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Depression

Newspaper Article: Getting Parkinson’s patients out of their homes

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Usually activities shut down over Christmas/ new year but something in me said “Let’s start this group and keep the momentum going”. So we started in November and continued with meetings in December, January and February and March with Dr Karlos Lizarragas’s visit. It was a busy few months but it turned out to be a good decision because the week after the Doctors visit we all went into lockdown. I was grateful that I got to know the people who came and connect with them over the ‘summer break’. Now we can’t meet and it is day 108 of the lockdown and we’ve got at least a month to go and because many are elderly and at risk it will be some time before we can meet again.

This is a newspaper article that appeared in the CORREO newspaper the week Dr Karlo came. I have attached the link but have included a rough translation as the article in in Spanish. It might be old news but it reminds me to keep sending them messages of hope and encouragement by whatsapp or sms to my people here and since I didn’t translate this is earlier it is still new to most of you. Please note it is a loose translation and sounds a little strange but you can get the gist. 😉

This article is titled: “Those affected by Parkinson’s take on the challenge to to fight against Parkinson’s”

https://diariocorreo.pe/edicion/arequipa/afectados-por-enfermedad-asumen-reto-se-superar-parkinson-933641/

The Activate Association of Parkinson’s is growing and on Tuesday, March 3, they will receive the Arequipa neurologist Karlo Lizárraga Mendoza 03/01/2020 at 12:30

Last December, The Correo (newspaper) spread the encouraging message of Christine Jeyachandran, an evangelical Christian missionary, who manages well her symptoms in her body although it is affected by the disorder of the central nervous system. Three months later, her aim to create the Parkinson’s League – ‘Get Active'(Activate) is paying off with 26 people attended the last meeting. Christine, who has overcome the limitations of the disease through gym sessions, wishes her peers a similar experience. The first step, and perhaps the most difficult, has been to encourage this significant group of people of different ages to come along and not hide at homes. They are now the founding members of Actívate, and the next step will be to involve everyone in physical exercise as therapy.

Limitations. Parkinson is terrible: the physical limitations, the inability to speak loud and clear, tremors, dragging feet, drooling, diminished facial expression, the lack of balance, the frustration of not walking well, all this causes a heavy load of vulnerability that you carry to everywhere” says Christine to describe the diagnosis of parkinson’s. Activate began on November 3 with 5 members supported by two professionals from the Honorio Delgado Espinoza hospital, one of them is the psychologist Rita Ames who has strengthened Christine’s knowledge of group management and emotions of those affected by the disease.

Since then until February, they have met three times and each time the number of members has increased, reaching 26 people who have left isolation and are willing to continue on the path of integrating and growing the League, eager to achieve control of your movements. “Affected people do not have to be embarrassed in our meetings. You don’t have to explain your symptoms to anyone here because we understand each other. The reason for our name, Get active (Activate yourself), is that we want to do gymnastics, but we haven’t started for various reasons, but the first thing is that they came out of hiding, “says the promoter of the organization excitedly. In these sessions, with the help of the psychologist Rita Ames, everyone can share their ideas, some very shy and others less, they tell their stories, tears are not lacking because they finally have people by their side who understand them.

TO THE FAMILY. The meetings are focused on educating people and their families about the disease and about exercises that can help overcome their symptoms to improve their quality of life. Rita Ames indicates that many suffer from depression and apathy but they are explained how the Activate League will work, that is, with their participation. They find it hard to stop focusing on their weaknesses, but little by little they have shown hope in their eyes. One of the participants, Juan, acknowledged that at first he was only interested in reinforcing his depression due to the disease and its symptoms, but now he maintains the hope of engaging in physical exercises as a means of reducing them and thus improving his quality of life.

MUCH FAITH. “Telling PD patients they have a movement disorder and leaving it at that is a self-fulfilling prophecy. It would be better to tell them, “You have a disorder in which the motivation for movement is significantly impaired, along with movement . But by knowing that, and using conscious mental effort, you may be able to override the impairment to a significant degree” says Canadian psychiatrist Norman Doidge, and members of the Activate League have begun to believe it.

