Parkinson’s & Hearing Loss: Fact or Fiction- By Dr. De Leon

Blindness cuts us off from things, but deafness cuts us off from people.” Helen Keller

 

 

 

Since I came back from Hawaii, I feel like this is me above constantly asking people to speak into the stethoscope,  ear trumpet, or speak into my good ear because my hearing has not been quite the same. I have been told by my family that I am speaking louder and yelling more than my usual customary “Mexican-ess” calls for. When a Mexican tells another Mexican that they are too loud than you know you are definitely in trouble! Plus, everyone in my family including me have found it terribly annoying having to ask for someone to repeat what they said and always seem to be two steps behind on the conversation. Over the last few years I have noticed that I have more trouble hearing and understanding what people are saying in crowed, noisy rooms as well as on the phone particularly with my right ear. But, things in the communication department seem to have gone south fairly quickly for no reasonable explanation.

Initially, since I came back from trip with a severe case of the flu, followed by pneumonia and then severe ear infections, causing the worst case of vertigo I have ever had in my life, I paid not much attention to it and assumed the problem was related to infections. However, once symptoms cleared I still have continued to experience this problem.

So I almost don’t like speaking on phone if a lot of ambience noise involved. Otherwise, I feel as if I were just guessing leading to some pretty funny and embarrassing assumptions and scenarios.

Of course being a doctor, I must research everything and find the root of the problem. The only new medication, I have added to my regimen is Rytary, thus I went in search of  possible side effects of this medication causing hearing deficits. What I found out is that in fact one of the side effects of Rytary is ear fluid build up which along with my history of chronic ear infections surely seemed like a plausible explanation for my acute and sudden worsening hearing. nevertheless, I went to have an audiology exam. Ears were intact with normal pressure and normal conduction but its the nerve that is not processing information properly- almost a delayed reaction. I am on no other medication which could harm the cochlear- aspirin use can do this on chronic basis but I take a baby aspirin about 2 times a week and this would produce bilateral problems. Doubt I have a brain tumor- aka a Schwannoma  of the eight nerve- I had normal MRI a year ago in so far as tumors but one never knows so will repeat just for peace of mind given my family history.

In the meantime, I began poring over articles on the subject and much to much chagrin I discovered several studies staying that Parkinson’s patients do in deed have hearing loss believed to be caused by the disease itself. Just like me some say not so much in loss of sound but rather slow processing and comprehension of spoken word…there seems to be a delayed reaction. now that I am aware of this when I don’t capture what is being said is I stop for a second and like a slow printer or processor that has to type one word at a time the words come to me slowly ..and I say AHH. Of course this only works if its quiet and not in active conversation because to overwhelming to have to intensely focus on what is being said.

In a study at the University of Naples, Italy  back in 2012, the researches discovered that out of 106/118 patients with Parkinson’s had age related hearing loss (presbycusis) in one or both ears. This was statistically significant finding since the a study of equal healthy counterparts did  not yield as high a figure. Another study in Taiwan revealed an increase in hearing loss of 1.5 times greater in those with Parkinson’s disease. Therefore it is speculated that a chemical specific to PD patients can cause noise-induced or age-related hearing loss or degeneration of various systems important in the integration of information from cochlear into Wernicke’s area could be another mayor problem.  Although, the actual cause of impaired hearing loss in PD’s still remains to be seen it appears that at least in my experience with PD in my own life this is a very real and potentially devastating problem leading to what I spoke of before impairment in communication causing greater isolation in those who have Parkinson’s disease that only worsens as we age and also if have a history of essential tremors for it is well known that most if not all patients with ET will develop hearing loss. This is because movement disorder specialists and neuroscientists believe that the  defect for tremors, hearing loss and longevity lie within the same gene.  

I also believe that perhaps Hispanics who  develop PD will be at an even higher risk for hearing loss since many in my observation have histories personally or in their family of essential tremors.

Once again the teacher has become the student in this ever evolving disease that seems to impact all aspects of our lives. Thus, we need to begin thinking about auditory loss as another non-motor symptom of the disease to which unfortunately I don’t have a solution for as of yet other than possible hearing aids. I don’t know if this will respond to increases of dopamine or not I suspect it might improve some since learning and understanding are higher cortical functions dependent on dopamine. So I will increase my medication and follow up with outcome. Hopefully, I won’t end up with my stethoscope or my daughter’s French horn wrapped around my head like princess Leia’s hair do…

In the meantime …. don’t be like these folks..

