DBS On My Mind

The road leading to deep brain surgery for tremor of Parkinson's and other movement disorders is a long and arduous one. It includes several tests prior to even talking with a surgeon. However, enough is known about who might benefit from this surgery and who might not, that the preliminary screening process is essential.

"Blue hole" over Whidbey Island 

On the Road
Carolyn, Bella and I wait for the 10:15 ferry to Port Townsend. A road trip to St Helens, Oregon lies ahead where we intend to spend some time with our son Jay and his wife Luka in their new place of residence. 

This morning the weather is moderate and there are breaks in the persistent Northwest cloud cover.  Patches of blue sky appear among the clouds and brighten my spirit.  Such a sky is a hallmark of central Whidbey Island. Geographically we live in the shadow of the Olympic mountains, a shadow that reduces our rainfall to 20-22 inches annually.  Mountaineer, author and former pharmacy customer of mine, Harvey Manning, called it the blue hole over Whidbey in his book "Walking The Beach to Bellingham."  However matters of weather often change rapidly and as we crossed the sound to Port Townsend the heavy clouds closed rank, the blue hole vanished and the once glowing Olympics were obscured by layers of gray, misty clouds.

This blog may be about a road trip but I find it difficult to put the events of the previous week aside and not think about them.  After all it has only been a few days since I was treated to a Skype style live computer conference to review the results of my recent cognitive and memory testing. This testing is required for those considering deep brain surgery or DBS.  If memory loss or the presence of dementia is detected during this process they are considered ito be reason enough to disqualify the patient from DBS surgery.

The video format proved to be an amazingly personal way to get the results of a medical procedure recently completed in Seattle.  Carolyn and I were able to make a much shorter trek to a satellite clinic to be given the results personally via the miracle of television.  We just got seated in front of a large screen television when the doctor, a Phd psychiatrist, dialed in and her live image, direct from her desk jumped to life.

After stating that I did all right in the cognitive testing. She went on to explain that I had scored below expectations on two areas of testing and above expectations in two others.  Below expectations included situations in which I would be slow to react on information given and difficulty functioning in situations where processing information from multiple sources(multi tasking). She emphasized that these changes were consistent with Parkinson's.  The condition described, that of slow response to a variety of stimuli and difficulty processing multiple inputs is called neuro-cognitive disorder. In my case it is mild neuro-cognitive disorder. The psychiatrist, went on to explain that in a ten year period one with mild neuro-cognitve disorder might expect that among similar patients 30% would remain the same, 30% would get better and 30% would get worse.  Mild neuro-cognitive disorder is not a deal breaker with DBS.

I was in charge Bella's needs but the duties were shared .

My cognitive and memory test results would be compatible with surgery.  The next stop in this process will be Swedish hospital in Seattle for physical assessment both on and off of medications.  Before the computer conference was complete the Psychiatrist, inserted what I took to be a warning. She cautioned that mild neuro-cognitive poblems may worsen with DBS surgery. She quickly added that many considered that to be a fair trade for the physical improvement. Is it? How could any deterioration of cognitive function represent a fair trade for something else? She inserted this warning into the conversation more than once.

The ferry had rocked and rolled just a bit this morning, with a light chop on the water but no whitecaps. After putting ashore in Port Townsend Carolyn pointed our Toyota away from town and about 8 miles later we turned South on highway101.  101 is a beautiful highway which runs quite a few miles along a natural fiord known as Hood canal which demarcates the large peninsula on the West side of our state.  I was not worthless on this trip and had a well defined role and a purpose: support man for Carolyn.  Under this title I was official road trip copilot, which included: GPS monitor, lunch server, and disc jockey.  Informally I was also in charge of Bella's needs.  Things like when where to stop for water and other basic dog needs.

We passed the turn off to the small town of Chimicum, the location of Bettty Macdonald's wonderful, humorous book, "The Egg and I." Her memoirs of life in the 1930's with her young husband on a chicken farm. A delightful book that made old fashioned hillbillies Ma and Pa Kettle household names in America during the 40's and 50's. More than 80 years later Chimicum is still rural and sparsely populated.

