Aging Well With Parkinson’s Disease

 

Well, we aren’t getting any younger, let’s face it. And thanks to new research on Parkinson’s Disease, we’re living longer with new pharmaceuticals and an increased understanding of what happens to a person who has this disease. But now that we’re living longer, what can we expect from the aging process? How will we know what is normal aging and what is PD related?

To help us learn about what lies ahead, we asked Maura Sughrue, MD, a family practice doctor recently named one of Washingtonian Magazine’s “Top Docs” for 2016. She graciously sat down with us and discussed aging and PD.

Just to know how confusing this can be, the same non-motor symptoms of PD can also come with aging, (can include constipation, sweating, sexual dysfunction sleep problems, psychiatric issues, fatigue and pain). One exception relates to blood pressure. , With PD you can have low blood pressure. but BP usually goes higher as you get older. You’ve heard the expression that “aging is not for sissies”. For most people, aging is a challenge but its even more so if you also have a chronic disease.
Dr. Sughrue recognizes our challenge of trying to discern what is coming from our PD and what isn’t, and what might be a side effect of medication. For guidance, she recommends you talk with both your neurologist and your PCP; both will have helpful and different insights.

To age well, here are some basic recommendations for staying healthy as you age.

Planning Your Food. Concentrate on fruits and vegetables and limit the amount of red meat you consume. Avoid fast food and processed food. When you eat, watch your portion sizes. The dietary pluses are best gained by by eating the foods instead of taking supplements. Good advice at any age.
Regular Exercise. Strive for 30 minutes a day, five days a week. Pay attention to balance and strength along with aerobic activity.
Sleep. Sleep can be elusive as we age. Strive for the best quality and best quantity you can. Tell your doctor if you can’t.
Stress and anxiety actually affect your health. Find ways to deal with it, either by something like yoga or reducing exposure.
Stay ENGAGED! We’re all better off when connected with others.[ When my mother was in a nursing home, she’d get depressed sometimes. But when she had tasks for her church or a goal that involved her being and working with others, she was much happier and energetic.]

Topics on Aging

Menopause
Some people slide right through menopause and others really struggle with it. Symptoms of menopause include hot flashes, mental fogginess, sexual issues, insomnia and abnormal bleeding.The thinking on taking hormones after menopause has shifted back and forth. But the 2001 Women’s Global Initiative (a comprehensive long-term study of the health of 100,000 women from the 1980’s) said that no one should take them. Other thinking is that there’s a place for hormone therapy and everyone could benefit for their use. Now there’s more of a middle ground on the usage; there are some situations where a woman could benefit from hormones for a certain time.

Cataracts
When you have cataracts, you have cloudy lenses. It could be a result of genetic, environmental (sun exposure ) or diet.

Oral Steroids
Oral steroids, like one might take for asthma doesn’t cause cancer. It is the long-term steroid usage at a high dosage that is problematic.

What can I do to prevent problems as I age?
Dr. Sughrue says one of the best things to do is up your Vitamin C level, not by taking supplements but by eating it, so up the citrus in your grocery trip.

Osteoporosis
Parkinson’s Disease does not affect your bone density. Rather, it is less activity which leads to decreased bone density. Doctors strongly encourage Vitamin D3 supplements to help strengthen them. Seniors absorb the sun at 20% of the rate of 20 year olds. Also, if you’ve been a smoker and you are inactive, you have a higher chance of getting osteoporosis. There are websites that have a calculator to show your risk. One the doctor mentioned was the FRAX calculator (FRAX stands for Fracture Risk Assessment Tool.

Metabolic Syndrome
Metabolic Syndrome refers to a combination of medical conditions that conspire against our arteries in negative ways. If you have any of the following, you should work with your PCP to minimize and control them.
Hypertension
Diabetes
High cholesterol numbers
Overweight
Memory Loss
Are you worried about possible memory loss? How can you tell whether it’s a regular part of aging or if its something more? You should bring your concerns to your doctor but if you’re bothered by it, if you’re aware enough to realize you forgot something, you probably have nothing to worry about. It’s when you aren’t aware of gaps in your memory that there’s more likely to be a problem. For memory loss prevention, the recommendations are the same as stated with other issues, sleep, exercise, food, stress reduction and avoiding social isolation.

Lack of Energy
A lack of energy as you age could have a lot of contributing factors. It could be due to a one or a combination of the following:
* Chronic pain
* Poor sleep habits
* Changing body
*  High stress load.
It’s important to try to identify the critical factors to get quality sleep. This includes ruling out apnea, for example.

Osteoarthritis
Osteoarthritis can be due to genetics but could also be a result of wear and tear on your joints, whether you’re athletic or not. You can minimize the impact by maintaining a healthy weight and staying physically active. Usually treated with pain-killers but that has concerns too, as far as what they can do to your kidneys. Dr. Sughrue
recommends trying to stay as physically active as possible. Movement is important.

Mammogram
The best frequency for having a mammogram has been debated and changed over time. Currently, the advice is to have one every other year. Doctors take an oath to first do no harm, but too many mammograms creates a risk , too,considering how much radiation you’re exposed to. Mammograms can also give false positives leading to more biopsies than really necessary. That’s not to say that someone with a family history, genetic testing or prior history have to follow the recommended schedule.

Pap Smears
Pap Smears are not as accurate for detecting cancer as HPV (Human Papiloma Virus) testing. Where there’s no HPV, there’s no cancer so the focus is on identifying HPV. If your HPV test and your pap smear is clean, you’re probably good for 5 years.

Shingles and other Vaccines
The disease known as shingles occurs when the virus that causes chickenpox is reactivated in the body. The virus, once contracted, stays in the body, dormant until the person’s immunity begins to decline as they age. The result of the reactivated virus is the painful rash known as shingles. The shingles vaccine is generally approved for those who are 60 and over.
Here’s a fact about vaccines that I didn’t know: they are less effective as you get older. So why bother? One important reason is “herd immunity”. If you are in a large group of people who, say, have all had chicken pox and someone walks in with a full-blown active case, it won’t spread through the “herd” . ( I’m assuming no pregnant women, no one with compromised immune systems.) But if that same person walks in to a community where only a percentage have had the disease, some people may contract it and spread it.

What’s with all the Hepatitis C commercials aimed at baby boomers?
Hepatitis C was spread along with all the “free love” of the 1960’s. A test was available but insurance wouldn’t cover it. Most insurances still won’t but if you’re concerned, you can ask them about coverage before asking talking to your doctor.

Other Suggestions
A low dose chest scan would be good for former smokers.
Oh, and a one-time HIV test could be a good idea.
Colon cancer screening. You can have a colonoscopy or a stool test, Some prefer the colonoscopy. If you’re clean, you only have to repeat in 10 years. The stool test is annual.
Encourage your doctors to converse, especially if they disagree about your treatment. It’s much easier now that there are shared digital patient records and email.
It’s important to keep your GP updated. This is a long-term investment. In case of an emergency, its good to have your doctor know you well. It’s recommended to see your GP every year or two.
One way to keep the GP updated is by asking your other doctors to send a copy of your visit notes.