5 Best Coloring Books for Parkinson’s Patients: By Dr. De Leon.
5 Best Coloring Books for Parkinson’s Patients: By Dr. De Leon
“Art is like chocolate for the brain” ~ G. Cohen
There is a new trend of adult coloring books popping up all over the place that are designed to stimulate the mind. These consist of intricate designs from abstract images such as the ones in the ART NOUVEAU DESIGNS coloring book to images of iconic monuments worldwide found in INSPIRED COLORING TRAVEL. Although the concept is good, I find these books extremely tedious and lacking in mind stimulating abilities for those that have neurological disease such as Parkinson’s, Parkinson’s dementia, or other Parkinson’s Plus syndrome in which cognitive abilities are compromised. These books promise ‘to relax and free the mind.’ Have you ever worked or cared for an agitated person who is losing ability to recognize an entire scene of a painting to focus only on the individual parts? This can only cause them to become more agitated. Try putting together a puzzle where the pieces have no connection to one another. This is virtually impossible. So why would you give these patients something they will not be able to enjoy? Plus, these coloring books are expensive.
1-You can achieve same mindless coloring in advanced dementia patients with dollar coloring books which have a variety of themes for every occasion making it fun! However, the purpose of these books and activities is not only to calm, and sooth the patient but rather stimulate their remaining intellect and preserve function for a longer period of time.
We want a variety of activities that will stimulate several areas of the brain at the same time such as frontal lobe tracking things and put things in sequence, parietal lobe matching shapes, and temporal lobe to trigger memories of objects being painted. Best to have larger images and space for coloring enabling patients to stay entertained and focus for longer periods of time. Having larger images also makes coloring easier to stay within the lines and gives a chance to express individuality by using different types of coloring materials like watercolors, markers, crayons, acrylic paints and colored pencils. 
My grandmother who suffered from Parkinson’s disease for many years enjoyed these type of coloring books which not only entertained her but calmed her down. Plus, it was easy to share the coloring books with my daughter who would sit opposite her and color the adjacent page. They used all sorts of materials for their wonderful creations including finger painting. One of their favorite methods to paint. Another one was to use scented colors which also help to stimulate the olfactory nerve.
2- Besides my favorite cheap coloring books which also have a number of activities like tic-tac-toe and word puzzles, I really like the Osborne Big Color by Numbers Book– I like because it has variety of designs, colors and shapes- some small and others larger within same book. These are reasonable and can be found at all large bookstores including amazon. 
3- Another fun way of painting is paint famous work of arts by numbers – you can pick favorite artist or period or do a variety. Always pick larger canvases. Room for creativity as well because can use own proper brush stroke technique as well as paint colors to reflect own individual whimsy. 
4 – I also like the Books Dream Big, Draw Bigger 
5- For those who are dealing with advance Parkinson’s in their life or dealing with dementia, Draw, Doodle Design & Doodle Imagine, Draw. 
The last three books allow for both the caregivers/partners and Parkinson’s people themselves to become more engaged and interactive thus stimulating cognitive function in several aspects of brain because it asks to do tasks while drawing which requires recollection of objects, places and memory of shape of what is being asked to draw plus helps with coordination and fine motor skills. But, in reality all of these books/ painting crafts are perfect for any stage to keep the pathways and neuronal connections viable. Remember art is 
a gift many of us with PD have been given due to our illness as well as a side effect of medication so go ahead indulge.
Tips & Tricks: Traveling with Parkinson’s Disease – Part Deux: By Dr. De Leon
Tips & Tricks: Traveling with Parkinson’s Disease – Part Deux: By Dr. De Leon
I love summer not just because my birthday highlights the beginning of the best season where the days are long and the possibilities seem endless. But, because I always seem to rejuvenate during this time of year. As I get ready for my first real trip of the summer after an exhausting year, it occurs to me that since I have developed PD it takes me longer to pack my medications than it does my actual clothes and toiletries. We all know PD symptoms can vary with stress, weather conditions, and other variables like sleep. Therefore we have to be prepared for the not so good days particularly when far away from home and even more if out of the country.
