My Parkinson’s Story: Impulsive Behavior

– ALVIN AND I HAVE BEEN MARRIED FOR A WONDERFUL 42 YEARS, AND WE'RE BOTH VERY PROUD OF THAT – I MEAN, WE DO EVERYTHING TOGETHER

WE'VE BEEN MARRIED 42 YEARS AND I HOPE WE HAVE A BUNCH MORE LEFT I WAS DIAGNOSED WITH PARKINSON'S DISEASE IN 2008 I FIRST NOTICED THAT I WAS HOLDING MY RIGHT ARM ALL THE TIME I'D GET STIFF AND I COULDN'T MOVE IT LIKE I DID MY LEFT HAND – HE GETS TIRED VERY EASILY

HE JUST GIVES OUT WHEN HE TRIES TO DO SOMETHING IT TAKES HIM LONGER TO DO TASKS NOW WHEN HE WALKS, HE HAS THE SHUFFLE YOU CAN ACTUALLY HEAR THE LEFT, RIGHT, LEFT, RIGHT FEET – AND WE WORK IN THE YARDS A LOT

WE GOT A LOT OF FLOWERBEDS, AND I JUST DO A LITTLE BIT AND GET TIRED I SIT DOWN AND GET BACK UP AND KEEP DOING IT ALL DAY – WE'VE ALWAYS BEEN ACTIVE PEOPLE WE LIKE TO STAY BUSY, WE LIKE TO SEE THINGS ACCOMPLISHED, SO WE WORK OUT IN THE YARDS WE DO YARD WORK

WE DO GARDENING WE DO THINGS AROUND THE HOUSE WE'VE ALWAYS DONE THINGS TOGETHER SO WE'RE OLDER FOLKS, BUT WE WANT TO TRY TO STAY AS YOUNG AS WE CAN AND AS ACTIVE AS WE CAN – I'M AN ACTIVE PERSON AND I'M KIND OF HYPER, REALLY

I JUST LIKE TO STAY GOING I BELIEVE THAT'S THE KEY: YOU GOT TO KEEP GOING – THERE'S MANY FORMS OF IMPULSIVE BEHAVIOR SOME PEOPLE HAVE IMPULSIVE BEHAVIOR TO PULL OUT THEIR HAIR– THAT'S CALLED TRICHOTILLOMANIA SOME PEOPLE HAVE THE DESIRE TO STEAL THINGS– THAT'S CALLED KLEPTOMANIA

SOME PEOPLE HAVE IMPULSIVE BEHAVIOR WHERE THEY ACTUALLY WILL OVEREAT, COMPULSIVE EATING – AN IMPULSIVE BEHAVIOR IS ONE THAT'S NOT NECESSARILY PREMEDITATED IT'S AN URGE THAT PEOPLE ACT ON WITHOUT THINKING ABOUT THE CONSEQUENCES – IN PARKINSON'S DISEASE, WE KNOW A GOOD BIT ABOUT IMPULSIVE BEHAVIOR AFTER PATIENTS ARE TREATED AND WHAT EMERGED WAS WITH DOPAMINE AGONISTS SUCH AS ROPINIROLE OR PRAMIPEXOLE, OTHER DOPAMINE AGONISTS, WE LEARNED THAT PATIENTS CAN SOMETIMES BE PRONE TO THESE IMPULSIVE BEHAVIORS, AND THE MOST COMMON ONES THAT WE HEAR ABOUT ARE COMPULSIVE GAMBLING OR HYPERSEXUALITY

– IMPULSE CONTROL DISORDERS ARE COMMON IN PARKINSON'S PATIENTS, ESPECIALLY WHEN THEY'RE BEING TREATED WITH DOPAMINE AGONISTS I THINK THE PREVALENCE IS APPROXIMATELY 15% TO 20% – BEFORE I HAD PARKINSON'S, I'D WANT SEX, I DON'T KNOW, A COUPLE TIMES A WEEK BUT AFTER I GOT PARKINSON'S, I JUST ASKED FOR IT ALL THE TIME – WELL, TO BEGIN WITH, HE WAS HAVING A SEXUAL IMPULSE

YOU KNOW, HE WAS AFTER ME ALL THE TIME – I DON'T KNOW IF IT WAS THE MEDICATION OR PARKINSON'S DOING IT – WE TALKED ABOUT IT, AND I REALIZED THAT THIS WAS HIS PARKINSON'S, AND MAYBE EVEN MEDICATION, THAT WAS CAUSING THIS PROBLEM – MR SHEALY WAS A TYPICAL PARKINSON'S PATIENT THAT I SEE

WHEN HE CAME TO SEE ME, YOU TALK ABOUT VARIOUS TREATMENT OPTIONS IN PARKINSON'S PATIENTS IT DEPENDS ON HOW BAD THEIR SYMPTOMS ARE, WHAT YOU START, SO A LOT OF PRACTITIONERS WILL START WITH A DOPAMINE AGONIST DRUG–AGAIN, LIKE MIRAPEX OR REQUIP OVER TIME, HE NEEDED HIGHER DOSES OF THE DOPAMINE AGONIST TO TREAT HIS PARKINSON'S DISEASE, WHICH IS TYPICAL AS THE DISEASE PROGRESSES SO I BELIEVE I GOT HIM UP TO ABOUT 8 MILLIGRAMS 3 TIMES PER DAY, WHICH IS ABOUT THE MAX DOSE – INITIALLY, WHEN WE INCREASED MR

