Patient educational presentation reviewing fatique and comprehensive strategies to find more energy.

1. Finding Energy with Parkinson’s Sierra Farris, PA-C Neurological Physician Assistant Certified Clinical Exercise Specialist Sponsors Northwest Parkinson’s Foundation and Teva Neurosciences @Sierra Farris 2011

2. Fatigue & Parkinson’s Earliest reference to fatigue 1967, first papers on fatigue in PD published 1993 “a sense of tiredness, no energy, total body give out” “infuriating and awful feeling” debilitating frustrating exhaustion heaviness @Sierra Farris 2011

3. Understanding General Fatigue Mental – Neuroconnections and Neurotransmitters Physical – Mass - Physiologic - Biochemical @Sierra Farris 2011 Use It or Lose It

4. Understanding General Fatigue difficulty initiating and sustaining mental and physical tasks Reduced focus or attention Reduced motivation Every movement is with effort Causes Vary @Sierra Farris 2011 Mental May respond to targeted treatment

5. Understanding General Fatigue Loss of power Associated with sedentary life-style Motor inefficiency Higher energy cost to move Not related to muscle overuse (exercise) @Sierra Farris 2011 Physical Responds to rest nutrition exercise mindfulness

6. Fatigue - PD Symptom or Side Effect? Medication side effects can be elusive Fatigue Tiredness Sleepiness Drowsiness Lightheadedness Low blood pressure @Sierra Farris 2011

7. Fatigue and PD Symptoms Mental Physical More energy to initiate and sustain mental and physical tasks Depression and Anxiety Insomnia Every movement is with effort Tremor Stiffness Slowness Posture Dyskinesia Off Time @Sierra Farris 2011 Improves with rest nutrition exercise medication mindfulness

8. Confounding Factors Fatigue is more common if: Decreased leisure physical activity Excessive Daytime Sleepiness Lower frequency vigorous physical activity Less time doing routine tasks Lower blood pressure Lower aerobic capacity Longer time from sit to stand = routine tasks @Sierra Farris 2011

9. Analyze and Prepare Extreme Example…But, Parkinson’s related fatigue can feel like you are literally climbing a mountain every day. @Sierra Farris 2011

10. Comprehensive Approach to Gain Energy Nutrition Supplements Hydration Rest Exercise Mindfulness Stress Reduction Medical Evaluation @Sierra Farris 2011

11. Comprehensive Approach to Gain Energy Record some details for your doctor When and Severity Associated factors Cramps or RLS Prior night’s sleep Prior two days of tasks Meals and Fluids Exercise log Blood Pressures @Sierra Farris 2011

12. Medical Search for Contributing Factors Anemia – Complete Blood Count Thyroid Function Nutritional labs B12, protein, iron, electrolytes Infection – (Bladder) Anxiety and/or Depression Insomnia Stressors Medication Side Effects @Sierra Farris 2011

13. Is there a pill to fight fatigue?2009 World Congress Reports Dr. Stocchi, Italy Azilect showed benefit for fatigue over a 9 month study DBPC N= 1176 PWP P<0.01 Significance over placebo Dr. Ferreira, Portugal 19 trials reviewed Azilect only drug associated with decreased risk of fatigue @Sierra Farris 2011

14. Modafinil(®Provigil) Modafinil improved Excessive daytime sleepiness but not fatigue in a small PCT 2010 (n=13) @Sierra Farris 2011

15. Fatigue Fighting – Energy Promoting Exercises Yoga TaiChi Dance Aquatic Therapy Trekking Poles Wii Walking Single leg stance Tandem Stance Tandem Walk Corner Standing Posture Exercises Hiking Wall Climbing @Sierra Farris 2011

16. Energy Foods and Nutrients Antioxidants Anti-inflammatory Fats Good Carbs, Protein Fluids Grazing better than one large daily meal Magnesium, Calcium, Potassium What does your food pyramid look like? @Sierra Farris 2011

17. Energy Conservation Proper body mechanics (posture) Plan ahead Pace yourself Scheduled rest time Prioritize activities Limit environmental impacts 2008 MS Study – Mastery over the environment @Sierra Farris 2011

18. Exercise and L-dopa Moderate exercise increases clinical efficacy of L-dopa No alteration in pharmacokinetics of L-dopa Muhlack et al 2007 During exercise, growth hormone concentration is increased No change in L-dopa levels Miller et al 2007 @Sierra Farris 2011 (Egypt J. Neurol. Psych. Neurosurg., 2004, 41(1): 141-150).35min cycling (15m post drug)

19. Worksheet Every Victory Counts Essential Information and Inspiration for a Lifetime of Wellness @Sierra Farris 2011

20. Proper Footwear @Sierra Farris 2011

21. Strength @Sierra Farris 2011

22. Flexibility @Sierra Farris 2011

23. Endurance @Sierra Farris 2011

24. Take Time to Assess @Sierra Farris 2011

25. Assist Device @Sierra Farris 2011

26. Companions @Sierra Farris 2011

27. The top ten guesses will win an Every Victory Counts manual – Essential Information and Inspiration for a Lifetime of Wellness with Parkinson’s disease by Dr. Monique Giroux and Sierra Farris PA-C. Must be present at the September 10, 2011 Team PD Kilimanjaro event in Shoreline. Registration @ NWPF.org @Sierra Farris 2011 How many steps does it take to climb Kilimanjaro?