NBA Star Brian Grant Living On Time with Parkinson’s

Episode Transcript

Dr. Correa:
Welcome back to The Brain & Life podcast, Audrey.

Dr. Nath:
Hello.

Dr. Correa:
This week I'm talking to Brian Grant. Brian Grant is an NBA player, retired, played 12 seasons on five different teams. Also played for Xavier University. Actually had his number retired there at Xavier and as an NBA player who actually was acknowledged by many of his own colleagues for his citizenship and his outstanding service.

Dr. Nath:
Oh, wow. Incredible.

Dr. Correa:
But right after retirement, he also ended up being diagnosed with young onset Parkinson's disease.

Dr. Nath:
Oh geez. After like a huge athletic career to then have a motor disorder.

Dr. Correa:
Yeah, I think it's going to be really important for all of us to hear what it is dealing with the mental health impacts of being diagnosed with a degenerative condition and something like Parkinson's and that's the sense of isolation that can come with that. And hopefully he shares that, and he also has a great podcast where he also talks about many of those issues that he deals with.

Dr. Nath:
Oh, awesome. It really makes me think about our previous episode with Jamal Hill, how he talked about the double edged sword of being a quote "inspiration." How kind of being held on a pedestal as a hero of some sort, maybe in the sports world, especially with the disability, it can be exhilarating, but then the flip side can be maybe suppressing some of the harder feelings, suppressing dealing with bullying, having the confusion of dealing with a new body, and that it's really important to work through those feelings. Just as much as enjoying some of the more positive feelings, too.

Dr. Correa:
That was a great episode and just both touching on the mental health issues of many neurologic conditions. I've been thinking more recently about our episode with Peter Frampton and him talking about the importance of participating in clinical research. So many of our conditions, we really need everyone to participate and join together, but I hope everyone gets a chance to go back, listen to the Jamal Hill episode, the Peter Frampton episode and enjoy today's episode with Brian Grant.

Dr. Nath:
Absolutely. Tune in with us.

Dr. Correa:
I'm really looking forward to connecting with former NBA player Brian Grant. Brian played college basketball at Xavier and is one of only four players in Xavier history to have his number retired. Then he was drafted in the first round into the NBA, played 12 seasons for five different teams and was really known for his tenacious rebounding. He was honored by his own colleagues with the NBA's J. Walter Kennedy citizenship award for outstanding service and his dedication to the community.

Dr. Correa:
Then shortly after he retired from the NBA, he was diagnosed with young onset Parkinson's disease. He recalls these experiences in his book, Rebound: Soaring in The NBA, Battling Parkinson's and Finding What Really Matters. Brian, in your efforts to create the Brian Grant Foundation and the On Time Podcast, you have helped bring more awareness to living with Parkinson's. Thank you so much for taking time to join us on the Brain & Life podcast.

Brian Grant:
Thanks for having me on Dr. Correa. Appreciate it.

Dr. Correa:
So, Brian, I wanted to take a step back and start before your neurologic condition entered your life, and I'd like to hear what it was like on your basketball journey and how that helped form you to be the man you are today.

Brian Grant:
Well, I got to be honest with you. There really wasn't a basketball journey as a kid. As a teenager, I wasn't very good. I was athletic but just uncoordinated. I was a little taller than everyone, but my basketball career didn't start until after my freshman year when I was 5'10 1/2" at the end of the school year and came back that next year and I was almost 6'4" over a summer. It was the craziest thing. People literally saw me grow, and my classmates thought I was a new student. But the journey was rough. It was filled with pitfalls, and I stepped in just about every one of them and thank God there were saviors along the way to pull me up and give me opportunity, which allowed me to go to college. Same thing, barely fast in college because I got into college with a C- in pre algebra.

Brian Grant:
That was like the last year you could do that. Like now you got to have like algebra two and geometry, but things worked out again, helping hands were there. And I listened to them and I wound up in the 1994 getting drafted eighth by Sacramento. So just the work ethic, knowing that things can go wrong with me, remedy was kind of how I grew up, and that's kind of how I entered into Parkinson's. I didn't know what it was, but once I did it was like, this is just another challenge that I'm going to have to get through. And all those hands that are reaching down to help me out, I got to make sure I reach out to them because when it's basketball, it's you and your individual skill and what you can do. But with Parkinson's, there's so many different components of it that if you don't need help in the beginning, you're going to need help at some point, and you got to allow that help to come.