If hearing loss is one of your symptoms, ask your doctor for a referral to a hearing care professional for testing to determine the extent of your hearing loss and advice on treatment to restore as much of your hearing as possible. don’t forget to rule out medications and other organic causes- don’t just assume is PD.

Sources:

http://www.hearingaids.com/parkinsons-disease-hearing-loss/

https://www.researchgate.net/profile/Gabriella_Santangelo/publication/231862911_Hearing_impairment_in_Parkinson%27s_disease_Expanding_the_nonmotor_phenotype/links/004635398b58fef8c9000000.pdf?origin=publication_detail

Parkinson’s Disease: Impact on Family-by Dr. De Leon

“Friends LOVE through all kinds of weather, and families stick TOGETHER in all kinds of trouble.” ~Proverbs 17:17

A Midst increasing focus on women’s issues in PD, I and others are beginning to realize the burden of living with and having a chronic illness like Parkinson’s can exact on the family nucleus. Sometimes the burden can extend to close friends, co-workers, and others in the circle around the nucleus.

How then, do we decrease the burden?

The first order of business for me as a neurologist and Parkinson’s patient is advocacy. Education is the single most important factor to decrease the load of the family and of society by raising awareness of the issues which require a not just a holistic approach; but a timely one as well.

First, we must understand the symptoms of the disease (sometimes the rest tremors may not be present from the get go; yet if there is family history of PD, or history of tremors in you, or have any number of symptoms including but not limited to constipation, loss of smell, depression, bladder issues, gait difficulty, stiffness seek advice of a physician asap)  in order to get an get early diagnosis followed by early treatment. This latter part cannot be underscored enough in my opinion. EARLY treatment DOES improve quality of life in the present as well as in the future!!!

Second, once diagnosis is establish and medication initiated it is important to evaluate patient in his or her natural surroundings. this means evaluating their role in the family as well as in society. understanding the impact of chronic illness in every individual is crucial to developing the right treatment plan. for instance, the plan is going to be entirely different if we are dealing with a young mom versus an older woman. also different from one that is employed especially if main provider versus someone that is retired. Single vs part of large family with good support system. Therefore, it is our duty as physicians to recognize the wide and variable effects of having PD to help you the patient build tools to best manage your situation and help you and your family cope with the illness.

Third, one way I recommend that you help your neurologists make the most informed decisions on your behalf is to have an open line of communication. after all, communication is a two-way street. Your physicians unless they have an illness themselves as I do or have had to deal with someone chronically ill in their family, they might not know the ins and outs. this does not mean they don’t care but rather lack of experience in the matter. Therefore, I suggest that at least once a year if not twice you make an appointment with your physician to discuss social needs only. This will go a long way in building a rapport with your doctor as well as getting the right treatment plan for a more fruitful life. understanding your social situation along with any co-morbidities like having migraines, high blood pressure, pre-existing depression are the pillars to a comprehensive approach to PD patient care.

The goal is to be present in your life living it fully. Sometimes we think we are coasting along just fine handling our own problems but we may not realize the impact on our family and our friends, etc. I am sure you have seen the commercial for asthma in which the woman says I rarely need inhaler rescue and they show her whizzing and being short of breath most of time. Same for us. I know that for me this true. 

How many times in the past month alone have you been unable to keep your plans expected because you were not feeling “right?” There was a time I became the most unreliable person because I cancelled more functions then I attended. How many times have you missed family functions or activities or cancelled the vacation you have been waiting on for months because you could not travel?

If this strikes a cord with you then it has been happening way to much. you need to sit with your family and alone and write down the reasons then take to your physician to work together on a solution. Is it because your depressed, in pain, fatigued,  embarrassed of being seen in public? Most issues have a solution, don’t wait.  if you live alone and cant afford to go out talk to your doctor about meals on wheels, help in the house, a nurses aid and so on.

it is always best to write down wishes early on which can always be amended than to have no plan and wait for crisis to arise and no one knows what to do and you are to sick to make any life decisions.

Remember, the better you and your close family understands the disease the better handle you will have on the situation.