How is your body when you are stressed?

Do you notice yourself feeling tense, for example in your shoulders? Does your headache? 

Do you feel tired or easily irritated? Does your stomach get upset or do you experience shortness of breath?

While everyone might be a bit different it is important that we notice what stress looks like and notice what happens in our body. Looking for the signals is the first step in dealing with stress.  This was one strategy the fabulous psychologist Rita Ames taught us in an interactive talk about dealing with stress and Parkinson’s disease. She got everyone talking, even those who seemed reticent at first.

Looking back these feelings of stress were with me at the January Activate meeting where I felt overwhelmed leading almost everything at the meeting. So I had noted this and delegated a few things and asked for volunteers. I was encouraged to have lots of help and glad to not be stressed during our February meeting. 

Rita did the main talk and Elizabeth, another volunteer and gifted communicator, encouraged us spiritually. We had a volunteer bring crackers and water and others helped with registration. This allowed me to be free to organise the meeting while carers could tell their side of the story to our registration helpers. The carers often feel isolated so they appreciated having someone to listen to them and show them love. 

The biggest surprise was Juan who I asked to report on our legal status and our plans to create a Non government organization (NGO) so we can receive donations. He shared how he had caught my contagious attitude and was now planning big things for “Activate – Liga Contra el Parkinson”. It’s very encouraging as his plans go way beyond my ideas. He also shared about his life with Parkinson, his struggle with depression and thoughts about how we can help others with this debilitating sickness. It’s exciting to see Juan’s approach changing.

Needs:

  • We may need a new venue in the future so please pray for this.
  • We need to have space for exercise classes too (could be the same place). 
  • Also pray we find a physiotherapist to evaluate people, so we can understand their needs before we start classes and track their progress.
  • Volunteers for Registration at events
  • Volunteers to distribute and hang posters to educate the public 
  • Volunteers for administration and translation, 
  • Our next meeting on the 3rd of March is with a Peruvian Doctor who lives in the USA, so we need to get an organising team going very soon. 

So thanks again to those who helped me this month. I couldn’t do this alone. 

I am still thinking of how to avoid stress. I’m really enjoying the work but the extrovert in me doesn’t want to go it alone.

What can you do when you recognise stress in your life?

What is your strength or talent?

That may seem a strange question to use in a Parkinson’s association meeting. But that what I asked is very strategic. These people have parkinson! They have plenty of weaknesses. They are used to people asking them about symptoms and many suffer from depression, anxiety and lack of motivation. It is part of the disease though everyone is affected differently do not everyone has it.

The other reason I use such an approach is because I did a Masters in Community Development which is an aspect of social work and international development which approaches development from a different perspective. The role of the community development worker is to help the people themselves. 

One of the key methods is  asset-based development. Instead of going in and asking ‘what do you need’ or condensing statements or questions about their situation they look at the strengths they have. Helping people find their strengths means helping them see their worth and see how that could help each other. That is one of my aims with Activate – the Liga of Parkinson’s en Arequipa. 

I also wanted to avoid the tearful diagnosis stories this meeting and keep it more positive. Not to say we won’t do these stories but not everytime we meet. Instead we started with singing, actions and dancing to a children’s song with a good latino rhythm. This helped everyone loosen up and have a bit of fun. 

Feeling useful and valued brings people joy and my strategy is to get people involved in running the Liga. Let’s be honest it is a lot of work alone so having help will lighten the load too especially as the people get the hang of what is involved. Family of the people with 

Parkinson’s are also invited to help out too. 

We are hoping to start some sort of exercise classes for those interested so I asked if people could help find a location and teachers and or funding or the user pays. It could take some time. 

We also had life size person outline on paper and we had everyone yell  their symptoms, and we put up the labels on the body of where they related to.  They enjoyed being the experts on the disease as we of people learn about symptoms others have. 