Dr. Correa:
And I'm wondering towards the end of your NBA career, were you already noticing some changes in your movement or your coordination or tremors or what happened?

Brian Grant:
Absolutely.

Dr. Correa:
Really?

Brian Grant:
Absolutely. I actually was noticing changes in 2005 when I played for the Lakers. I just thought I was getting old because I was having trouble jumping off my strong leg, which is my left leg, felt really uncoordinated. I just felt like my timing was really off. I wasn't able to zero in on rebounds and things like that, but I've seen that happen to other guys in the league. And it's just that time. But when I went to Phoenix, that's when I started having a skin tremor in my left wrist. And I went to the neurologist there, and they told me, "You know, you're a 12-year vet, those types of things are going to happen. You're going to have all kind of little twinges and tweaks." And then I retired, went through the depression, came back to Portland and was diagnosed with Parkinson's.

Dr. Correa:
And so that is some of that initial tremor or some changes in your movement and coordination, what were some of the other early symptoms that you noticed at the beginning of your diagnosis?

Brian Grant:
Well, I think one of the biggest things besides the skin twitch tremor was depression. I got to be honest and maybe some of you felt like this too, but I was so in control of my body and of myself at the time that when I'd hear about people dealing with depression, I thought they were weak minded. Like, how is it that someone cannot leave a house or go do something they want to do when there's a beautiful day out there in a beautiful world.

Brian Grant:
And believe me, I changed those thoughts as quickly as I thought them up when I was diagnosed with clinical depression, which I understand now probably was brought on by the loss of dopamine. I was already less than 80% of dopamine producing cells were already dead. So I was on that edge. Retirement just sent me over, and I just went in deep. So anyone who deals with depression, if you've never dealt with it, it is no joke. It's something you don't have any control over. You can take meds, you can see someone to help combat it, but when it hits, it hits.

Dr. Correa:
Yeah, I think some people describe depression as being paralyzing, and people don't realize like that not that euphemistic. It really does impact your ability to approach life, interact with others, socialize, and sometimes it has many other symptoms.

Brian Grant:
It really is a paralyzing feeling. I can remember in 2007, I was in Miami, and the Miami Heat, started training camp on October 1st. When October 1st hit, my body went through this like thing where I was like panicking because it knew I wasn't in shape, but I needed to be in shape. I've been in shape by October, every year for the past 12, 13 years. And when I didn't do that, I went to their first game, and I had to leave at halftime because I felt nauseous and dizzy. And when I got home that's when it hit. Something clicked. I don't want to do anything. I don't want to go anywhere.

Dr. Correa:
So just that sense of losing control of your body really just impacted you with significant depression, and I think because sometimes those mental health effects of these conditions really just get overlooked.

Brian Grant:
They do. And you want to do things, you know something's wrong, but you know everybody's thinking that you're depressed. That's why I was like, "I'm not depressed. I'm not going to let my wife tell me I'm depressed. I'm not going to let her friends tell me I'm depressed. I'm not going to let my mom tell me I'm depressed." And so then there's that struggle from the people trying to help you. There's that struggle with people who are seeing you from the outside, they know exactly what it is. Like you're depressed, and I'm trying to fight them to show them that I'm not depressed. I played that game for about six months, destroyed my marriage. And then I finally went and got help in three months after that, I started to kind of come out of it a little bit.

Dr. Correa:
What helped you along the way to manage your depression? What kind of help did you end up seeking? Counseling, medications, a combination?

Brian Grant:
Yeah, I went to a psychiatrist first, and she diagnosed me with clinical depression and started me off on Zoloft. And then I also saw a psychologist and did a lot of speaking about what I was going through. We didn't talk about Parkinson's we talked about retiring and most professional athletes go through that, especially ones who have played more than five years. So she helped me realize these things that were happening to me because my mind was like a tornado, is a tornado of mess, that I couldn't grasp onto anything and say, "Okay, this is what it is." It was everything. It was my wife, it was my kids, it was my career being over, it was just... People go through depression for different reasons. But for me, that's what it felt like.

Dr. Correa:
And you talk about some of this experience with your Parkinson's and with the mental health and depression symptoms in your upcoming or your book has now been released, right?

Brian Grant:
Yeah, it has. It's been out.