As a colleague once said: “without education you can not achieve proper control,” referring to treatment of chronic migraneurs. However, the principle still applies for those of us with Parkinson’s disease. Case in point, I believe one of the biggest problems in Parkinson’s disease is medication overuse. This is one of the main reason, I think patients have increased dyskenisias  as well as increased side effects. this remains a huge barrier to break because I was trained at the cusp of new medications (dopa agonists and others that have followed subsequently) coming on board which means that physicians were accustomed to letting their patients take the medication when they ‘thought’ they needed it. even I at the beginning of my practice would tell patients it was ok to take extra.. However, I began realizing that when I asked how much med they took, how often, and for what symptoms? 1) they were overdosing and 2) often times they were taking medication unknowingly for side effects of medication NOT the disease which only worsened when took more like dyskenisias!

Therefore, my recommendation is keep a diary when you take extra medicine, the amount, the name, the reason, and what happens when you take it ..this will be a much better method of helping your physician track your symptoms and make appropriate adjustments. My philosophy is small amounts of various types (agonists, MAO inhibitors, COMT inhibitors, cholinergics, along with dopa) evenly spaced works so much better for control of side effects, mood control and decrease incidence of motor fluctuations which in turn will lead to a less burdensome life on others.

EVERY DAY IS A FIGHT. I am a Parkinson’s WARRIOR!

Tips to Over come Communication Impairment in PD: By Dr. De Leon

 

As we near the WPC 2016 which will be held in Portland, Oregon this year..one of the topics of great interest being presented is one of communication impairment.

First, we must look at what is meant by communication. The word  “communication”  implies the usage of  a deeper and complex network of interconnected neurons in the brain actively working to conceive, send, receive, and interpret  auditory, written as well as verbal & non- verbal messages. A problem or disruption at any point in this chain and we have ineffective or impaired communication. And as we all know ineffective or poorly executed communication can lead to disastrous outcomes.

For instance, there is a well known story which highlights this problem, a message given by a British Army Commander which stated: “Send reinforcements, we’re going to advance,” was lost in translation.

However,  reinforcements NEVER arrived because message received at command center heard instead:

“Send three and four-pence, we’re going to a dance”

A very humorous statement in the middle of a war but also quite out of place!

Not all communication failure can be as disastrous as this; yet it can be extremely frustrating for both the messenger and receiver. Lately, since one of my biggest problems with PD is actual voice related, I too am finding out how difficult it is to get things accomplish when those around you don’t get a clear message from you.

Why is this important?

  • Communication problems can be equally frustrating for all involved.
  • Person with problem of hypophonia  (low voice) or aphonia may become angry, irritable and isolated worsening an already existing depression or cause depression to ensue.
  • Some communication problems, such as having a soft voice, may be temporary and reversible with higher doses of levodopa. While other  speech related problems may be more permanent or caused by things like DBS implant or DBS positioning and activation of leads; in many cases leads may need to be readjusted because active electrical impulse is getting into areas of speech and affecting swallowing as well.
  • Sometimes medications, infections, dehydration, or depression itself  can cause difficulty in communicating with others due to the creation of confusion in the patient or person having these problems. the confusion then leads to an inability to state concretely or clearly their needs, concerns, or wishes. It is important to always review all medication with new onset of speech impediment especially when there appears to be a globally impaired person- not able to understand, read, write, or communicate verbally- we must exclude structural problems such as strokes and tumors in these individuals.
  • Of course the presence of dementia can also make communicating extremely difficult. This is a problem as 40-50% of PD patients are said to develop PD dementia after 15 years of disease. Thus, we have to take great measures to decrease risk factors especially as women are at higher risk for stroke but men are at higher risk for dementia and behavioral problems with PD. I recommend early screening as well as routine screening to avoid rapid cognitive decline when possible.

Whatever the cause poor communication can lead to depression and further isolation which only leads to a vicious cycle of increased deficits in communication and further withdrawal.

Identifying and solving communication problems:

As with most other problems in PD,  voice issues will develop slowly and subtly overtime. For instance, I have noticed that my husband and daughter are frequently surprised when I mention we are doing some activity on a given day which I had already mentioned to them before. After several episodes of me thinking I clearly stated something, I realized that they were no longer hearing me because I am developing softer voice. When I am completely aphonic, the communication is not as bad in my family because they pay more attention to my needs and watch for other non-verbal cues. But is the daily goings on that can be frustrating. Of course, as we age we tend to develop communication changes due to aging such as having poor sight or hearing which in turn can limit us as well significantly and in fact also cause much irritability if not able to hear or understand those around you.

Most people will seek medical help when things become bothersome enough or begin interfering with activities of daily living such as speaking in loud crowds or in a group, speaking on the phone, which I am beginning to have some degree of difficulty. Also everyone’s degree of impairment in their social life may be different even if the deficit is the same. this depends on each persons social abilities and needs.  If a person is a lecturer like myself than having any degree of hypophonia is significant  compared to one that lives alone and rarely socializes. Same goes for understanding written word. This can be a major problem if the person having these issues is the one in charge of important document handling.

