Good Medicine - May 2009
The Best of Both Worlds
Dr. Bernard Feinberg is having lunch at an outside table at his favorite Hillview Street restaurant. It’s a light affair of seared ahi tuna atop fresh salad greens. He sips his iced green tea and sets it down. "My table manners might not be the best," he warns with a smile. "It can get a little messy when I eat."
Feinberg is a Sarasota-based physician specializing in internal medicine. His bearing is calm. You wouldn’t know it from a casual meeting, but Feinberg, 60, has waged a six-year battle with Parkinson’s disease. Spend enough time with him and you’ll spot its telltale signs: hand tremors and rigid posture and movements. Other than that, he looks like a physically fit man in his prime. That alone is a quiet miracle.
He didn’t always seem so fit. Six years ago, Feinberg noticed disturbing physical changes. His feet were starting to move with a will of their own. His hands felt blocky and clumsy when he tried to write or type. Fearing he’d suffered a small stroke, he had a CAT scan. The surprising results? Feinberg had hydrocephalus, a rare disorder in which the fluid surrounding the brain and spinal cord can’t drain properly. The pressure of the backed-up fluid can damage brain tissue, resulting in reduced motor abilities, poor coordination, lethargy and cognitive dysfunction.
Although his doctors couldn’t determine what caused the hydrocephalus, they could repair it. Surgeons inserted a shunt (a long thin tube) and drained the fluid. This immediately relieved Feinberg’s motor difficulties. His arms and feet obeyed his brain; his movements were more fluid. Feinberg was elated. Then, a few days later, his symptoms returned with a vengeance. Feinberg was faced with more tests, neurological consultations and a terrible truth.
"They told me I had Parkinson’s disease," he recalls.
Parkinson’s has been in the news lately. Actor Michael J. Fox suffers from it. Politicians argue about using stem cells to treat it. That’s all widely known—though the disease itself isn’t widely understood.
Parkinson’s disease results from the death or impairment of certain nerve cells in the brain. When healthy, these cells produce dopamine—the orchestra conductor in the symphony of brain chemistry. When the brain has enough dopamine, the body’s muscles and movements are coordinated. When too many dopamine-producing cells are damaged, muscular dysfunction appears—perhaps a slight tremor, mumbled speech or stiffness of movement. These are Parkinson’s initial symptoms, but the symptoms get progressively worse. So far, the disease can’t be cured, but it can be treated.
Early in 2004, Feinberg’s doctors started him on a regimen of drugs, including dopamine agonists, which mimic dopamine’s stimulation of nerve receptors. But by 2005, Feinberg felt hopeless. The drugs made Parkinson’s manageable, but the cure seemed worse than the disease. For him, the side effects included depression, hopelessness and exhaustion. Feinberg wondered if he’d be forced to abandon his medical practice.
"I saw no light at the end of the tunnel," he says.
His wife, Barbara, showed him the light, urging him to fight back in every way he could. "Despite all my kicking and screaming, she inspired me to take back control of my life," he says.
Feinberg began with lots of sweat. Jason Nippert, a local exercise physiologist, put him on a rigorous workout program. Although it didn’t eliminate his symptoms, the exercise renewed Feinberg’s vitality. Within months, he shed some extra pounds and improved his muscle tone and fitness. But when Nippert suggested craniosacral and neuromuscular massage therapy, Feinberg balked.
"For most of my career, I’ve been the typical conservative-minded doctor," says Feinberg. "I was very skeptical of so-called alternative health and wellness therapies."
As a courtesy to Nippert, Feinberg agreed to have one session with Valerie Hunt, a Sarasota-based massage therapist who practices neuromuscular and craniosacral massage therapy.
She opened his eyes to a whole new world of healing.
"I came home from that first session floating," says Feinberg. "My leg twitches and tremors were gone! With the barest touch, she eased my symptoms. It felt like a miracle."
His symptoms weren’t cured. Even so, the respite was life-affirming. One alternative healing modality led to another. At Hunt’s suggestion, Feinberg attended his first yoga session in December 2007. Lynn Burgess was his teacher. She’s the founder of Yoga from the Heart, a Sarasota yoga studio that practices alignment-based yoga—a variant of Hatha yoga that emphasizes core strength and flexibility. Again, Feinberg was pleasantly surprised. "After an hour of yoga, I didn’t hurt," he says. "After a few weeks, I became more flexible and balanced. I even walked better. I went from being a total skeptic to embracing yoga."
To Burgess, this makes perfect sense. Many of her clients struggle with Parkinson’s and a host of other degenerative diseases.
"Yoga enhances strength, balance and range of motion," she says. "People with Parkinson’s especially need that kind of training. Their disorder robs them of these very qualities."
Burgess created a program of yoga poses addressing Feinberg’s key issues: trunk rigidity, hamstring tightening and compromised balance and breathing. He began taking two classes a week and practicing daily at home.
Two years of this discipline have strengthened Feinberg’s core and upper body and improved his gait, posture and flexibility. And yoga gave him more than physical benefits.
"Bernie seems less stressed, happier and more peaceful than when he started," Burgess says.
Feinberg agrees. "I feel the best I’ve felt in six years. I used to shuffle, and I don’t anymore. I was tired all the time, and now I’m not," he says.
Feinberg has also benefited from acupuncture, which he started last year. And he takes Sinemet, a drug that activates dopamine receptors.
Invented 40 years ago, it’s still the best medicine for Parkinson’s disease, despite its severe side effects.