Dr. Correa:
That's good. So tell us about that experience of writing the book and really opening yourself up and that vulnerability. What did you learn from yourself and your life as you were writing the book that taking that step back and getting to reflect you weren't as aware of.

Brian Grant:
It really showed me my true nature. I thought that when I was talking about writing the book that I was wanting to put the blame on anything bad that happened in my life on someone else and then take all the credit for all the good things that happened in my life, that I did it. And as I started to work with Rick Buker, when you start reading that stuff, it's like, "Wait a minute. That's not how I want to be. It's not what I want to do with this project." So I very quickly turned it into a thing where I was able to purge some things that I've been dealing with like the loss of a 16 year marriage, retirement, being diagnosed with Parkinson's, being diagnosed with clinical depression.

Brian Grant:
And I was able to just take them for what they were and see my side of each thing like with basketball my side of it is that I got old. I look at my rookie Yodana Sasm he was my rookie when I was in... He and Dwayne were my rookies, and now he's like the journey man. I think he's got 20 years or something like that. Like you go ahead, man, you go ahead Yodana. I'm proud of that.

Brian Grant:
But I just tried to look at my inner situation and take things onto my shoulders because I think there were probably a lot of people that was like, "What's he going to say? What's he going to do?" I'm only going to tell the truth, but I'm not putting truth out there to hurt anybody. Whereas maybe the old me might have because I'm hurt.

Dr. Correa:
And you had some pretty epic and story to playoff battles back in the 2000 season you had playoff with Timberwolves, guarding Kevin Garnett and then guarding Karl Malone on the Utah Jazz through a playoff series, you get to learn and play and respond to how the other players are working. Now, you're battling Parkinson's. How have you been kind of applying some of that same idea of adapting to the condition you're in with your Parkinson's that you kind of maybe learned from your defending practice?

Brian Grant:
Well, it's two different battles because when I'm defending Karl Malone or Kevin Garnett on any given night, either they could come out on top or I can come out on top, but there's no written rule or law that says that they're going to beat me every time. Now, when I step into the ring with Parkinson's, I know I'm getting knocked out. I know I can swing as hard as I want to swing, I can survive as long as I want to survive, but in the end I'm going to get knocked out. And that's a tough fight to be in, but we do it. Those of us who suffer from Parkinson's PD and many other neurological disorders, we deal with it, and we take it one day at a time. That's why I was saying that the landscape changes so quickly. My aunt and my cousin they're out because we're having our gala.

Brian Grant:
And they happened to just, my cousin happened to just get here at a time where one of my meds, I ran out, and I had to get it from Canada. So it was a lapsed time on it. And I didn't know how important that medication was to the other medication because for four days I was really rigid and stiff, very tremorous. It was the first time that I felt pretty bad physically. Usually for me, it's mental trying to get over myself, just get over yourself. You're 50, you turned 50 on March 5th, come on.

Brian Grant:
But it was a rough four days, back locking up, and I started seeing a lot of things in my gait and in my facial expression that I see on other patients, that I always say when it's my turn I got to figure out how I'm going to deal with it. But I know it's coming at some point, and it came. And long story short, just from one med, not having it for those four days gave me a real eye opener because sometimes things are so good for so long for me that I don't forget that I have Parkinson's, but I think I forget that this is only a short period of time. We still got to keep going up different levels with this thing. And the higher up we go, the more it starts beating you down.

Dr. Correa:
And it's important to realize that you're adapting and adjusting and every time it's going to be different as things change, it'll be different how you're working with Parkinson's. But yeah, unfortunately it's not a condition where there's any way to beat it necessarily. But how has been your experience with the medications and the symptom management? You talked some about the balance of all your different medicines. How was that pathway of like picking what works for you?

Brian Grant:
I kind of went with the neurologist once I started seeing the neurologist because when I very first was diagnosed, I had a neurologist, but I wasn't taking any meds that they were prescribing. I was doing all naturopathic medication, and I started working with Dr. Nutt who was a neurologist at OHSU. And so I got introduced to sentiment and over the years we would tweak things and get things right. But the meds I take now work, but as compared to last year on my off time, my off times are worse now than they used to be.