Communication is a TWO-WAY street:

 Both the speaker and listener play an integral role as such both can and may need to alter their behavior in order to maintain a successful form of communication. one may have to try to speak louder and the other to make more eye contact and listen more intently. conversation requires all parties involvement- so tell your friends you cant speak as loud or cant hear them in loud places adjust your gathering environments rather than stop trying all together.

Make sure you get hearing tested- getting this done tomorrow.

Do speech therapy – which may include the LSVT- LOUD program to improve quality of speech and volume of voice. I think I will be enrolling soon. the speech therapist can also help with other types of communication skills like doing cognitive training or offer assistive devices to help you be heard and understood. there are a great number of assistive devices to aid in communication some are quite simple and inexpensive while others are more complex and expensive. May even consider choir therapy as well – for fun and perhaps may turn out to have some value in improving voice quality and clarity of speech.

The other great treatment available is collagen injections into the vocal cords which helps with voice volume.

 Don’t delay help and suffer frustration and isolation- talk to your physician asap .

Going to the Dentist Can Be a Challenge When You Have PD: by Dr. De Leon

Life is short so smile while you still have teeth.”

I wrote a while ago about the importance of maintaining dental hygiene particularly in light of a chronic illness like Parkinson’s disease. The slew of medications can potentially lead to tooth decay due to drying of mouth and wearing of enamel. However, keeping and scheduling dental appointments can potentially be challenging particularly as our disease advances. I know this too well both as a neurologist and as a patient with PD. Going to the dentist use to be common place but now ten years into my disease I have to think about it twice and may have to reschedule a time or two.

Yesterday, I went to the dentist although I seriously considered rescheduling once more due to severe nausea. Some of you may know what I am talking about, but for whatever reason now dental cleaning is extremely uncomfortable. One it always leaves my mouth and teeth incredibly sore for a day or two not to mention that keeping my mouth open for whatever extended amount of time needed for hygienist or dentist to work on triggers my dystonia not just in my jaw but in my neck which adds to the pain and discomfort which then triggers a migraine. It is an inevitable chain reaction unless I prep myself. So before I Go to the dentist, I have to take my nausea medicine, my migraine medicine and a muscle relaxant to keep the dystonia from setting in.  Needless to say I can only stand having my mouth open for so long so as you can imagine if you had the same problem doing procedures of any kind which could last more than 45 can be quite challenging. In a previous blog titled “tips on how to maintain dental care,” I provide some insight on how to get ready for a dental appointment. As I mentioned before it is important to schedule the visit at the maximum. Peak of your medication effect so if you are better in afternoon schedule at that time. For me now as I am beginning to have more difficulties with swallowing as my disease progresses I especially have to make sure medication is full force because there is nothing worst like having a choking sensation and having to tell yourself ” swallow” every time you have to especially when your head is tilted back, mouth wide open and water squirting at you!

If you experience some of these problems talk to your neurologist ahead of time especially if having major dental work done. He she can prescribe oral dissolvable medications as well as sedatives and muscle relaxants to aid in the process as well as coordinate care with your dentist.

I now in need of a couple of fillings repaired. Besides taking my muscle relaxants and anti-inflammatories, I may need a dose of Xanax which requires someone accompanying me to the appointment to drive me home. Another alternative is scheduling sedation which will definitely require making prior arrangements with a friend or loved one to accompany you.  The same is true if you are suffering from blood pressure problems particularly if it drops. So now for at least last 3-4 years my dentist always checks my blood pressure before commencing any treatment. He also lets me wear my sunglasses during the procedure to avoid extra sensory articulation from light shining directly on my face and compounding any possible migraine trigger. Can also ask for quick short breaks if work is extensive.

Even though I don’t much enjoy going to the dentist anymore and is no longer “routine,” it is equally important to continue care for my teeth as for my body; so with careful planning and necessary preventive treatments I can still go on my own without much difficulty other than a sensitive mouth for a day or so. At least both of my dentists are well versed on the manners of PD so I know I am in good hands.

 

 

The Power of The Mind in determining Our Response to Medications & Other Therapies : By Dr. De Leon

“One believes things because one has been conditioned to believe them.”   Aldous Huxley, Brave New World

 

 

Have you ever wondered why some people seem to always get better with any medication or treatment given; while others have the opposite effect no matter what the treatment therapy is?