Feinberg’s neurologist, Dr. Dean Sutherland, who specializes in Parkinson’s disease, started him on Sinemet in 2005. The founder and medical director of Sarasota’s Southeastern Center for Parkinson’s Disease, Sutherland is also medical director for the Neuro Challenge Foundation (NCF), a not-for-profit that supports Parkinson’s patients and families with outreach programs, scientific research, and a host of educational resources. NCF operates the Parkinson Care Center, which offers doctors, counselors and physical therapists at Sarasota Memorial Hospital’s Institute for Advanced Medicine.
Sutherland agrees that Feinberg’s symptoms have dramatically improved since he first saw him. He gives most of the credit for Feinberg’s improvement to Sinemet, the "gold standard for Parkinson’s." But he doesn’t discount the benefits of yoga and acupuncture.
"Drugs aren’t the only way to alleviate certain symptoms of Parkinson’s disease," says Sutherland. "Exercise is as important as any medication. When I first saw Bernie, he was overweight and out of shape. He was slow and depressed, freezing while walking and constantly fatigued. In four years he’s undergone a tremendous transformation."
Sutherland cautions that there’s still no proof that exercise, yoga and other non-drug therapies slow down brain cell death. Even so, he says, these therapies increase wellbeing and reduce stiffness.
"It’s the use-it-or-lose-it phenomenon," he says. "It’s best to keep Parkinson’s patients as active as possible. Parkinson’s patients can’t move around as much. As a result, muscle flexibility and strength diminish. Exercise reverses that, and produces brain chemicals that may have an antidepressant effect."
In Sutherland’s view, fighting against Parkinson’s requires everything you’ve got. Integrative medicine takes exactly this approach, combining advanced medical practices and alternative modalities. He explains that the Southeastern Center for Parkinson Disease embraces this philosophy.
"We focus on healing the whole person—mind, body and spirit—by combining the best of Western scientific medicine with other healing modalities, including acupuncture, massage therapy, yoga, Tai Chi, dance—even golf therapy," he says. The center also employs such cutting-edge technologies as deep brain stimulation and implanting electrodes into the area of the brain associated with Parkinson’s.
In large part because of his own experience, Feinberg is working with medical and healing professionals to establish Sarasota’s first integrative medical clinic. "It’s an idea whose time has come," says Feinberg. He explains that many major university hospitals have opened integrative medical clinics treating major diseases with a combination of Western medicine and alternative healing modalities.
"Alternative healing comprises a range of modalities, some valid, some not," he says. "In the 19th and 20th centuries, in its zeal to discredit quack medicine, Western medicine threw out the baby with the bathwater. We eliminated the snake oil that didn’t work, and herbal remedies that did. Today, we’re reappraising non-Western healing techniques. The result is a fusion of the best of both worlds."
What advice can Feinberg offer someone diagnosed with a debilitating disease like Parkinson’s?
"Never accept defeat," he says. "Keep moving. You’re in the fight of your life, so fight. Take your life back. You’re the only one who can."
Neuro Challenge Foundation and the Neuro Challenge Parkinson Care Center:
Southeastern Center for Parkinson Disease:
Yoga from the Heart:
Ste. B, Sarasota; (941) 929-9878.
Valerie Hunt Massage Therapy:
The National Parkinson Foundation:
The Michael J. Fox Foundation for Parkinson’s Research:
The American Parkinson Disease Association, Inc.:
Parkinson’s disease affects both men and women in almost equal numbers. It shows no social, ethnic, economic or geographic boundaries. In the United States, it is estimated that 60,000 new cases are diagnosed each year, joining the 1.5 million Americans who currently have Parkinson’s disease. While the condition usually develops after the age of 65, 15 percent of those diagnosed are under 50. Source: National Parkinson Foundation
Signs and Symptoms
The symptoms of Parkinson’s disease vary from person to person. Early signs may be subtle and can go unnoticed for months or years. Symptoms typically begin on one side of the body and usually remain worse on that side. According to the Mayo Clinic, Parkinson’s signs and symptoms may include these:
Slowed motion (bradykinesia)
Impaired posture and balance
Loss of automatic movements
In the later stages of Parkinson’s disease, some people develop problems with memory and mental clarity. Alzheimer’s drugs appear to alleviate some of these symptoms to a mild degree. Many people with Parkinson’s disease have problems with speech. You may speak more softly, rapidly or in a monotone, sometimes slurring or repeating words, or hesitating before speaking. Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson’s disease, these acts tend to be diminished and even lost. Some people may develop a fixed staring expression and unblinking eyes. Others may no longer gesture or seem animated when they speak. Your posture may become stooped as a result of Parkinson’s disease. Imbalance also is common, although this is usually mild until the later stages of the disease. Muscle stiffness often occurs in your limbs and neck. Sometimes the stiffness can be so severe that it limits the range of your movements and causes pain. Over time, Parkinson’s disease may reduce your ability to initiate voluntary movement. This may make even the simplest tasks difficult and time-consuming. When you walk, your steps may become short and shuffling. Or your feet may freeze to the floor, making it hard to take the first step. The characteristic shaking associated with Parkinson’s disease often begins in a hand. A back-and-forth rubbing of your thumb and forefinger, known as pill-rolling, is common. However, many people with Parkinson’s disease do not experience substantial tremor.
www.apdaparkinson.orgwww.michaeljfox.org (941) 780-62312010 Pine Terrace, 1921 Waldemere St., Suite 701, Sarasota; (941) 487-2160. 5880 Rand Blvd., Suite. 209, Sarasota; (941) 926-6413; www.neurochallenge.org.