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."

Thanks for the book tip, Carolyn.
Dr. Guten (love that name, sounds like a madcap scientist out of the Marx Brothers or something ) names the two things I'm still good at after 13 years with PD: long hikes and playing ping-pong. The sideways movements in table tennis are very easy for us.

Love that quote : "If something is worth doing, it is worth doing badly." I am going to include that in my philosophy along with two I try to live by: "If you have something bad to say about me, say it behind my back. I don't want to know you don't like me," and, similar to the first quote above, "If you can't do something right, do it half way, because doing it half-way is better than nothing at all."

Now why didn't one of us think of writing that book?

Ann

Just bought and read this book.As books on Parkinson's go I feel it is good and at least up to date.I found it very up beat and liked the emphasis on preparing for the future but do not projecting.I also liked the sections for care partners which I felt often hit the nail on the head.

If they've put out a "Dummies" book on a subject you know there's a large enough audience in the mainstream of society to make it viable economically.
The baby boomers have entered the PD zone and are climbing (literally in this case) in numbers. Now if we can get them politically active (is that an oxymoron: an active Parkie?) then there may be much more political clout ahead. Let's hope so.

Checked the index. Not a single listing for stress! Does he have the same thing I do?

My husband has P.D, I do not. Yet throughout our 40+years of married life he has been the calm unstressed one and I have been the anxious stressed one. That is still true.Yes, this does not seem to be one disease.I think of it like I think of having a temperaturene symptom that has multiple causes.

My wife is the emotional/excitable one for sure. I have always been stress tolerant or so I assumed. But now even simply rushing for an appointment can trigger symptoms and trash the whole day.

The surprising role of stress comes much earlier, even in utero. It is amazing what maternal stress can do to the fetus if it occurs at the wrong time. The net result for PWP is elevated cortisol which leads to inflammation and so on.

On the old BT we had a long thread on our childhoods and were surprised that most of us had high-stress ones. Didn't know it at the time but our systems remain "plastic" far longer than we realize. Stress is a very big factor in PD. Thus my surprise at its

This caught my eye:

I've been using the sideways notion for a few weeks now. Someone here mentioned moving side to side to break a freeze. It helps me overcome start hesitation.

I expanded the use to walking and my gait is better. Instead of focusing on walking foward, I think of my walking as walking side to side, sideways. Sometimes I sway a bit. But just imagining moving sideways helps my gait a great deal.

I don't have resting tremor but my gait disorder and bradykinesia are helped by 'moving sideways' instead of foward, even thought the the motion is a foward motion. When my brain thinks sideways, I just move better, and I don't know why, but it works.

If PD were just a shortage of dopamine inhibiting movement, this could not happen. That it does would seem to indicate a control problem of an unusual nature. It also means that far too much money goes into levodopa research and too little into other areas.