– I SIGNED UP
FOR THE ARMY IN 1978. I REPAIRED WEAPONS. ANYTHING THAT THE MILITARY FIRED
I FIXED. GOT HIRED AT THE POST OFFICE
IN 1983. I ENJOYED BEING A LETTER CARRIER
FOR 30 YEARS, AND I WOULD’VE
STILL BEEN DOING IT IF I DIDN’T GET BLESSED
WITH THIS ILLNESS. I COULDN’T DRIVE
MY VEHICLE NO MORE. I COULDN’T WALK… HAD NO MOVEMENT
IN MY SHOULDERS. I COULDN’T PERFORM MY ROUTE. I’D GET ON THE ROUTE
AND FREEZE UP. IT WAS VERY HARD FOR ME. – MILES IS A 53-YEAR-OLD MAN WHO HAS PARKINSON’S
FOR THE LAST 14 YEARS. HE HAS SUFFERED
UNTIL ABOUT A YEAR AGO WITH REALLY BAD
MOTOR FLUCTUATIONS, SEVERE RIGIDITY, TREMOR, AND WHERE HE DID GET TO A POINT
WHERE HE NEEDED A WHEELCHAIR TO GO LONG DISTANCES,
AND ALSO HE HAD A LOT OF PAIN. – PARKINSON DISEASE PATIENTS
DO HAVE A LOT OF PAIN, AND WE OFTEN DON’T STRESS THAT
AS THE MAIN SYMPTOM THAT WE TALK ABOUT
WITH PARKINSON’S DISEASE. WE OFTEN ARE THINKING
ABOUT THEIR MOTOR PROBLEMS, THEIR TREMOR, THEIR SLOWNESS,
THEIR GAIT, BUT PAIN CAN BE
A SIGNIFICANT SYMPTOM, AS WELL. HI, MR. GARCIA.
– HELLO. – DR. OSTREM.
NICE TO SEE YOU AGAIN. THERE’S A LOT OF DIFFERENT WAYS
IN WHICH PAIN CAN BE A PART OF THE SYNDROME,
AND ONE OF THE THINGS THAT WE OFTEN SEE IT
ASSOCIATED WITH IS THAT OF PROMINENT RIGIDITY. – THE WAY A PATIENT
WOULD SENSE RIGIDITY IS THAT THEY’RE VERY TIGHT. IT’S LIKE YOU HAVE
TIGHT MUSCLES. – AND DYSTONIA
IS ANOTHER TYPE OF MOVEMENT THAT IS ASSOCIATED
WITH CO-CONTRACTION OF MUSCLES. – FOR EXAMPLE, THE NECK
WILL START ACTIVATING ON ONE SIDE REPETITIVELY,
CONSISTENTLY WITHOUT STOPPING, AND YOU START TO SEE MAYBE
THAT SAME TURN OF THE HEAD IF THE NECK MUSCLES
ARE DYSTONIC. – THERE’S MORE OF A ABNORMAL
CURLING OF A JOINT, OF A FOOT, OF A TOE. IT COULD CURL DOWN.