We had about 16 people with Parkinson’s plus family. I have 42 contacts with Parkinson’s now and the Doctor just rang to say she has more people wanting to come so we a have penciled in the 11th of February for the next meeting in the same venue to keep things moving.

In all, exciting meeting and we hope and pray the enthusiasm continue. 

Starting the Parkinson’s Association in Arequipa

Speaking at a Lima event of the Parkinson’s Association

The process of starting the Parkinson’s association in my city is taking time. That is the way life is here in Peru as there is always paperwork and permissions and more paperwork to be done. But because of this delay I organised a more intimate meeting with a handful of people that I know to see if I could build up the trust between us. 

Edith (name changed) is a retired teacher who I have heard speak various times and always admired as she is so interactive and creative in the way she presents. I invited a group of pastor’s wives to my home, including Edith,  for a time to encourage one another and before long she mentioned she too has Parkinson’s disease. She didn’t know that exercise helps slow the advance of the disease. It was a surprise, but it shouldn’t be as my research shows that people with Parkinson’s (PWP) in Peru don’t have a clear understanding of how exercise rebuilds the nerve connections again and practice and movement help with coordination and walking.  To make a long story short it is exciting as Edith helped me host the first Parkinson’s association meeting in my home. Her talk were real blessing to others.

Another member is a lawyer Pablo (name changed) whose wife I know through my current circle. He is very capable in helping me with the paperwork for the association and also helping set it up legally.  His story is that he had been told he ‘shouldn’t dance or exert himself too much’. He actually struggled with this advice as he loved dancing but had to give it up. But scientific studies say the exact opposite. Dancing is an excellent form of exercise as the music helps move people too. Scientific studies say that while stretching is good but one needs to also get out of breath,  – which in Spanish is ‘agitarse’ – like agitate yourself a little. Dancing is great for Parkinson’s but so are running, walking, boxing, yoga and many other forms of exercise. They help with movement and prevent rapid disease progression. Exercise also helps with depression, and social interaction with exercise is great too. 

But this man has had the disease over 10 years, still works full time, and is now accustomed to inactivity. I have heard it said that people with Parkinson’s are resistant to exercise. This sounds strange but depression and apathy are also common and affect motivation. 

So pray for this new friend who wants to help with the association that he’ll have the time and energy to help and that also he can find the motivation to get exercising. I believe he can do it… he just doesn’t know it yet. His wife told me how amazingly smart he is and I don’t doubt it but sadly sometimes Parkinson’s affects so many parts of one’s life and this affects one’s confidence. 

It may all just take a little longer than I had planned but we had a lovely time together with just 5 of us in total. I hope we can integrate others soon. 

Peru and Parkinson’s Disease

According to the World Health Organisation 7 million people around the world have Parkinson’s disease. In Peru there are no official statistics but it is it is estimated that 30,000 people suffer with Parkinson’s and every year 2000-3000 new cases are found.

But from observation and comments of friends here, people hide disabilities or they can be undiagnosed so the numbers could be higher.

The treatment and lack of education about the disease is concerning.

Diagnosis of Parkinson’s disease in Peru is usually done by a neurologist but outside of the capital there are no Parkinson’s specialist neurologists (registered as Movement specialists)  and this can cause a variance of treatment. Unfortunately ‘Levodopa’ is prescribed from the beginning of the disease when it should be prescribed after about five years according to Doctor. Cesar Casteñada, Neurologo, Movement Disorders Specialist de Lima. The Parkinson’s medication “levodopa” has a shelf life and becomes less effective with time, and can even stop working after 5-10 years. Other drugs called Antagonists should be prescribed but they are expensive and may not be covered by health insurance in Peru (public or private).

Aside from drugs, the most important treatment that slows the diseases advancement is exercise but doctors here rarely mention this. One does not get a lot of time with the specialist and patient education is not a priority. It’s possible that doctors are not trained in what to recommend in terms of exercise therapy. Likewise referring people to a physiotherapist may lead to the same problem as in my experience in a regional city, physiotherapists lack training too.