Brian Grant:
And I think that's what separated me from other people that I'm around here in the Portland area with Parkinson's is that they would be like, "Are you on meds?" And I'd be like, "No, I'm on my off time." They'd be like, "Yeah, those off times. I remember when my off times were good like that, but the more meds you take, they become less effective and your off times become worse." And now I'm dealing with that, but I'm not saying it to be woe was me. I'm just saying, I know that there are people out there who are going through these changes and that may have thought about things like I did an not that I thought I was cured, but that I wasn't going to have to move to the next level. And that's just not true.

Dr. Correa:
Yeah. There's no one and done. It needs to be adjusted. Your body changes with the medicines, or you have changes in the on and off times. And so it's continuing to work with your neurologist to adjust the meds and consider all the side effects and possible complications that can come with them. So that way really picking what works for you.

Dr. Correa:
Now, you started the Brian Grant Foundation. So we'd like to hear a little bit about the Brian Grant Foundation, and you guys have also had a podcast going on for a while to help the Parkinson's community. So, please tell us about the foundation, its efforts, and the podcast.

Brian Grant:
Well, at the Brian Grant Foundation, I didn't know what I really wanted to do when I first got into this. I just knew that I wanted to help Michael J. Fox because I felt as if there's going to be a cure, it's probably going to be through his efforts that brings it about. And so we had a gala the first year, it was really successful. We gave him a kind of a large check from us. And then after that, I kind of wanted to join the fight and do something on my own. And it's hard to know what you want to do, especially when you know someone like Michael J Fox and how big his organization is and then the Alis and everything that they were doing. And so I just wanted to help people live active and fulfilling lives through the things that I know, and that's exercise.

Brian Grant:
If you're out there, and you're newly diagnosed, we hope that we're one of the foundations or organizations that are recommended to you as far as being newly diagnosed and seeing how you could be proactive in your own care because too many people, including myself at times, we get lazy, we just want to sit on the couch. It feels good to relax, but we relax for the month or two and then we start getting off the couch and now something new is wrong because we weren't taking care of ourselves.

Brian Grant:
That happens to people who don't have Parkinson's. And so it's really going to hurt us, especially when we're dealing with something with tremor or those of us who don't have tremor who freeze. So once we got the foundation up and running, we focused on exercise and nutrition. We have exercise classes on our website. We've had cooking classes and speak about replacement ingredients for some of the ones that we may naturally use. And then we started a podcast called On Time because we all want to be on time. Those of us with Parkinson's are on time is when our meds are working.

Brian Grant:
So I did it with Heather Kennedy, and she is just amazing. The woman I tell you, when I talk to her I feel bad. It's like, I feel like an ignorant student. Because she knows all these things and being the person that she is, she's like, "Why do this every day? There's no way you could know all this." But she pushes me to want to learn more and more about what I'm going through because I could be another pitfall. I got Parkinson's, I'm just going to put it over here to the side. Well, Parkinson's doesn't deal with you like that. If it wants your attention, it's going to slap you with something, you're having trouble swallowing, your bowels are messed up, anxiety, sweat attacks, which hit me all the time. So with that podcast, we've got I believe five shows that we produced and put out, you can get on I believe iTunes.

Dr. Correa:
Yeah. I've enjoyed the podcast. You guys specifically had an episode you talked about socializing and the isolation that comes with Parkinson's, and you've talked about that a few times, I hear about your experience with Parkinson's. What would you suggest to people newly diagnosed or living with Parkinson's or their family members to try to battle and balance out the isolation that comes with the condition?

Brian Grant:
Well, I guess the first thing I would say, and I think a lot of people say it is that you're not alone. When I was diagnosed, I felt alone. I felt alone those first two years when I was only telling close family members. It wasn't until I had Rick Buker break the story that I had Parkinson's that things started opening up because I would go to my son's football game, this is when they were in Peewee football, and every day people I'd see them all the time. "Hey, how you doing this and that?" But after that came out, those same people were, my brother has it. My mother has it. My sister has it. And then one person's saying my wife has it, but she's too embarrassed to come up and tell you. It was just like the world opened up.

Brian Grant:
Like I did not know that so many people were affected by this disease. And it is really mind blowing when that world starts to open up to you. When you open up, it opens up to you, and that's when you find what I call my family of friends who have it, that I can turn to and lean on. I love you neurologists. You guys are great with the science and everything, but a lot of things, sitting across from someone else who's taking the same drug as you and hearing how it's affecting them goes a long way with this disease because we're all so different. I know that it may get you hyped up, but it does help with your tremor. With me, it puts me to sleep. The meds affect everybody differently, and PD affects everyone differently. So yeah, you're not alone, and when you're ready to open up, open up to people, people we think are normal, you'll see how many people come back that are affected by this disease. At least I did.

