Fly Well: Sparring with Parkinson’s

Dr. James Parkinson described the “shaking palsy” in 1817, and French neurologist Jean Charcot further characterized the disease, naming it for his British predecessor. In the 1960s the cause was identified: a brain area, the substantia nigra (Latin for “black stuff”), contains dark nerve cells that release a chemical called dopamine. In Parkinson’s these cells disappear, so replacing missing dopamine has become a mainstay of therapy.

Affecting one in 300 people, and the fourteenth leading cause of death, Parkinson’s risk factors include aging and environmental insults such as pesticides, which interfere with dopamine production. Genetics and repetitive head and neck trauma are factors, and men are at higher risk—possibly because of the higher propensity to engage in risky endeavors; estrogen is protective, and causative genes are sex-linked.

The bout begins with tremors, initially in the lips, tongue, feet, or a finger, then hand or entire arm when at rest or held stiffly and not supported. Movement and speech become slow and problematic, muscles stiffen and become unresponsive, the face becomes mask-like. Smaller writing (micrographia) is common; depression, difficulty digesting, balancing, and maintaining body temperature and blood pressure complete the slow, progressive picture. Although not inherently fatal, the knockout comes from conditions such as pneumonia caused by immobility.

Accepting a Parkinson’s diagnosis may induce denial and anger, among other emotions. But with treatment and support, life proceeds.If your opponent might be Parkinson’s, don your gloves and enter the ring with the neurologist in your corner. At the weigh-in, diagnosis is largely based on clinical presentation, although natural aging can deliver a split decision and mimic Parkinson’s. Doctors can test for a poor sense of smell, characteristic of Parkinson’s disease. As Parkinson’s affects involuntary functions, testing breathing, heart rate, and reflexes can be helpful. Saliva samples are used to identify genetic mutations that might help afflicted families. Brain imaging after injecting a chemical that attaches to dopamine cells is then seen with a single-photon emission computerized tomography (SPECT) scan.

Occupational and speech therapy and lifestyle changes help. Many are improved by medications such as levodopa, which is converted to dopamine in the brain. Segeline stops enzymes, which degrade dopamine, and a range of anticholinergic drugs regulate muscle movement. Botulinum toxin can help control tremors. Some patients are drug-resistant and are candidates for deep-brain stimulation, whereby a brain electrode is implanted and connected to a pulse generator hidden under the chest skin. Although not without risk, the effects can be dramatic.

Although common, “alternative” therapies such as acupuncture and massage therapy have not been critically studied. One herb, St. John’s Wort, effectively treats depression and insomnia—and fava beans, consumed whole, increase dopamine levels. Research into new drugs, other brain-stimulation methods, or stem-cell therapies holds promise for the future.

Accepting a Parkinson’s diagnosis may induce denial and anger, among other emotions, so some patients may avoid their doctor, fail to take medication, or not inform their aviation medical examiner. This is not a wise course of action, because with treatment and support, life proceeds. AOPA and the AME can help you with medical certification. The FAA can grant a special issuance authorization if symptoms are well controlled on allowed medications; currently, the only such medications are those with the active ingredients carbidopa/levodopa. Pilots are certificated annually and asked to provide a status report from treating physicians each year for continued certification. For pilots flying under BasicMed, Parkinson’s disease is not one of the 11 conditions that require a one-time special issuance medical certificate.

Ali’s humorous ripostes were as admired as his athleticism, although it is tragic that the sport that made him an international figure may have also pinned him against the ropes. One of his quotes is so appropriate here: “I done wrestled with an alligator. Tussled with a whale. I done handcuffed lightning, threw thunder in jail. I murdered a stone, I hospitalized a brick, I’m so mean I make medicine sick.”

If Parkinson’s is of possible concern, get to a doctor soon and try to knock out this opponent as early in the fight as possible.