What is needed is an expansion of the education about Parkinson’s disease for patients, their families and the medical community. Recently I attended the Parkinson’s Association meeting in Lima and found it to be so beneficial for the people emotionally as we connected with others like us. We became more educated about the disease and the event finished with some physical therapy which encouraged people and informed them about what they could do to help prevent the disease getting worse. We all participated and had fun.

Let me give you one case study that shows the benefits of education and of Parkinson’s sufferers meeting together. Over the last 6 months I have been chatting on WhatsApp and by phone with a lady of about 49 years of age with severe Parkinson’s. I’ve encouraged her about doing exercise, sent her videos of simple things she could do and articles to read about benefits of exercise and how to have a positive attitude. I pray for her too but unfortunately she never said she did any of the exercises. She was encouraged by our friendship but was often depressed and didn’t want to go out. She wanted to meet me and go to the Parkinson association meeting so she came all the way to Lima from a city 12 hours away. She attended the meeting and I could see that the people around her encouraging her  and challenging her about some of the things that I have been saying for months. When she got home she found it hard because her symptoms were getting worse and the drugs weren’t working as well as they did before, but then she wrote me saying she was meeting someone else with Parkinson’s disease and she was realising the importance of exercise and they were doing it together. She realised with her diseases advancement she had to exercise and stretch as the drugs didn’t help much. Amazing progress.

She benefited from both the educational meeting of the Parkinson’s Association and uniting with other people who had the disease – this was a great encouragement to her.  This is needed across Peru.

PS- There are many more stories to tell and more stories and background can be found in previous blogs.

Articles in Spanish Media:

https://elperuano.pe/noticia-parkinsonconociendo-enfermedad-48861.aspx

https://peru21.pe/amp/lima/lima-habria-10-000-personas-parkinson-72412

https://alicia.concytec.gob.pe/vufind/Record/UPCH_2f01252d8dff0d77e52d8faa46f8b494

hLa Enfermedad de Parkinson’s en Peru

Según la Organización Mundial de la Salud, 7 millones de personas en todo el mundo tienen la enfermedad de Parkinson. En Perú no hay estadísticas oficiales, pero se estima que 30,000 personas sufren de Parkinson y cada año se detectan 2000-3000 casos nuevos.
Pero a partir de la observación y los comentarios de amigos aquí, las personas ocultan discapacidades o pueden ser no diagnosticadas para que las cifras sean más altas.

El tratamiento y la falta de educación sobre la enfermedad es preocupante.
El diagnóstico de la enfermedad de Parkinson en Perú generalmente lo realiza un neurólogo, pero fuera de la capital no hay neurólogos especialistas en Parkinson (registrados como especialistas en Movimiento) y esto puede causar una variación del tratamiento. Desafortunadamente, “Levodopa” se prescribe desde el principio de la enfermedad cuando debe recetarse después de unos cinco años, según el médico. Cesar Casteñada, Neurologo, Especialista en Trastornos del Movimiento de Lima. El medicamento “levodopa” de la enfermedad de Parkinson tiene una vida útil y se vuelve menos efectivo con el tiempo, e incluso puede dejar de funcionar después de 5-10 años. Se deben recetar otros medicamentos llamados Antagonistas, pero son caros y es posible que no estén cubiertos por el seguro de salud en Perú (público o privado).

Aparte de los medicamentos, el tratamiento más importante que retarda el avance de las enfermedades es el ejercicio, pero los médicos aquí rara vez lo mencionan. Uno no tiene mucho tiempo con el especialista y la educación del paciente no es una prioridad. Es posible que los médicos no estén capacitados sobre qué recomendar en términos de terapia de ejercicios. Del mismo modo, remitir a las personas a un fisioterapeuta puede llevar al mismo problema que en mi experiencia en una ciudad regional, los fisioterapeutas también necesiten capacitación.

