Mountain biker, hiker and skier Robert Berlin, M.D., was just 53 when he began experiencing symptoms of Parkinson's disease. Today, thanks to health care tailored to his lifestyle, he remains active and optimistic.

Dr. Robert Berlin can tick off a nearly 50-mile bicycle ride in a single afternoon. He can climb a 1600-foot-mountain and ski back down. Each day he performs about 90 minutes of cardiovascular exercise. And he does it all while dealing with early onset Parkinson's disease.

With help and guidance from his Mayo Clinic neurologist Rodolfo Savica, M.D., Ph.D., Robert has been able to take tailored doses of medication to suppress the condition's symptoms and maintain the avid athleticism that's integral to his psyche.

"Bob is a person who if you saw walking around, you would not say he has Parkinson's disease," says Dr. Savica, who has been part of Robert's care team since 2014. "Bob is an avid athlete and really likes to be at 100 percent. We want him to be as close to 100 percent as possible. I want him to have as much ability and function as he can."

Activity and a positive outlook

For Robert, exercise not only allows him to remain physically strong, but it bolsters his emotional and mental fortitude to fight the disease, which is normally diagnosed at about the age of 71.

"Trying to maintain doing the things that make you happy is a good approach to maintaining a positive outlook," Robert says. "Besides the medication, I think you've got to keep moving. That's what I do. I find there's some peace in that, and I think it's a healthy thing to do."

In fact, research studies show exercise may actually curb the effects of Parkinson's disease.

"… Bob is an inspiration to many. He's putting forth all of the effort he can by following our direction trying to fight the disease." — Rodolfo Savica, M.D., Ph.D.

"Theories show exercise is crucial for the mental part of Parkinson's disease, and some theories suggest that with exercise the neurons that are damaged can build up new connections within the cortex," Dr. Savica says.

Although Robert has bad days sprinkled in with the good, his commitment to an active lifestyle serves him well.

"The disease definitely will progress, but the beauty of Bob is that he's really buying in to exercising. He's buying into being mentally active," Dr. Savica adds. "That's why I feel Bob is an inspiration to many. He's putting forth all of the effort he can by following our direction trying to fight the disease."

Depression, denial and diagnosis

 A resident of the resort town of Jackson Hole, Wyoming, Robert was head of the radiology department in the community's hospital for more than 20 years. The area is known for outdoor recreational activities. Robert, an avid mountain biker and skier, took advantage of the area's topography. But in the summer of 2013, he began to feel depressed.

According to the National Institutes of Health, between 40 to 50 percent of people affected by Parkinson's disease experience depression. In retrospect, says Robert, depression was his first noticeable symptom of the disease.

"I took a trip back East to see my sister and a good friend of mine from medical school. I remember very matter-of-factly thinking, 'This is going to be the last trip I'm going to take,'" he says. "While working in the radiology department, I was very emotionally affected when reading patients' examinations containing pathological findings."

"I received treatment for all sorts of things, but the one thing they weren't treating me for was Parkinson's. My personal denial resulted in a delay of my diagnosis." — Robert Berlin

Soon after, physical problems began appearing. He sought help from a neurologist, who recommended Robert visit a neuro-ophthalmologist to undergo testing for a motion disorder called progressive supra-nuclear palsy, or PSP. His neurologist also suggested Robert visit a movement disorder specialist. That physician turned out to be Dr. Savica, who at the time practiced at the University of Utah. Robert was advised to consult with a neurosurgeon as well, to discuss a pre-existing case of cervical stenosis. Lastly, the neurologist suggested Robert visit a psychiatrist to manage his depression.

The neuro-ophthalmologist ruled out PSP. In June 2014, Robert's neurosurgeon performed cervical fusion to help with the cervical stenosis. His psychiatrist prescribed multiple medications.

"I received treatment for all sorts of things, but the one thing they weren't treating me for was Parkinson's," Robert says. "My personal denial resulted in a delay of my diagnosis."

With symptoms such as tremors and lack of coordination progressing, Robert says he could no longer work. His wife, who is an internist, suggested he go to Mayo Clinic for a definitive diagnosis.

Robert made an appointment to be seen in the Department of Neurology at Mayo Clinic's Rochester campus. He was scheduled for an exam with J. Eric Ahlskog, M.D., Ph.D. After a thorough assessment of Robert's condition, Dr. Ahlskog was clear and direct about his diagnosis.

"It was so evident to him," Robert says. "He literally shook my wrist and said, 'You have Parkinson's.'"

