Parkinson's fails to slow sports-medicine doctor

By: Kate Nolan
The Arizona Republic
Mar. 20, 2007 12:00 AM
http://www.azcentral.com/news/articl...sease0320.html

Dr. Gary Guten was a top orthopedic surgeon, a team physician for the Milwaukee Brewers.

Then, at 55, he developed hand tremors diagnosed as Parkinson's disease and had to stop doing surgery.

Twelve years later, Guten, who splits his time between Scottsdale and Milwaukee, has co-written Parkinson's Disease for Dummies, a 364-page book about the illness and guidelines for living with it.

The author of six other books, Guten contributed the chapters on nutrition and exercise. An earlier book, Injuries in Outdoor Recreation, addresses challenges for healthy people. This one tells Parkinson's patients who want to pursue normal activities how to do it.

Guten would know.

One recent morning at Scottsdale's Pinnacle Peak Park, the 67-year-old demonstrated how a guy with a chronic neurological disorder can do a lot of the things he used to do, such as hiking a 1.75-mile trail.

While his tanned muscular calves propelled him up the mountain, Guten aggressively jabbed twin aluminum hiking poles at the trail bed to maintain his balance. He moved carefully, the points of the poles hitting the ground together, each foot plodding rhythmically forward.

"This is the ideal trail for Parkinson's disease. It's so well-groomed, and there aren't a lot of rocks to stumble on," said Guten, who also plays the piano and gives a recital every six months.

Guten, who still practices sports medicine, argues that physical activity is especially therapeutic for people with the illness and urges them to exercise. He plays golf several times a week and hikes or bikes daily.

Parkinson's disease results from diminished dopamine, a brain chemical that influences movement, balance and coordination. In Parkinson's, cells that produce dopamine die earlier than normal. It is diagnosed in 60,000 Americans a year and affects Muhammad Ali and Michael J. Fox.

Guten had the classic symptom. He noticed the telltale hand tremors while playing chess. Some conditions produce tremors during movement, but Parkinson's tremors appear while a limb is at rest. When Guten responded to medication, the diagnosis was conclusive.

He takes four drugs to stimulate production of dopamine, but said he intentionally undermedicates. The side effects - dizziness, light-headedness and mental dullness - affect his quality of life more than the tremors. He said exercise and nutrition can control symptoms, too.

A lifelong athlete, Guten said, "The biggest mistake people make is letting themselves get depressed. Sure, if you get cancer or break a bone, you get depressed. But in PD, the chemical changes cause depression. That's why I think activity is so important. Exercise produces endorphins, which keep the spirits up."

He cited studies of mice with Parkinson's disease; those allowed to run had less neurological disease.

Addressing a peculiarity of the disease, Guten often chooses activities that stress sideways movement.

"When I move sideways, there's very little tremor," he said, jerkily picking up a hiking pole and swinging it like a golf club, his stroke clean and smooth as a pro's.

The same phenomenon applies to table tennis, where the player crabwalks side to side. Guten uses a robotic ball server for frequent workouts.

He urges people who haven't been active to set goals and train toward something, such as walking a marathon.

His favorite slogan: "If something is worth doing, it's worth doing badly."