Ask Dr. Friedman- Frequently Asked Questions answered by one of our Favorite Movement Disorders Docs
Who is Joseph Friedman MD
Dr. Friedman attended medical school at Columbia University, College of Physicians and Surgeons, and neurology residency at the Neurological Institute of NY. He has been practicing in Rhode Island since 1982, and is the Director of The Movement Disorders Program at Butler Hospital, and Professor in the Department of Neurology of the Warren Alpert Medical School of Brown University. His clinical research has focused on behavioral aspects of Parkinson's disease and he is an amazing advocate for persons with Parkinson’s. We were lucky to interview Dr. Friedman for this blog.
His newest book is $2.99 at Amazon with all the proceeds to a Canadian charity supporting medications fr Africans with Parkinson’s: https://www.goodreads.com/book/show/54022101-a-free-brief-guide-to-parkinson-s-disease-for-patients-and-family
He also wrote Making the Connection Between Brain and Behavior: Coping with Parkinson's Disease, which discusses only behavioral topics. This book is not free and is available on Amazon, or possibly in your community library.
1. Are the stages of Parkinson’s disease important
to know?
There are 5 stages in the Hoehn-Yahr staging system for PD. These were described in a 1967 paper about the response to the then new drug, L-Dopa. This staging system, in which stage 1 means PD on one side only; stage 2 means PD on both sides but with normal balance; stage 3 means that walking is independent but balance is impaired; stage 4 means that walking is poor and often requires a cane or walker; and stage 5 is for those unable to walk. The problem is that patients don’t progress in a predictable fashion from one stage to the next, and, problems that don’t involve walking or balance aren’t taken into account. A stage 3 patient with normal speech and cognition may be in much better shape than a person who is stage 1 with speech problems. A stage one patient whose dominant side is affected may be disabled but if the problem had been on the other side at the same level of severity, the person may only be inconvenienced.
Staging is useful for interpreting clinical research papers, but not for individual patients.
2. When is it ok to nag?
I tell family that nagging is good in two situations, for issues regarding safety and for exercise. I don’t think it is helpful to nag about posture, for example. PD patients can usually stand up straight, but only when they’re thinking about it, and the posture returns to baseline once they stop thinking about it. Since many patients have a hard time with multitasking, it is hard to think about standing up straight, swinging the arms, taking big steps and not walking into a tree. Most PD patients have time to exercise, although those that work often don’t. Exercise is crucial for long term well-being. Exercise in an investment in your future.
3. What is the difference between a realistic dream
and a hallucination?
L-Dopa frequently causes dreams to become very realistic. We call them “vivid dreams.” They can be so real that when a patient wakes up she might ask about an event in the dream, thinking that it really happened. This often causes concern about hallucinations or confusion. If someone dreams that their neighbor was taken by ambulance to the hospital, she may ask what happened, and the family will become very concerned about the PD patient. Understanding that dreams may seem very real can take the worry out of these situations.
4. When should I go to the emergency room?
PD patients should go to the emergency room for the same reasons that other people their age go, after possibly serious injuries from a fall, chest pain, fever and cough, stroke, heart attack, etc. It is usually not a good idea to go to the ED because the PD gets worse. Of course, sometimes PD gets suddenly worse due to a bladder or lung infection, but if the PD is a little worse than usual, and nothing else is going on, the usual outcome of an ED visit is a 12 hour stay, multiple tests and a recommendation to call the neurologist when you get home. It’s usually quicker and cheaper to call the neurologist before you go to the ED if the reason for going is PD related.
5. Should I tell my doctor the way I really take my
medications?
My patients sometimes don’t tell me that they didn’t take the medications I prescribed, unless I ask specifically about the lack of response to the new medication I prescribed at the last visit. “Well, I didn’t really take it.” “Why not?” “I read the side effects and got worried. “Why didn’t you tell me?” “I was afraid you’d be angry.”
My view of the doctor-patient relationship is that I’m an advisor, much like a financial advisor. I give my best advice, and my patients are free to follow it or not. I never “fire” a patient for declining to follow my strategy. It’s their bodies. I also point out that all medications have the potential for causing side effects, and that I, like all physicians, weigh the benefit against side effects in every treatment we prescribe.
To read more books and articles by Michael S. Okun MD check on Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside
He also serves as the Medical Advisor for the Parkinson’s Foundation.
To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.
The blog artist is Jonny Acheson.