Dr. Correa:
I think, yeah many people don't realize how many people we walk around thinking that they're "normies." There's really lots of people out there living with different neurologic conditions, either themselves or a family member, including Parkinson's and thank you for the work that the Brian Grant Foundation is doing to help and support the community, encouraging them in exercise and the frank discussions that you guys have with the On Time podcast and opening yourself, vulnerably with your book, Rebound: Soaring in the NBA and Battling Parkinson's and Finding What Really Matters. I think all of these resources are great for the community, and I really appreciate the effort that you're doing to support the community.

Brian Grant:
Thank you. And I appreciate you having me on your show today.

Dr. Correa:
And thank you very much, Brian. We really appreciate you joining us today.

Dr. Nath:
Can't get enough of the Brain & Life podcast? Keep the conversation going on social media. When you follow @brainandlifemag or visit brainandlife.org. As your hosts, we would also like to hear from you on Twitter @NeuroDrCorrea and @AudreyNathMDPhD.

Dr. Correa:
Welcome back to the Brain & Life podcast. Today, I'm really glad now to be joined by Dr. Sotirios Parashos he's a neurologist in Minneapolis at the Struthers Parkinson's Center. When he's not caring for people living with movement disorders and their families, he leads research work on symptoms and Parkinson's that don't respond to the typical medicines such as falls, memory, and cognitive dysfunction. He's also co-authored a book on navigating life with Parkinson's disease. So we're really glad to have him here. Thank you, Dr. Parashos for taking the time to join us on the Brain & Life podcast.

Dr. Parashos:
My pleasure. Thank you for having me.

Dr. Correa:
So we just had a great discussion with Brian Grant about being diagnosed with his young onset Parkinson's disease just after his retirement from the NBA. How do you explain what is Parkinson's disease to your patients, and what's the difference between early or young onset?

Dr. Parashos:
So it is usually is a difficult discussion, which unfortunately, a lot of neurologists and a lot of physicians don't realize how difficult that is for people when you actually tell them that they have Parkinson's disease. For a neurologist, it's always important to explain to people what's behind the diagnosis of Parkinson's disease. I typically will explain to them that although we all lose a lot of brain cells from our brain day after day after day and the counts are in the millions, not just in the hundreds or the thousands, I explain to them that there's a particular part of the brain that seems to suffer prematurely, a premature aging process in Parkinson's disease. Those nerve cells in the brain stem part of the brain's called the substantia nigra tend to die prematurely much faster than the rest of the brain cells. And this is not just because of the aging process, but it is because of a degenerative process for those particular nerve cells.

Dr. Parashos:
And although the pathology of Parkinson's disease affects many parts of the brain, the main symptoms that we see in the early stages of Parkinson's disease come from that part of the brain that's called a substantia nigra and that has to do with losing the nerve cells that produce and manage a chemical that's called dopamine that is necessary for smooth movements. And when you don't have enough dopamine in your brain, your movements become slow, become stiff, and you may develop tremors. Some of my colleagues use an analogy. They tell people that it's almost like you need more oil in your engine, and you don't have enough oil in your car. I then go on to briefly talk a little bit about what we know about the etiology of Parkinson's about the causes of Parkinson's disease. We don't know very much, but we have some ideas.

Dr. Parashos:
We know that there are some genes that will cause Parkinson's disease. The people who have a gene that causes Parkinson's disease are a very small minority among everybody who has Parkinson's disease. What is more common is to have a genetic predisposition. Maybe you have a gene that will not necessarily give you Parkinson's, but will increase your chance of getting Parkinson's. And then there is also some exposures that we know about some herbicide and pesticide exposures that may increase the risk of getting Parkinson's disease.

Dr. Parashos:
So why you got Parkinson's disease may be just a perfect storm of multiple factors that you have to do with where you grew up, what are your genetic predispositions. Sometimes even what's your ethnic background that play into why you get Parkinson's disease. Now, when it comes to the young onset versus old onset Parkinson's disease, there is a general tendency, and there is enough literature to suggest that people who have a younger onset Parkinson's disease tend to have more genetic factors or more genetic predisposition to Parkinson's disease than people who get Parkinson's at an older age.