We passed through the Columbia river town of Longview

Later as we approached our destination we passed through the Columbia river town of Longview.  A dreary and industrial looking city and even more on this day we had begun with the uplifting sight of the blue hole over Whidbey. We approached the end of our journey in the dismal contrast flattening gray fog of Longview. Here we drove by acres and acres of fir and hemlock logs which lay trimmed and ready for loading onto, ocean going transport ships for export to Japan. Some will be milled to lumber and sent to California or other places for home building.

We crossed the bridge over the Columbia river and entered Oregon and then it is only a short stretch to St Helens. Soon we would be spending time with our son and his new wife in their new home. The matters of weather and other concerns fade when Thinking of this.

The road home

Shaky in Coupevillle 

Deep Brain Surgery - Cognitive Testing

A sight to remember  -  Port Angeles, WA.  11/14

After an early morning drive down to Seattle amongst heavy traffic, Carolyn and I sat together in the neurology waiting area patiently listening for my name to be called.  Ahead were 4 hours or so of both cognitive and memory testing intended as part of the selection process for deep brain surgery. Cognitive functions include much of our thinking capabilities.  This means long term memory, working memory or executive memory, creativity, judgement and much more. 

I once regarded this testing as a small step in the path that could lead to deep brain surgery(DBS)but now it seems to be much more.  If the test shows evidence of cognitive decline and memory loss it likely would mean disappointing results from the surgery and probably a worsening of cognitive function.  It also may mean a tough time dealing with and cooperating with "awake" surgery.  It may also mean difficulty dealing with the complexity of the process of deep brain surgery period.

It always feels good to be in Seattle regardless of what brings us down here.  I lived here for a short while in the 70's and it was here that I met Carolyn.  We enjoyed the perfection of physical health and youthful minds that were ours for that short period of our lives. Now I recognize that at least some of that is slipping away but I will always remember that Seattle was our city for a short while.  Lucky me.  The girl I love still sits by my side.

Tucked in my briefcase are 3 sets of paperwork.  The first set of paperwork included questions for me to answer and were intended to obtain an up to date medical history.  The other two sets of questions were identical.  One for me and one for Carolyn.  These sets included questions that were geared to finding out what we both had observed about my current mental status.

The questions included things like:

     Am I still able to manage our finances?

     How many items can I remember to get at the grocery without needing a list?

     Am I still able to drive?

     Do I have trouble remembering details of recent conversations?

     Have you ever used mind altering drugs?
     Do you consume alcohol?

      And so it goes.

My name was called well before my scheduled 8:30 appointment and both Carolyn and I were taken back to a small exam room.  We waited for a few minutes and two attractive women  entered.  The older, in charge of the test, introduced herself and was a doctor.  She also asked permission for the younger, who was a student, to sit in and help with the testing.  I gave her permission to stay.

The doctor sat down in front of a computer terminal and pulled up my medical record for reference.  She then went through the observed mental status questions Carolyn and I had both filled out previously and separately. Her intent appeared to be, to fully understand what was behind our answers and to reconcile any differences.

I think that over the past several years I have noticed more frequent lapses in at least some of the areas questioned. I am not certain what this means.  The brain itself is so complex and is likely influenced by many things currently shaping my life.  Is it Parkinson's?  What about aging or even lack of sleep?  Is it some sinister side effects of the medications that I take?  Each of the drugs I take for Parkinson's is targeted at the brain or central nervous system and probably have some effect. How can these things be sorted out?  Do they need to be sorted out?

After the questions were reconciled and the interviewer believed that she understood the answers we had given, she turned the actual testing portion over to the student.  The Doctor and Carolyn both exited.  

The student began by reading me a list of 7 words and then asked that I repeat them back.  No problem.  She then asked another question or two and then surprised me by asking me to recite what I could remember of the original 7.  Whoops, I must have missed the bit that said I would be asked to repeat those 7 words later.  I had made no mental notes and could not remember even one of the words.  Alas the student giving the test genuinely seemed to like me and was delighted when I was successful and appeared disappointed when I was not. So she gave me a second chance and we  repeated the process with a different list and I once again was asked to repeat what I could remember of the list later. I did better this time around but still found it difficult. 

As the test went on she asked questions to verify that I was oriented to time and place.  I did pretty well but occasionally got hung up a bit.  I did fine with President Barack Obama but could not come up with Joe Biden's last name.  Poor Joe his last name on the tip of my tongue but would not come.  Also I could not think of our Governor's last name either.  What does that mean?  Maybe nothing, I think it is compatible with my age to come up with name blocks. What I think may not matter and so the testing went on. I was shown patterns of geometrical objects and then asked to pick out similar patterns among different objects.  I drew stick diagrams from memory of stick diagrams I had previously seen.  I counted numbers backwards by differing increments.