Tips for Traveling: 
As I had described on a prior blog “Tips & Tricks: Traveling with Parkinson’s Disease” always carry with you a complete list of medications (over the counter, natural supplements as well as prn medications).
You should also have your doctor’s phone number handy along with a letter stating diagnosis and medications needed including name, dosages, and times to be taken. As a girl scout I guess my motto is always to be prepared which means making sure that ALL of your medications fit into a small carry-on luggage that you can keep with you at all times. In this carry-on keep an extra set of clothes, undergarments (this includes disposable undergarments…there are many to choose from recommend depend because great variety for both men and women), snacks, and water (which can be easily purchased once go pass security.
- Especially when traveling by plane during busy season or to certain regions of the country such as some famous ski resort areas even in the summer, they have a tendency to be delayed which may result in luggage being misplaced during trip. In Aspen since it lies in a valley surrounded by mountains, the departure of flights is very much dependent on weather. This was one of the first times, I experience crew talking about weight of plane in to take off safely. This means that you may leave but not your luggage necessarily. Believe me, it is easier to change clothes than have to wash clothes in a hotel or worst in an airport bathroom. If possible carry sleep wear (best something silky which allows for greater mobility at night). I can’t sleep in regular clothes. But, if there is no room in luggage, do as I do travel with extra comfy clothes like pants with elastic band made of combination Lyocell and spandex (and some cotton) because these will allow you to move with ease, not wrinkle, and is odor absorbent as well as breathable. The last two qualities are extremely important since a lot of us with PD tend to perspire especially under duress.
- When booking a trip always ask for wheelchair assistance even if you end up not using it. This will give you peace of mind especially if you happen to suddenly need one because meds have worn off unexpectedly. Having a wheelchair available comes in very handy if connecting flights happen to be in opposite ends of the airport or if luggage retrieval is several terminals away.
- Don’t get in a hurry. Pace yourself. Give yourself extra time to get to destination (e.g. Airport or ship boarding)
- Don’t make changes to your medicine regime on the day of travel or while on vacation since you don’t know what kind of side affects you will experience.
- If you are going to get a cooling vest, as I am carrying one for me and my niece who has medical condition requiring skin to stay cool, Don’t wear it while going through security. Guess what this vest looks like on X-ray machines? Something akin to wearing a bomb strapped to your chest is the appearance of those gel packs next to your body inside the vest. If you don’t want to cause a huge incident video- taped and posted all over the media take the vest off. Also best to bring a doctor’s note to avoid confiscation by the TSA. The gel and filling may make them uneasy as well.
- Don’t be ashamed or proud to ask for early boarding. Don’t be afraid to let the crew know your condition in case you may need assistance with meds etc. during the flight or out to sea.
- Further, make sure to bring a back up to your cane. Do you know how many times my father left his at restaurants, hospitals, public bathrooms, etc.? It’s good to have a ready replacement.
- Although your primary walking assistive device is not a cane but a quad cane or u- walker some places are not as easy to navigate like small narrow brick streets of New England or some European countries. In these cases a walking stick or cane may be an alternative option which will allow you to keep touring or enjoying your trip. In my case, my large umbrella always serves me as a walking assistive device when traveling. This way I am ready for inclement weather due to rain or bad terrain. However, the umbrella must be a sturdy to sustain your weight and also handle severe winds up to 55mph. This one device also helps to provide shade and keep you cool when outdoors. Here is one link you may find useful www.innovagolf.com
- If you depend on scooters for mobility look at place of destination to see if you can rent one or one is available to you which will make your traveling much easier. For instance, I have been told that in France, wheelchairs are now available to rent at local pharmacies. In Italy however, when I was there only 3 years ago, I found it extremely difficult to navigate at times as a person of disability. Any person using more than a cane would find little to no support in most places including big cities like Rome. Taking tours can be more than a challenge since most places are not handicap friendly (Made me appreciate the commodities and privileges we as Americans take for granted at times, even when cities are not as handicap friendly here in the States- they are superior to many European countries in which I have traveled). Wheelchairs are not easily available in a lot of countries.