Dr. Parashos:
However, just like with a lot of other things in medicine, it's a continuum, and it's like a bell curve and you have a lot of people who develop Parkinson's disease in a young age. And although the majority of people who will develop Parkinson's disease are in between their 60s and their 70s, it is not uncommon at all to get Parkinson's disease in your 50s. And it's less common if you're younger than 50, but it happens for somebody like myself who sees a lot of Parkinson's disease, we see it all the time, but it's not as rare as people think.

Dr. Parashos:
I do try to give them some resources, like some of the Parkinson's advocacy groups that are available online. They have a lot of information online. I tell them not to Google it, but I tell them that if they want to research it themselves to go to reliable sources, such as the National Institute of Health, the American Academy of Neurology, Parkinson's Foundation, and so on and so forth and movement resource society where they can get reliable information rather than just Google it and get the first website and get even more confused.

Dr. Correa:
That makes sense. Now, you mentioned that it's a problem with that chemical dopamine. Now, many of the people out there probably have heard about dopamine as like a chemical in your brain that rewards you or that's related to your mood. So are there other symptoms beyond the movement in Parkinson's that are related to the dopamine or the condition itself?

Dr. Parashos:
So dopamine is a neurotransmitter. So it's a chemical that brain cells use to communicate with each other. Different brain cells use different neurotransmitters to communicate with each other, and one of the more common neurotransmitters is dopamine. Dopamine, as you pointed out, has many, many different functions in the brain, and one of the functions of dopamine is to act as a feel good chemical. Now, this is kind of like a simplistic way of presenting it. What dopamine does in terms of our mood is it helps us, or it encourages behaviors that are good for our survival. So when we do something that turns out to be good for us or it's a feel good feeling, then we get a little bit squirt of dopamine in our brain that is in a different part of the brain than the one that has to do with movement.

Dr. Parashos:
And that little squirt of dopamine gives us the feel good feeling. That's part of the learning process. That's how our brain starts to learn behaviors that are good for us, or that are pleasurable to us versus behaviors that are not. So if you get the little dopamine squirt, then you feel good about it, but if you don't get the dopamine squirt or if your dopamine drops instead, then you feel bad about it. So when you have excess dopamine, when you're not supposed to have excess dopamine, then you may feel good about doing bad things, and that is not good.

Dr. Parashos:
But the concept behind it is that Parkinson's disease because it affects dopamine, does not just affect the movement, but affects all these other subtle areas of function of your brain. And it may have to do with emotions. It may have to do with how prepared your brain is to accept new knowledge. It may have also to do with how you direct your attention and to what you pay attention to. So other people with Parkinson's disease, and they sometimes they do not see them in the early stages of the disease but more so as the disease progresses, will notice that they may not get as much pleasure out of things as they used to.

Dr. Parashos:
They may start losing interest in doing things. We call that phenomenon apathy. They may lose interesting things that they used to be interested in before, or they may start noticing that they have difficulty concentrating. It takes them longer to process new information, and all those are subtle non-motor symptoms of Parkinson's disease, as we call them. In terms of emotional problems, both depression and anxiety are very common accompaniments of Parkinson's disease. Not everybody gets depressed from Parkinson's, not everybody gets anxious with Parkinson's, but at least half of people with Parkinson's disease will have at some point in their lifetime problems with depression and anxiety. So it is something that it is important for people with Parkinson's disease to be aware of.

Dr. Correa:
That's helpful. And Brian talked about for himself how he struggled with symptoms of depression, symptoms of a sense of wanting to isolate or apathy and thank you for touching in on so many of those. So what are some of the impacts of Parkinson's that on an individual and their family that they may not often expect?

Dr. Parashos:
Yeah, so there is that. People, when they are given a diagnosis of Parkinson's disease, often wonder sometimes they may not quite articulate the question as such, but the question is really what does that mean for me? What does that mean? How is my life going to change? What is the next step? What does that mean for my family? And it is a little bit of a journey because those kind of questions change as the disease progresses, since the disease changes.

Dr. Parashos:
And it is important for people to understand that nobody can predict the future. Unfortunately, we don't really have much nowadays that will tell us who's going to do well and who's not going to do well. I do explain to patients that there are people who live for many years, and they have a very productive lives with Parkinson's disease. And there are some people, there are also many people who do not have a good course with Parkinson's disease.