Well, you have heard of the “placebo” effect, I am certain. Today, I will discuss the “nocebo” effect…

The term nocebo in Latin translates to English as “I shall harm.” this is in contrast to the commonly known placebo effect in which any  type of intervention whether medical, surgical, or homeopathic results in a perceived beneficial response not directly attributable to the mechanism of action of the intervention prescribed. I along with other scientists and clinicians suspect that this harmful effect (opposite of placebo) has been largely ignored and overlooked for many years, particularly when it comes down to treating patients in a healthcare setting.

Both of these outcomes are directly linked to a subconscious mind effect related to our expectations of benefit/ improvement/ as well as side effects and complications with any given treatment.

We tend to feel better and do better when we like the doctor treating us, the setting of our care, as well as if we believe there is merit to the treatment. This is particularly true when participating in a clinical trial – since only highly motivated individuals are prone to partake of these investigations especially as it relates to more invasive studies like DBS, gene therapy, focus ultrasound, and so forth. this of course always begs the question of how much benefit MUST we see before we know it REALLY is beneficial to the majority? Because invariably the mind is a powerful instrument that can render someone completely paralyzed and immobile or have the opposite effect…some may even call it faith. Whatever this intrinsic mechanism is (which some studies have alluded to PD patients having greater faith compared to other chronically ill neurological patients); it usually manifests in improvement of motor symptoms. This is extremely important in studies that rely heavily on self reporting of symptoms. The initial believed improvement could be a figment of the mind, wanting and hoping to have real relief. But, what happens when the study is unmasked and this type of patient find out they were not on treatment? the same holds true for those who believe everything will go wrong and have a slew of side effects on placebo. There is an unraveling- patients may than underreport improvement or exaggerate positive response either way skewing the data.

However, where I have witnessed the biggest problem in outcome in treatment is in clinical practice. There is such a thing as having “too” much knowledge or anticipatory effect. If one goes into a clinic already believing there is no treatment possible to help symptoms, that no matter what you will experience side effects and adverse events or that your physician is not in touch with your condition- this will automatically create a nocebo effect and I guarantee there will be no force or treatment to make you well!

This is why I always highlighted the positive effects of the medication and underplayed the negative possibilities and encouraged patients to not read the entire list of possible side effects before starting a new treatment. I rather recommended trying it first with an open mind. This also applies to getting advice from others. when people hear of great things with a particular treatment they are willing to try more readily but if they constantly hear negative reports the outcomes are mostly going to be disastrous. remember that every individual is unique as to their response of medications, systemic illnesses, and overall genetic and cultural composition so we can not really expect to have same treatment across the border although there are some generalizations across gender and ethnicity. Second, this fact is the reason why I suggest everyone follows up with a physician /healthcare provider they absolutely trust because their faith in this person will subconsciously alter the response to care for the better.

So next time you participate in a study, ask yourself the reason for participating?

  • are you trying to please your physician?
  • are you desperate for good results?
  • did you feel coerced to participate?
  • are you just wanting to help science?
  • do you have preconceived expectations from what you read or heard?

If you are honest with yourself, these questions will help you decide when and how to participate and have the best outcome…

likewise before you go to the doctor, ask yourself these questions?

  • what do I expect from therapy?
  • can I talk to this physician?
  • does he/she listen to my concerns?
  • do I trust this physician? or do I have to consult with others? get second opinion?
  • have I heard negative things related to my illness or medications?
  • am I going to follow through with directions/recommendations?

We must find a balance between being able to advocate for ourselves, acquire knowledge about our disease and treatment without jeopardizing our future outcome and limiting our treatment options.

With practice and keeping  above scenarios and questions in mind – you too can have a better quality of life and be a better research participant without losing faith.

 

Travel Tips with DBS- by Yuma BeV/Dr. De Leon

I have the great pleasure of having my friend and yours write a blog for us today on how to get going in an efficient and effective way when getting ready to travel- you all know her as the ‘Parkinson’s Humor’ author and Queen YumaBeV.