- While in Rome, I felt extremely bad for this one person on a motorized wheelchair and her daughter who were tour with us. Before they boarded, the daughter asked our guide if the place where we were going to was handicap friendly otherwise they would stay. The guide without missing a beat said, ” oh yes, we have elevators!” Needless to say, this was a large misrepresentation of the truth! As soon as we got to the gardens there was a large steep stairwell. I saw the disappointment and frustration in this family’s face. Seeing the anger the tour guide said:” don’t worry once inside there is an elevator! Turns out the elevator only went down two floors which did not even cover the entrance of the beautiful gardens …even myself could only see about a fourth maybe less of the spectacular scenery because the stairs were so steep and winding down forever; I was afraid I would be stuck at the bottom and unable to climb back-up since I was already experiencing extreme weakness.
- Make sure you do your research ahead of time and talk to other people that have traveled there before going.
- Wear sun protective clothing. We are predisposed to melanoma and UV rays can go through clothing especially bathing suits. Wear a sun protective hat and if you plan on being out in sun and beach may consider this link: http://www.coolibar.com/ Be aware that some medications like Azilect also make skin more sensitive to sun and if prolonged exposure can lead to rash.
- Also, remember that sitting for a long time in a plane can cause ankle swelling this is aside from the fact that some medications like NEUPRO, Azilect, Amantadine are known to increase leg swelling especially in women. Since the combination can lead to increase water retention it may be wise to get compression stockings to avoid DVT’s (clots) and improve blood flow. Look at the following link: http://www.tommiecopper.com/?gclid=CNbf0MmdwsYCFQtqfgodZLYC8g Also talk to your doctor about diuretics (water pill) as a prescription if this is a severe problem for you.
Now that you have everything in order- you are set to go! Have a great trip & Happy Independence Day everyone!
“Life begins at the end of your comfort zone!”
@copyright2015
all rights reserved by Maria De LeonMD
FDA Approves New Deep Brain Stimulation Device
Tips for Treating Swallowing Difficulties in Parkinson’s: By Dr. De Leon
Tips for Treating Swallowing Difficulties in Parkinson’s: By Dr. De Leon
Most of us know that one of the hallmarks of PD is muscle rigidity. Since the muscles of mastication and deglutition (swallowing) which include tongue, palate, pharynx and esophagus can also become affected and stiff as the disease advances swallowing can become not just a challenge but a matter of life and death as time goes by.
There are 4 Phases of Swallowing:
If there are problems in any of the main 3 phases (oral, pharyngeal or esophageal) this can lead patients to feel like they are chocking, feel like something is stuck in their throw, or like a child who can’t seem to coordinate the swallowing maneuvers (i.e. their tongue to push pill back at same time as they swallow) no matter how much fluid they drink.
Dysphagia (or difficulty swallowing) affects not just intake of pills but solids, liquids, and eventually even one’s own saliva resulting in increased drooling. This sensation can cause anxiety, feeling of panic. If dysphagia goes untreated it can lead to a person becoming malnourished because the energy required to consume a small amount of food can become extremely tiring to the point that many people with this disorder simply give up. Further, the more weakened and malnourished someone becomes the less energy they have to toil creating a potentially hazardous vicious cycle unless there is proper medical intervention.
So what can you do to avoid feeling this frustration? To avoid poor nutrition? And most importantly to avoid hospitalization due to aspiration?
Silent (not even being aware) aspiration resulting in pneumonia is one of the most common reasons for hospitalizations in those with PD. Although, it is preventable, this remains one of the top reasons of morbidity and mortality in PD patients.