Lo que se necesita es una expansión de la educación sobre la enfermedad de Parkinson para los pacientes, sus familias y la comunidad médica. Recientemente, asistí a la reunión de la Asociación de Parkinson en Lima y descubrí que era muy beneficioso para las personas emocionalmente, ya que nos conectamos con otros como nosotros. Nos educamos más acerca de la enfermedad y el evento terminó con una terapia física que alentó a las personas y les informó sobre lo que podían hacer para ayudar a prevenir que la enfermedad empeorara. Todos participamos y nos divertimos.

Permítame darle un estudio de caso que muestra los beneficios de la educación y la reunión de los pacientes de Parkinson. Durante los últimos 6 meses he estado hablando en WhatsApp y por teléfono con una mujer de unos 49 años de edad con Parkinson grave. La alenté a hacer ejercicio, le envié videos de cosas simples que podía hacer y artículos para leer sobre los beneficios del ejercicio y cómo tener una actitud positiva. Ore por ella también, pero desafortunadamente ella nunca dijo que hizo ninguno de los ejercicios. Nuestra amistad la animaba pero a menudo estaba deprimida y no quería salir.
Quería reunirse conmigo e ir a la reunión de la asociación de Parkinson, por lo que vino a Lima desde una ciudad a 12 horas de distancia. Ella asistió a la reunión y pude ver que las personas a su alrededor la alientan y la desafían por algunas de las cosas que he estado diciendo durante meses. Veía la muy atenta. Cuando llegó a casa, lo encontraba difícil porque sus síntomas empeoraron y las drogas no funcionaban tan bien como antes, pero luego me escribió diciendo que estaba con alguien más con la enfermedad de Parkinson y que se estaba dando cuenta de la importancia del ejercicio y lo hacían juntos. Se dio cuenta de que con el avance de sus enfermedades tenía que hacer ejercicio y estirarse ya que las drogas no ayudaban mucho. Increíble progreso.

Se benefició tanto de la reunión educativa de la Asociación de Parkinson como de la unión con otras personas que tenían la enfermedad, esto fue un gran estímulo para ella. Esto es necesario en todo el Perú.

PD: Hay muchas más historias que contar y más historias y antecedentes se pueden encontrar en blogs anteriores.

Artículos en medios españoles esten arriba.

Some days…

Some days I sense the urgency, other days I want to stay in bed

Some days I am full energy, other days not

Some days I am strong, other days I struggle with one chin-up

Some days I am happy, other days cranky

Some days I go to the gym, other days I don’t.

Some days I am extroverted, other days I want be alone

Some days I am patient with homework, other days I want to give up.

Some days I wish I was a better parent, other days I realise so do most

Some days I pray for healing, other days I accept my situation

Some days I want to do amazing things, other days I remember ‘I have too much on’

Some days I kiss my children goodnight, other days they tuck me in

Some days I feel depressed but most days I am super grateful

Everyday I have Parkinson’s Disease and everyday I need to take drugs

Every day I struggle to walk when my drugs wear off

Everyday I need to be determined, Everyday I need to be strong

Everyday I need to ignore the apathy and push on

Everyday day I make mistakes but then I am guessing so do you.

Everyday I am grateful for husband who sees the positives in me

Everyday I trust God to use me: the good, the bad and ugly

Everyday for better or worse Parkinson’s inspires me…

 

 

A friend asked me how my personality has changed – this is my response.

Algunos dias…
Algunos días estoy llena de energía, otros días no
Algunos días estoy feliz, otros días renegona.
Algunos días beso a mis hijos buenas noches, otros días me acostarme temprano
Algunos días soy paciente con la tarea, otros días también quiero rendirme.
Algunos días desearía ser un mejor padre, otros días me doy cuenta de que otras padres sienten igual
Algunos días soy extrovertida, otros días quiero estar sola
Algunos días voy al gimnasio, otros días no.
Algunos días soy fuerte, otros días no puedo hacer mucho
Algunos días ruego por sanarme, otros días aceptó mi vida como es
Algunos días quiero hacer cosas impresionante / dejar un legado, otros días recuerdo que “tengo demasiado para hacer ya”
Algunos días siento la urgencia, otros días quiero quedarme en la cama
Algunos días quiero viajar por todo el mundo, otros días soy realista.
Algunos días me siento deprimida pero la mayoría de los días estoy súper agradecido

