundation Allied Team Training Program and Director of the National Parkinson’s Foundation Care Center Consortium project. She has partnered with the Davis Phinney Foundation to co-author this manual.

Her focus of care and research is the development of interdisciplinary rehabilitation, team medicine, hope and wellness for people with progressive, disabling conditions. She has received training in mindfulness-based stress reduction, which she has adapted to create wellness programs for neurological conditions.

[R.S.]