Dr. Parashos:
I tell them that there are certain things in their lifestyle that isn't there, most of the time is in their power to do. For example, we know that people who exercise regularly with Parkinson's disease retain much better function, much better quality of life in the long term than people who don't. So I tell people most patients come here asking, "What can I do to make my outlook better?" And I tell them regular exercise is one thing. A good Mediterranean diet is another good thing. We don't know that directly, but we know that indirectly, if you look at brains of people with Parkinson's disease and you try to distinguish who are the ones that had a better course versus the ones that had the worse course, if you look at the brains, the brains that have a better vascular health, the people who had a better vascular health, the brains was looking better from the vascular standpoint, those people had a much better course with their Parkinson's than the people who had vascular problems.

Dr. Parashos:
So we know that vascular brain health is better in people who have Mediterranean diet. So oftentimes people ask about nutrition and we tell them, "Well, exercise, Mediterranean diet are the kinds of things that you can use to change your long term options." Another thing that we need as physicians actually, we need to be well aware of is that Parkinson's disease affects the whole family. It affects the pressure with Parkinson's disease, affects their significant other, their partner life, affects their children, if they're younger affects their parents. So at some point in my practice as a disease progresses, I make sure that I get to meet everybody who is an important person in that patient's, in that person's with Parkinson's disease life. Because it's important to know how much they can count on their family when they will need the support.

Dr. Parashos:
Now, it is important when I explain things to patients and when they ask the difficult questions about the future, it is very, very important not to be Polyannaish. At the same time, it is very important for the message to get across that this is a disease that's treatable, that people can have a good quality of life for many years, and that what the future will bring is different from person to person. I tell people, look... When I diagnose them, I tell them, "Look. You just got diagnosed with Parkinson's disease. I can tell you that we can treat symptoms really well for the next few years. And I can tell you the chances are you're not going to have any major issues in the next few years. What can happen down the road? I don't know. We don't treat Parkinson's disease now the same way we treated it 15 years ago and 15 years from now, we're going to have different treatments than we have now."

Dr. Parashos:
So it is nonproductive in a way to worry too much about what the future will bring. At the same time, it's also a good thing to be realistic, and it's best to have shorter term plans like next three to five years. But it's also important to understand what the future might bring. For example, if you're younger onset Parkinson's and you're still working, it would be important for me as a treating physician to know what are your plans for retirement? Do you plan to work until you are 65 and take full retirement? What would be the implications if you ended up having to retire earlier because a disease got in the way of you being able to do your job the right way?

Dr. Parashos:
And I tell him in that case, it is also important to understand what are your benefits from your work? So, where do you live? Do you live by yourself? Do you live in a big house? If you are approaching retirement, do you plan to sell the house and leave? So all those are conversations that have to happen as the disease progresses. As people age, of course, it's very important to also understand their long term wishes and particularly to see if they have any advanced directives.

Dr. Correa:
Yeah, I think that's incredibly helpful. And as you pointed out, no matter anyone's age, we should all be having these conversations with our family members about ourselves and what they want. Hopefully we all have the privilege of aging and growing older with our families, but whether you're 20 or in your 50s or your 70s, we should be clear with each other and with our families about what we want in any urgent situation and how we want to age.

Dr. Correa:
Well, thank you so much, Dr. Parashos for joining us here, for listening, and helping us answer some of these questions to help people in the community learn more about Parkinson's. How others live with it, how family members can help once someone cope and I encourage everyone to take a look at the Navigating Life With Parkinson's Disease book and the resources that we'll have included in our show notes.

Dr. Parashos:
Thank you for having me, and thank you for doing this for the people with Parkinson's and their families.

Dr. Correa:
Thank you for joining us today on the Brain & Life Podcast, follow and subscribe to this podcast so you don't miss our weekly episode. You can also sign up to receive the Brain & Life magazine for free at brainandlife.org.

Dr. Nath:
Also, for each episode, you can find out how to connect with us and our guests along with great resources in the show notes. You can also reach out by email at blpodcast@brainandlife.org.

Dr. Correa:
Follow me and Audrey and the Brain & Life magazine at your preferred social media channels. Thank you to our community members that trust us with their health and everyone living with neurologic conditions. We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Nath:
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NBA Star Brian Grant Living On Time with Parkinson’s

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