SHEALY'S DOSE OF HIS DOPAMINE AGONIST FROM 4 TO 8 MILLIGRAMS 3 TIMES A DAY, WE WERE HOPING FOR A REDUCTION IN HIS STIFFNESS AND RIGIDITY HOWEVER, HIS WIFE CAME BACK SAYING THERE HAD BEEN A DRASTIC CHANGE IN HIS NEED FOR SEX – I COUNSELED THEM BEFORE THERAPY AND THROUGHOUT EACH VISIT THAT IMPULSE CONTROL PROBLEMS CAN ARISE, AND IF THEY DO, PLEASE LET'S TALK ABOUT IT – AFTER AWHILE, WE DECIDED THAT WE BETTER TALK WITH DR MORGAN ABOUT THE SEXUAL BEHAVIOR

– IT WAS BROUGHT UP AT ONE VISIT KIND OF UNCOMFORTABLY, WHICH, OF COURSE, THESE ISSUES ARE–DISCUSSING SEXUALITY– BUT IT'S A PART OF EVERYBODY'S LIFE, SO YOU SHOULD DISCUSS IT – SO WE WENT FOR OUR VISIT BECAUSE WE ALWAYS GO TO OUR VISITS TOGETHER, AND WE TALKED TO HIM ABOUT IT – AS A APPROACH TO HELPING THE SITUATION, WE DECIDED TO BACK OFF ON THE REQUIP AND LOWER THE DOSE AND ADD SINEMET TO HIS THERAPY, CARBIDOPA, LEVODOPA TO HIS THERAPY – AT THAT POINT, WE LOWERED THE DOSE AND THINGS DRAMATICALLY IMPROVED WITHIN THE WEEK SO IT WAS THE MEDICATION

– I WENT TO DR MORGAN AND HE PUT ME ON MEDICATION, AND HE HELPED ME A LOT NOW I'M PRETTY WELL GETTING BACK TO NORMAL, BUT IT WAS JUST SOMETHING YOU HAD TO DEAL WITH – USUALLY PATIENTS CAN JUST REDUCE THE DOSE OF THEIR DOPAMINE AGONIST, OR GET OFF OF IT, AND THE BEHAVIOR MARKEDLY IMPROVES – IF YOU LOWER THEIR MEDICATIONS, THE URGES AND THE DESIRES TEND TO DIMINISH, AS WELL, AND YOU TYPICALLY DO NOT HAVE TO ADD OTHER TYPE OF MEDICATIONS, ANTIDEPRESSANTS, AND THINGS OF THAT NATURE

AS FAR AS THERAPY, THAT WOULD BE UP TO THE FAMILY YOU KNOW, IT MAY BE BENEFICIAL TO THE FAMILY TO WORK TOGETHER IN A THERAPY-TYPE SITUATION IN ORDER TO BETTER DEAL WITH PARKINSON'S IN ITSELF AS WELL AS THE IMPULSE CONTROL DISORDER – IT'S VERY IMPORTANT FOR THE PATIENTS AND THEIR FAMILY MEMBERS TO BE ABLE TO FEEL LIKE THEY CAN TALK TO THE DOCTOR AND NURSE ABOUT SIDE EFFECTS WITH THE MEDICATIONS AND PARTICULARLY WITH THIS DOPAMINE AGONIST – MY ADVICE TO ANYONE THAT HAS PARKINSON'S OR HAS A LOVED ONE THAT HAS PARKINSON'S, GET GOOD MEDICAL TREATMENT AND DON'T BE AFRAID TO ASK YOUR DOCTOR ANYTHING BECAUSE THERE IS HELP FOR YOU – DON'T WAIT TILL THE NEXT FOLLOW-UP VISIT TO ACTUALLY GET IN TOUCH WITH US ABOUT THIS PROBLEM

CALL US RIGHT AWAY AND WE CAN DISCUSS THIS – YOUR LIFE DOES CHANGE YOU HAVE TO ADJUST TO THE CHANGES BUT WE TAKE ONE DAY AT A TIME, WE'RE LIVING HAPPILY NOW, AND ANYTHING THAT'S GONNA COME UP IN THE FUTURE, WE GONNA HANDLE IT TOGETHER – WELL, THE ADVICE I'D GIVE THE PEOPLE THAT HAVE PARKINSON'S, MAINLY, DON'T GIVE UP

I MEAN, YOU GONNA GO THROUGH A LOT YOUR MIND IS GONNA CHANGE YOU'RE GONNA FEEL DIFFERENT YOU'RE GONNA ACT DIFFERENT BUT THE MAIN THING IS YOU NEED TO EXERCISE, TAKE YOUR MEDICATION LIKE YOU'RE SUPPOSED TO, AND JUST TAKE DAY BY DAY

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