Article published October 14, 2007

Clinic advances fight on degenerative disease


By JENNI LAIDMAN
BLADE SCIENCE WRITER

David Nash rakes the leaves in front of his suburban Detroit home. He looks like anybody else engaged in yard work on this autumn afternoon.

And that's the problem: He doesn't look like a Parkinson's patient. A couple of years ago, that landed him flat on his back - more than once.

The 71-year-old Madison Heights man had decided he would go to a neurologist closer to home, instead of making the twice yearly trip to see Dr. Larry Elmer at the former Medical College of Ohio. While he thought Dr. Elmer was tops - indeed, he'd left another doctor to be treated by Dr. Elmer - he worried that someday the 75-minute drive to the University of Toledo Health Science Campus would prove too difficult.

The new doctor took Mr. Nash off of all his medications.

"He didn't really think I had Parkinson's disease. After about a week and a half, man, I could hardly stand up. I was getting really bad," Mr. Nash said.

"That was a nightmare," adds his wife, Louise. "He fell in the grocery store. It was scary. He fell mowing the lawn."

In a way, David Nash was a victim of success. Treatments for Parkinson's disease have advanced so far in the last decade, it's not always possible to tell just who has Parkinson's and who doesn't. In fact, Mr. Nash isn't the only Parkinson's patient of the UT Center for Neurological Disorders to flummox other physicians.

"That's Dr. Elmer. He gets people looking perfect - like they don't have Parkinson's," says Gayle Kamm, an assistant professor of pharmacy who is part of the treatment team in the clinic.

"We've had a number of patients ... they go to Florida and they call us in absolute crisis," Dr. Elmer said. Their Florida doctor doubts their diagnosis, takes them off their medications, and symptoms of the degenerative disease flood in.

The Parkinson's clinic in the Ruppert Center on the UT Health Sciences Campus is a busy place. Patients dash down the halls, fighting their tendency to shuffle, to demonstrate their moves for physical and occupational therapists. They reach and stretch to show flexibility and agility.

Dr. Elmer stands in a hall perpendicular to this Parkinson's olympiad and grips the shoulders of a thin, stylish woman. He warns her to try to keep her balance then pulls her back suddenly. She tips like a tin soldier. Her balance is shot.

Volunteers shepherd other patients from room to room. John Temme's cell phone plays "March of the Toy Soldiers." It's his reminder to take his medication - something many do at least five times a day. Mr. Temme, 58, is a patient-volunteer here. The Whitehouse resident was diagnosed with Parkinson's at 51. He and his wife, Nancy, started volunteering when they realized how tasks like filing, and faxing, and making copies kept the staff from practicing medicine.

Today, Toledoan Robert DuBois, 62, also a patient, supervises a staff of 20 volunteers. By September, the group had donated 1,160 hours this year. They not only do clerical work, but act as mentors to new patients, create a patient newsletter, and organize an annual Parkinson's symposium.

"I'm having a good time," Mr. DeBois said during a break in his work at the clinic. He was diagnosed with Parkinson's at 58. "I really enjoy what I'm doing more than any job I had." His career was in the automotive industry.

"In industry, the bottom line is what you're asking for. Here, it's stay off the bottom line as long as you can. It's just fun. Everybody is smiling a little bigger when you leave."

Dr. Elmer inspires this kind of devotion: patients who volunteer, staff members, including other doctors, who gush with praise. Patients quick to point out his unusual personal style.

"He sits right there next to me, or gets down on his knees, looks right at me, and talks to me, and listens to me. That's the first time a doctor's done that," said Nancy Breivik, 76, diagnosed with Parkinson's in 1990s.

Larry Elmer, 49, is a big guy. He's given to laughter, sometimes, large, silly delight. He has nearly 1,000 patients now. When patients complain, it's because they only see him for the moment he sticks his head in the door to say hello. Instead, much of their time is engaged by specialists, other doctors, nurse practitioners, and physician assistants. In June, Dr. Elmer rejiggered his schedule to make sure he has face time with patients regularly.

"It probably slows us down a little more than we're used to, but it's been so gratifying. It means a lot to me," Dr. Elmer said.

Parkinson's is a disease of dopamine. Although that neurochemical gets its biggest publicity for its role in pleasure-seeking behaviors and addiction, it also plays an essential role in movement. Without dopamine, we're stuck. Literally.

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