IT COULD CURL UP. – AND IT’S OFTEN
ASSOCIATED WITH PAIN. – MILES’ WORST PAIN WAS
BETWEEN HIS SHOULDER BLADES AND IN THE BACK,
AND IT WAS REALLY TROUBLING TO TRY AND SORT THAT OUT,
WHAT THE PROBLEM WAS. WE DIDN’T KNOW WHETHER
IT WAS AN ORTHOPEDIC ISSUE OR WHETHER IT WAS
HIS PARKINSON’S, FROM RIGIDITY OR DYSTONIA. – THE PAIN THAT I’M DESCRIBING
IN MY BACK AREA WAS VERY INTENSE, VERY SEVERE, COULDN’T GET NO RELIEF AT ALL. – I THINK THAT PAIN
AS A NON-MOTOR SYMPTOM IS VERY DISABLING. – COULDN’T EVEN GET OUT OF BED
SOMETIMES BECAUSE OF THE PAIN. – SO PAIN AND DEPRESSION DEFINITELY CORRELATE STRONGLY
WITH EACH OTHER. – WHEN I WAS HURTING, I WAS SAD. I WAS DOING EVERYTHING I COULD
TO KEEP POSITIVE AND THINKING THAT EVERYTHING
WAS GONNA LOOSEN UP AND I WAS GONNA
GET BACK TO WORK. I WANTED TO FUNCTION
FOR MY WIFE AND MY SON AND MY FRIENDS AND MYSELF. I WASN’T READY TO
THROW IN THE TOWEL JUST YET. – IF THE PAIN IS FROM
PARKINSON’S DISEASE, IT OFTEN WILL GET BETTER
WHEN YOU GIVE THE PATIENT APPROPRIATE MEDICATION
TO TREAT THEIR SYMPTOMS. – LET’S JUST GET AN IDEA
OF HOW BAD THE PAIN IS. CAN YOU GIVE ME A SENSE
ON THE SCALE HERE HOW MUCH PAIN YOU’RE
EXPERIENCING RIGHT NOW? – I’ HAVING MAYBE TWO TO FOUR. – AND SO THE GOAL
OF A NEUROLOGIST TAKING CARE OF PARKINSON’S
PATIENT IS REALLY TO HELP IMPROVE THEIR ON TIME
SO THAT THEY DON’T HAVE THESE WINDOWS IN THEIR DAY
WHERE THEIR SYMPTOMS ARE VERY SEVERE AND THERE WON’T
BE AS MUCH PAIN THEN, AS WELL. – WE’RE REALLY HOPING THAT WHEN WE TREAT THE PARKINSON’S
SYMPTOMS WITH MEDICATIONS, WITH DBS, OR WITH BOTOX
THAT WE’RE REALLY RELIEVING THAT PAIN SYNDROME SO THEY CAN
CARRY ON THEIR LIFE. – EXERCISE IS ONE OF THE MOST
POWERFUL FORMS OF TREATMENT THAT WE HAVE
NOT JUST FOR PARKINSON’S, FOR MANY OTHER HEALTH
CONDITIONS. – AND WE KNOW THAT
IF PATIENTS DO EXERCISE AND ARE MOVING THEIR BODIES MORE
THAT THEY WILL HAVE LESS PAIN, ACTUALLY HAVE LESS PROGRESSION
OF THE DISEASE, AS WELL. – IN JANUARY, DR. GLASS
INCREASED MY MEDICATION TO FOUR TABLETS
EVERY THREE HOURS. I WAS ONLY GETTING
LIKE SEVEN MINUTES OF ACTUAL MOVEMENT, AND THEN I WOULD HAVE TO TAKE
ANOTHER FOUR TABLETS, BUT IT HAD NO RELIEF
OF PAIN AT ALL. I WENT TO PHYSICAL THERAPY,
WHERE THEY PRESCRIBED FOR ME A HEATING PAD AND THE PILLS ALLOWING ME
TO TRY TO ADJUST MY SPINE. I WENT TO ACUPUNCTURE. I TRIED YOGA, COULDN’T
GET NO RELIEF AT ALL. – WHEN HE HAD DEEP BRAIN
STIMULATION SURGERY ABOUT A YEAR AGO, THE MAJORITY
OF HIS PAIN IMPROVED. – RIGHT AWAY, I NOTICED
WITH THE BPS INSERTED IN ME THAT I HAD A FREE RANGE
OF MOTION IN MY SHOULDERS, AND THE PAIN STILL WAS THERE BECAUSE IT WAS WITH ME FOR SO
LONG THAT I STILL FELT THE PAIN, BUT I DIDN’T FEEL THE TIGHTNESS
IN MY SHOULDERS. – AFTER HE HAD DBS,
THE PAIN THAT HE HAD IN HIS MID-THORACIC REGION–
AND THERE WAS ALSO SOME PAIN, I THINK, IN HIS LOW BACK