Robert asked Dr. Ahlskog if there was any other testing that could be done to confirm the diagnosis. He suggested Robert take a dose of the Parkinson's medication carbidopa-levodopa. If it helped ease his symptoms, that would mean Robert had the disease.

"I took one pill, and an hour later I definitely felt better," he says. "There was no doubt about it."

Rather than feeling despair about having Parkinson's disease, the diagnosis brought Robert relief.

"I needed to figure out what was happening so I could get moving forward because I was pretty rapidly deteriorating," he says. "In addition to the carbidopa-levodopa, I needed antidepressant medication to alleviate severe depression."

Teamwork, treatment and triumph

 With his new diagnosis, Robert returned to Jackson Hole and made an appointment with Dr. Savica to monitor and tailor optimal medical treatment for his Parkinson's.

"When I met him, I knew right way that he was going to be my Parkinson's doctor for the rest of my life," Robert says. "I wanted someone who was empathetic, caring and to whom I was not just another number. Additionally, I desired someone on the leading edge of Parkinson's treatment. Dr. Savica does superb research of all the new developments in the field. His whole approach and commitment to me as a patient has been incredible."

"Dr. Savica does superb research of all the new developments in the field. His whole approach and commitment to me as a patient has been incredible." — Robert Berlin

When Dr. Savica moved to Rochester, Minnesota, to join Mayo Clinic, Robert says it was an easy decision to stay with him. Dr. Savica's personalized medical treatment has enabled Robert to maintain his highly active lifestyle.

"I hoped for a high level of function with no tremors and good motion enabling me to do the physical things that I like," Robert says.

Robert stays in contact with Dr. Savica, making follow-up visits to Minnesota, and phone calls and emails as needed to manage his medications and symptoms. "Rodolfo has been so incredibly responsive," Robert says. Even when he has an urgent issue in the middle of the night, he says, "I'll get a response before breakfast. I feel like I have an outstanding, extremely intelligent physician who is in charge of my care. He also considers me a good friend and treats me as a friend."

Dr. Savica says the feeling is mutual. As his friend, Dr. Savica will continue to support Robert both clinically and personally to help him keep the quality of life he wants.

"It's crucial to say to any patient that I want you to do well. I want you to feel good, and I want to give you everything in my medical expertise," Dr. Savica says.

With tailor-made treatment, Robert says he'll continue engaging in exercise for as long as possible.

"There is more to life than just physical things, and there's no doubt that eventually our physical bodies deteriorate," he says. "But personally, I've always found great happiness in being physical. Exercise of any intensity, from a long, difficult bike ride to walking the dog with my wife, brings joy into my life."

HELPFUL LINKS

• Read about Parkinson's disease
• Learn more about the Department of Neurology.
• Connect with others talking about Parkinson's disease on Mayo Clinic Connect.
• Explore Mayo Clinic.
• Request an appointment.

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ANSWER: There’s no one test that can be used to diagnose Parkinson’s disease. Instead, the diagnosis is based on a person’s medical history and symptoms, along with a neurological and physical exam. If your mother has doubts about her Parkinson’s diagnosis, getting a second opinion from a neurologist who specializes in the disease would be reasonable.

Parkinson’s disease is a progressive disorder of the nervous system that affects movement. In people who have this disease, certain nerve cells in the brain, called neurons, gradually die.

Many Parkinson’s symptoms are related to the loss of brain neurons that produce a chemical messenger called dopamine. Loss of dopamine can lead to a variety of symptoms. Those symptoms can vary widely from person to person. Parkinson’s develops slowly over time. In the disease’s early stages, symptoms may be very mild and barely noticeable.

About 80 percent of people with Parkinson’s have some type of tremor, or shaking, in a limb. It typically first affects a hand or fingers. Over time, Parkinson’s often makes it difficult to move quickly and causes muscle stiffness, limiting a person’s range of motion and sometimes causing pain. This can lead to a shuffling gait with short steps. It slows basic daily tasks, such as rising from a chair, writing or dressing. Some people with Parkinson’s develop a stooped posture and feel unsteady.

Parkinson’s typically impairs a person’s normal spontaneous body movements, such as blinking, smiling or swinging the arms while walking. The loss of dopamine that happens in Parkinson’s may sometimes trigger sleep disorders, panic attacks, anxiety or insomnia.

Neurologists review these symptoms when considering a diagnosis of Parkinson’s disease. Brain imaging or blood tests may be recommended, but, often, the diagnosis is made based on the features identified at an office visit. When a health care provider strongly suspects Parkinson’s after an initial evaluation, he or she may prescribe carbidopa-levodopa. This drug helps replace dopamine in the brain.