First, like everything else prevention is the key to improved quality of life. However, before prevention one must learn to recognize the symptoms of dysphagia. This means frequent follow up with your MDS/neurologist to adjust medications especially if you feel like saliva is pooling, this is caused by the muscles of throat becoming stiff and not working properly. If you are having to cut things up into smaller pieces or drink water (fluids) more frequently or taking a longer time to eat this is a sign things are not going so well. You should have frequent evaluation by a speech therapist (ST) throughout the course of disease especially as disease advances. They will not only evaluate quality of speech but also evaluate for risks of aspiration and teach proper swallowing techniques. Your neurologist may order a Swallowing test to be done by the speech therapist to further evaluate.
The speech therapist will teach how to:
- Close lips and make tight seal
- Move tongue and cheeks to prep for the swallow.
- Instruct on types of food should be eating (liquids, semi-solids, thickened).
- Sit upright when drinking & eating (this includes pills)
- Take small sips and bites- alternating between the two. Do not gulp.
- Avoid straws if possible because can pull too much liquid very quickly into pharynx (before airway has had time to seal). Straws are best kept for those with severe tremors or dyskenesias but actually now there are many other tools for this like Sippy cups and cups especially designed for PD patients. (see my book on Parkinson’s Diva: A woman’s Guide to Parkinson’s disease for other tools).
- Keep your chin tilted down when eating and as your mother said please don’t talk with your mouth full (turns out she knew what she was talking about after all)
Second, once swallowing difficulty sets in, in my experience this does not mean is the end; in the majority of cases with medication adjustment and the aid of a peg tube ( feeding tube) symptoms are only transitory. I highly recommend for patients and families in the advanced stages who are experiencing dysphagia to consider a feeding tube usually in most of cases this is a temporary measure of assistance which serves to protect the airway.
Having a feeding tube allows patients to still taste food but not rely on it for nutrition and also if only having trouble while off then can use to get medications down until they kick in. Plus, with the advent of new treatment options becoming available the time patients have to endure feeding tubes is getting shorter. In my practice, I often used feeding tubes successfully to maintain quality of life while we adjusted medications and allowed for new medicines to come to market. I had a few patients who were end-stage and had been on everything to date and now were bedbound on feeding tubes in a nursing home but when Neupro patch came to market these patients were able to leave the nursing home and ditch the peg tube. So, I don’t ever like to look at feeding tubes as the final step necessarily but a means to an end. this allows patients also to stay hydrated because as dehydration sets in so does confusion, psychosis, agitation and worsening PD symptoms.
Many of my patients opted to leave their tube in place even after they were able to swallow as long as they maintained proper care just in case they had trouble in future. this worked very well. Only once in 15 years of practice did I have to remove a feeding tube due to infection.
Third, many Parkinson’s patients experience swallowing difficulty or choking sensation after the food has passed the pharynx on the way to the esophagus. Remember, the muscles of the esophagus not only do they get rigid and stiff but they become extremely slow as well not being able to properly move food along. It is important to have a good GI doctor that understand PD well and works well in conjunction with your Neurologists/MDS. He or she will help guide therapy plus be on the look out for reflux which often occurs as PD advances due to back pooling of food and acid that is not able to go down. the acid then burns the esophagus and even the vocal cords and pharynx muscles causing a sensation of chocking or difficulty swallowing. Another common problem is the presence of bacteria known as H.pylori that can also prevent motility and cause not just reflux but poor absorption of medications thus causing dysphagia. He/she may order an upper endoscopy to further evaluate.
As you can see, trouble can occur at any of the 4 stages of swallowing but with proper care, recognition, and prevention you may continue to lead a fruitful and productive life.
For suggestions on various dysphagic diets look at my previous post:Brunette Guide to Managing a Parkinson’s Dysphagic Diet
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