Todos los días tengo la enfermedad de Parkinson y todos los días necesito tomar medicamentos
Todos los días necesito ser determinado, Todos los días necesito ser fuerte
Todos los días necesito ignorar la apatía y seguir adelante.
Todos los días lucho por hacer cosas que deberían ser fáciles.
Todos los días estoy agradecido por el marido que ve lo positivo en mí.
Todos los días cometo errores, pero luego pienso que supongo que tú también.
Todos los días confío en que Dios me usarme: lo bueno, lo malo y lo feo.
Todos los días, para bien o para mal, el Parkinson me inspira …

Un amigo me preguntó cómo ha cambiado mi personalidad, esta es mi respuesta.

Depression and Apathy

Depression is common in parkinson’s sufferers, but not just because of the deterioration the disease causes

At conversation club for English learners

and the fear of such a bleak future. Parkinson’s causes a lack of dopamine (the happy substance in the brain) this increases a sufferer’s potential for depression. So it is hard for parkinson’s sufferers to be motivated and proactive. They don’t get the dopamine hit from exercise. Their ability to produce of dopamine is limited. PD suffers may just feel tired or exhausted.

Why tell you this? I think it is because sometimes I don’t want to go to my work or exercise. I lack motivation, not because I am lazy, but the disease makes me more apathetic. One friend with PD gets down easily and feels sad a lot of the time. This can be tougher for Peruvians who feel the need to hide their sickness and who stay home a lot.

There is one man with PD who taught himself to walk normally again through extreme concentration and other methods (it is a long story). This man travels the world and his country trying to motivate others with PD to exercise. He finds only 25% are able to follow his advice. Intriguing isn’t it? He is a unique person for sure, but also the apathy and depression experienced by those with PD must play their part in such a low response to his encouragement.

Thankfully, I usually get a buzz from seeing people connect the dots when I teach, or see people encouraged and growing as a person. I get joy from being with others and helping them. SO I have learnt to try to focus on others not myself and not just stay at home, which can lead to more depression. I still have my moments, but right now feel protected from depression. Going out, working and exercising helps me keep going.

PS. This is a deep topic. I only hit the tip of the iceberg here.

La depression y apatía

La depresión es común en los enfermos de Parkinson, pero no solo por la disuasión de las enfermedades y el temor a un futuro tan sombrío. La falta de dopamina, la chemica de felicidad en el cerebro aumenta su potencial de depresión. Por lo tanto, es difícil que el Parkinson sufra motivación, sea proactivo y no produzca dopamina por el ejercicio. Su capacidad para producir dopamina es limitada. La persona que sufre EP puede sentirse cansada o agotada.
¿Por qué decirte esto? Creo que es porque a veces no quiero ir a mi trabajo o ejercicio. Me falta motivación, no porque soy flojo, sino porque la enfermedad me vuelve más apático. Un amigo con PD se deprime y se siente triste la mayor parte del tiempo. Esto puede ser más difícil para los peruanos que sienten la necesidad de ocultar su enfermedad y se quedan en casa mucho.
Hay un hombre con EP que se aprendió a caminar normalmente otra vez a través de la concentración extrema y otros métodos (es una historia larga). Este hombre viaja por el mundo y su país tratando de motivar a otros con Parkinson para que hagan ejercicio. El dio cuenta que solo 20% de la gente on EP siguieron su consejo. Interesante que no tienen motivación. Él es una persona única, sin duda, pero también la apatía y la depresión juegan su parte.
Afortunadamente, suelo sentirme alucinado al ver que las personas conectan los puntos cuando enseño, o veo a la gente motivada y creciendo como persona. Me da alegría estar con otros y ayudarlos. POR LO TANTO, he aprendido a tratar de concentrarme en los demás, no en mí mismo, y no solo a quedarme en casa, lo que puede llevar a más depresión. Salir, trabajar y hacer ejercicio me ayuda a seguir.