If symptoms substantially improve when a person takes carbidopa-levodopa, that’s usually a clear sign that Parkinson’s is causing those symptoms. The changes don’t happen within a day or two, though. To be most effective, a person must take the medication in the correct dose over a longer period of time.

Among people with fully developed Parkinson’s disease, an accurate diagnosis that leads to appropriate carbidopa-levodopa dosage is crucial. For most patients, treatment also involves an exercise program to increase fitness and improve muscle strength, flexibility and balance.

Although there is no cure for Parkinson’s disease, in most cases, the disease and its symptoms can be managed effectively, so those who have Parkinson’s are able to continue engaging in active, fulfilling lives. — Dr. J. Eric Ahlskog, Neurology, Mayo Clinic, Rochester, Minnesota

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Parkinson's disease is a progressive disorder of the nervous system that affects movement. April is Parkinson’s Disease Awareness Month, and on the Mayo Clinic Radio podcast, neurologist Dr. J. Eric Ahlskog discusses treatment options for Parkinson's disease. Also on the program, preventive medicine and rehabilitation expert Dr. Jay Smith shares new treatment options for carpal tunnel syndrome. And palliative care specialist Dr. Jacob Strand explains how early referrals to hospice care can help patients and families benefit from many of the services they are eligible for at the end of life.

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Listen to the program on Saturday, April 8, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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Listen to the program on Saturday, April 8, at 9:05 a.m. CDT.

Miss the broadcast of the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Parkinson’s disease / carpal tunnel / hospice care appeared first on Mayo Clinic News Network.

Myth or Matter-of-Fact: Men are more likely than women to develop Parkinson's disease.

Mayo Clinic Radio is available on iHeartRadio.

Listen to this program at 9:05 a.m. CT Saturday, October 31 and follow #MayoClinicRadio.

Access archived shows.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio appeared first on Mayo Clinic News Network.

Myth or Matter-of-Fact: Men are more likely than women to develop Parkinson's disease.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Parkinson’s Disease/Retinal Detachment/Halloween Safety appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC:

ANSWER: Essential tremor is among the most common of all movement disorders. Mild essential tremor usually does not require treatment. But if the tremor becomes worse or if it interferes with a person’s daily activities, treatment may be helpful. Medications can often keep essential tremor under control. Rarely, surgery may be used to treat severe cases.

By definition, tremor causes involuntary, rhythmic shaking. Essential tremor most often affects the hands, but may also involve the head or voice. The hand tremor typically is most obvious when a person is holding his or her hands outstretched or when using the hands for fine motor skills, such as writing. Essential tremor gradually worsens — but very slowly — over many years.

The cause of essential tremor is not known. As in the situation you describe, people who have essential tremor often have a family member with the disorder, too. That seems to indicate genetics plays a role.

When essential tremor becomes bothersome, medications often help. The first line of treatment usually involves drugs called beta-blockers, notably propranolol or nadolol. They tend to be particularly useful in treating mild hand tremors. It is worth noting that these medications are different from the usual beta blockers currently used to treat high blood pressure, such as atenolol and metoprolol. Those kinds of beta blockers are not very effective for essential tremor.

Alternative medications may also be helpful, but one should be mindful of side effects with these other drugs. These include the barbiturate primidone, as well as a class of drugs known as carbonic anhydrase inhibitors, including topiramate.

Essential tremor that affects the head or voice generally does not respond as well to these medications. Head or voice tremor may, however, benefit from botulinum toxin (Botox) injections. Botox temporarily weakens the targeted muscles, reducing the tremor amplitude.

For those with long-standing and severe tremor, especially hand tremor, deep brain stimulation (DBS) may be considered. This involves implantation of a stimulating electrode into the brain, and specifically targeting the region of a brain tremor circuit within the thalamus. A pacemaker-like stimulus generator, implanted under the skin, is connected via an imperceptible wire to the electrode, turning off the tremor circuit. This impulse generator is much like a heart pacemaker. This surgery is not without risk, but typically is very efficacious.

Your daughter may wish to talk with her doctor about her tremor. He or she can review your daughter’s medical history and current medications, as well as her symptoms, to help her decide how to best manage her essential tremor. Consultation with a neurologist, especially one who specializes in tremor and other movement disorders, may be useful.

Your daughter also may find it helpful to access the resources available through the patient support group International Essential Tremor Foundation. You can find this group online at www.essentialtremor.org. — J. Eric Ahlskog, M.D., Ph.D., Neurology, Mayo Clinic, Rochester, Minn.

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Medical Edge Weekend 6-19-10

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