AND IN HIS FEET– IMPROVED DRAMATICALLY, AND SO THAT TOLD US THAT
THAT PAIN WAS PROBABLY FROM RIGIDITY
OR A DYSTONIA. – MY PAIN LEVEL RIGHT NOW
ON A SCALE FROM ONE TO 10 BETWEEN NOW AND MY PAST PAIN, IT WOULD PROBABLY BE
A ONE AND A HALF TO TWO, CONSIDERING BEFORE, I COULD’VE
BEEN A 10 OR MAYBE EVEN A 15. – AND SO WE’RE MANAGING HIM
STILL WITH PARKINSON MEDICINES. WE’RE OFFERING HIM BOTOX. HE STILL NEEDS PHYSICAL THERAPY, BUT HE STILL GETS AROUND
REALLY WELL. MILES HAS SOME DYSTONIA, RESIDUAL DYSTONIA
IN HIS GREAT TOE WHERE IT’S REALLY DORSIFLEXING
UP TOWARDS HIS HEAD, AND IT’S QUITE PAINFUL. – ONE OF THE SIDE EFFECTS
THAT I HAD, IT MAKES MY TOE STICK UP, POKES A HOLE
RIGHT THROUGH MY SHOE, AND THESE SHOES ARE ONLY
THREE WEEKS OLD. – WE ARE NOW DOWN TO OFFERING
BOTOX FOR HIM TO TRY TO FOCALLY
MAKE THAT MUSCLE MORE RELAXED AND SO HIS TOE WILL BE MORE FLAT
INSIDE HIS SHOES. – SO WE WOULD USUALLY PLACE
A NEEDLE ABOUT RIGHT IN HERE, AND THAT’S ABOUT RIGHT
WHERE THE MUSCLE BELLY IS THAT’S CONTROLLING THIS MUSCLE, AND THEN WE’D SEE THE TOE RELAX. WE CAN’T INJECT BOTULINUM TOXIN THROUGHOUT THE WHOLE BODY
TO IMPROVE PAIN… YOU READY TO GO?
– YEAH. – OK. HERE WE GO. BUT IF THERE’S A SPECIFIC BODY
REGION THAT IS IMPACTED BY OVERACTIVE MUSCLES
OR SPASMS OR DYSTONIA, THEN YOU CAN TARGET THOSE
MUSCLES THAT ARE OVERACTIVE. ALL RIGHT. YOU DID A GREAT JOB. NICE JOB HOLDING STILL,
AND YOU SHOULD START TO FEEL BETTER
IN ABOUT FOUR TO FIVE DAYS, SHOULD START TO MAKE
THIS TOE RELAX AND NOT CONTINUE
TO POP UP LIKE THAT, OK? – I DON’T THINK PEOPLE NEED
TO LIVE WITH THEIR PAIN, BUT WE, AS PROVIDERS,
CAN’T HELP YOU IF YOU DON’T TELL US
THAT YOU’RE REALLY SUFFERING. – I WOULD SPEND SOME TIME
WITH SOMEBODY EDUCATING A PERSON WHO HAS PARKINSON’S DISEASE
AND PAIN THAT THEY’RE NOT ALONE, THAT THERE ARE MANY, MANY PEOPLE
WHO EXPERIENCED THE SAME THING, AND THAT THEY CAN DO
SOMETHING ABOUT IT. – I’M FUNCTIONING… NOT PERFECT… BUT I’M FUNCTIONING WELL, AND I’M HAPPY AS A MAN TO BE
FUNCTIONING LIKE THIS. MY 13-YEAR-OLD SON
BENEFITS FROM IT, MY WIFE, AND I HOPE
EVERYBODY THAT I TOUCH. – WE KNOW THAT IT’S REALLY
IMPORTANT TO ACTIVELY ENGAGE IN A SOCIAL LIFE AND GET
THOSE LOVED ONES IN YOUR LIFE TO STAY AROUND YOU,
SUPPORT YOU. – MY PAIN TOLERANCE
IS PROBABLY PRETTY HIGH, BUT MY WIFE COMING HOME TO ME
AND MY SON COMING HOME TO ME HELP ME WITH A LOT OF THAT. WHAT MAKES ME HAPPY THESE DAYS
IS KEEPING THE HOUSE IN ORDER, TO MAKE DECISIONS, PAY MY BILLS,
BEING RETIRED. EVEN THOUGH
I’D RATHER BE AT WORK, IT’S KIND OF NICE BEING HOME, MAKING SURE MY SON
GETS OFF TO SCHOOL. I’M NOT SCARED NO MORE.
I TAKE A WALK TO THE STORE. I WALK MY DOG. I HAVE CONVERSATIONS
WITH PEOPLE, TRY TO ENJOY LIFE
A LITTLE BIT SLOWER, A LITTLE BIT SHAKIER, BUT EVERYTHING IS OK NOW.

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