In the last few months, I have been doing some more frequent travel and I too have begun to keep some of the items like toiletries ready to go. Although, I wish I could keep my medicines already to go since this is what takes the most time to get together; but they are too costly to keep around in separate container and risk the chance of them going bad. however, for shorter trips I always carry my Vera Bradley pill box in my purse so I don’t have to worry about getting my medicines organized if traveling for less than a week. The one thing I am seriously considering especially since I have to travel via airplane is getting security clearing ahead of time to avoid waiting in line and going through hassle of always being patted down because my leg is so rigid it light up the screen as me possible having some sort of metal. I figure I should carry a note at least saying I have a “bum” leg or something… it would be easier if had DBS since then I could avoid that x-ray altogether. Here are some great tips for traveling  for those of you that do have DBS implants.

Packing for Traveling with Parkinson’s and DBS: By BeV M. Ribaudo ( Yuma Bev)

The hotel reservations are confirmed and your trip is only a few days away. You are excited because you will be spending time with family and seeing new things. All you need to do is figure out what to take and then pack it.

My Wonderful Husband and I travel light. We have a “Go” bag packed and in the closet by the door. It has almost everything needed to spend a night away from home: toothbrushes, toothpaste, deodorant, combs, shampoo and a razor. There is a list of items to add; prescriptions, DBS remote, jackets, cell phone charger, camera and a second list of things to do before leaving home; turn off the air conditioning, the water and set the alarm. All we have to do is grab some clothes and go. This is great if we are driving our car and staying out for one night, but if we are staying longer or flying then things become more complicated. For example:

We just returned from a 5 day/4 night trip to Las Vegas, Nevada. Our daughter and grandson flew in from Orlando to meet us there. It’s only 300 miles from Yuma, so we drove our car. All we need is extra clothes, right? No, because we’ll be gone for five days, I needed to bring extra batteries for the DBS remote and my camera, the original pill bottles and the pill splitter. The DBS remote goes through batteries like crazy, so I purchased rechargeable ones and found a charger that can charge both AAA (for DBS) and AA size (the camera uses these) at the same time.

Product Details
Battery charger and DBS remote 

Pill bottles and pill splitter

 

 

Packing these is the easy part; just toss them in the bag. It’s what to do with them once you get there that is the problem. At least for me it is.

 

I carry a small fanny-pack type purse. It’s barely big enough for car keys, ID’s, cash, credit cards and my cell phone. My shoulder won’t tolerate anything heavier and if my shoulder starts to hurt, I can put it around my waist. Here’s a photo of it next to a business size envelope.

There’s no room for the DBS remote or my camera unless I get rid of something else. And both are larger and heavier than my keys and cell phone.lenght of a letter size envelope

I tried to put the car keys in my jeans pocket, but the pockets in ladies clothes are worthless. It might work if I never sat down.

So, what did I do? I left the car keys and DBS remote in the hotel room and squeezed the camera into my purse. Some people carry their DBS remote with them everywhere, I don’t. At home it stays in the cabinet with the pill bottles. I use a daily dose pill holder that fits easily in my purse.

I currently take 1/2 of a carbi/levodopa 25/100mg tablet twice a day and 1 thyroid pill. I can easily fit a couple days worth into my little pill holder. However, the instructions on the bottle says take a whole one 4 times a day. Why? Because of cost. The price of 90 pills (a 3-month supply) is the same as for 360 pills (a whole years worth). My Doctor understands this and gladly writes the script this way to save me money, since I don’t have drug insurance coverage.

 

I just keep my fingers crossed that I don’t end up in an Emergency Room and have to show them the original pill bottle. At four times my normal dose, I’d be a dyskinetic mess.

Here’s a few other packing tips:

Print out a personalized info card, stating you have Parkinson’s and what symptoms you may have happen in an emergency. I have a large one in the glove box of our car and a smaller one in my purse, both in bright neon green, so they are easy to find.

Make sure you have your health insurance cards and phone numbers (including after hours contact info) for all your Doctors, especially your Neurologist.  

Take at least an extra week worth of all prescription medicines, in case you get delayed returning home.

If you have a cane or a walker that you use at home, even if it’s only once or twice a month, take it with you. You will be staying and walking in unfamiliar surroundings and falls can be deadly.

We have a night light and a small flashlight in our go bag; both come in handy when you need to go to the bathroom at night. Hotel rooms are notoriously dark.

Like a good friend always says, just remember to take your glasses, teeth and drugs, everything else…they sell at Walmart.

 

I rely on local drugstores and retail stores like Walmart  as well when ever I forget or intentionally leave at home things I know I can easily find in my travels.

for more tips look at my previous blogs…”Tips & Tricks: Traveling with Parkinson’s Disease – Part Deux” & “Tips & Tricks: Traveling with Parkinson’s Disease.”