Things went on and we finished up about lunch time.  The doctor in charge returned and said that it may be a month or so for the results to be ready.  So what then?  There may or may not be a decision for myself and Carolyn to make about deep brain surgery.  They either will pass or fail me to move on toward surgery based on the test results.  For now I am perfectly happy to simply wait.

Shaky in Coupeville

Catching The Frisbees of Life

....Should we accept only good things from the hand of God and never anything bad?...
From Job 2

I launched the Frisbee with a quick backhanded toss from my right hand.  At first the Frisbee flew a flat and somewhat rising trajectory to my right.  Juney eagerly retrieved it with typical Lab enthusiasm.  I tossed it many times but I could not get it to hold a level  flight long enough for Juney to catch up with it in the air.  Juney is our middle daughter and family’s black lab who has stayed with us this past week.  She is a lovely dog and is a people pleaser.  I am reconciling my advancing age with declining ability physically to throw a Frisbee.

Advancing age or not it is still a delight to throw a Frisbee to a Labrador after more than 40 years. Then it was with my brother’s black Lab, Tuco, who lived with myself and my brother in the Fall of 1970.  We were going too school at Washington State and lived together in a small basement apartment adjacent to Mcgee Park in Pullman, Washington.  I was young, Tuco was young and my brother was a young veteran of the Vietnam war.  My brother had lived through great pain by way of this terrifying curve called Vietnam. No such hard curves for me,  God was spinning perfectly thrown Frisbees my way.  I thought that was the way things would always be.

If my life was a picture book I would flip through pages and remind myself of all of the good things that have been sent my way.  I might come first to a picture of my wife.  At this I would pause for a while and think about what a miracle it was that I even met this wonderful girl from upstate New York: 

You know how it is: you’re twenty-one or twenty-two and you make some decisions; then whisssh! you’re seventy: you’ve been a lawyer for fifty years, and that white-haired lady at your side has eaten over fifty thousand meals with you.
From Our Town by Thornton Wilder

From our marriage came the most wonderful pieces of my life, three children.  Two girls and a boy, they are still young, married and are working hard to make their way in this world.  And yet they are no longer here most of the time and my wife and I have only smaller roles in their lives. 

There are no free passes in life and if I ever had one, it was revoked when the neurologist at the University of Washington told me I had Parkinson’s disease.  I had no clear idea of what living with a chronic degenerative disease would be like. Even less clear were what changes  mentally and physically that would come to roost and never leave.

I was about to learn what it is like to take prescription drugs daily for a long time.  I was about feel what it is like personally to balance intended drug effects with unintended effects or side effects.  I was about understand what all of my pharmacy customers already understood.  Taking drugs on the long term is an arduous, and difficult task that requires much effort and expense.

And yet there is reason to hope, given the scientific advances with Parkinson’s. The list of medications available to treat PD since I entered pharmacy in the 1970’s has risen sharply and is worth noting. Startling success has been achieved with DBS or deep brain surgery.  A story came across the internet this past week about a young woman with early onset Parkinson's who has recently ran a full marathon after receiving the surgery.  Not a cure but a procedure that can provide relief for many and often for a long time.  Still it is not a procedure to be taken lightly and does not cure while it apparently does a very good job of treating some of the symptoms.

In that Fall of 1970 I would rush back to our tiny apartment somewhere between my early classes.  I unlocked the door and Tuco would come bounding out bursting with Labrador strength.  With Frisbee in hand I stepped out to the park and dog and I would start our game.  With a quick flip of my wrist I could send a Frisbee straight and true halfway across the park.  It finished with a hover and was plucked from the air in perfect timing by a leaping 2 year old Lab. a crowd of students soon gathered and clapped and cheered every catch. Those days were a true gift followed by many more.  Now, long after Tuco has gone. It is my turn to retrieve the Frisbees thrown my way by God.  Both the good and bad.

Encounters Along The Spit

Do what you can, with what you have, where you are.
Theodore Roosevelt

 I went fishing this afternoon with my brother in law on this windy, blustery day in late September.  The kind of day that has you pulling your hood up and tightening its' drawstrings to keep the chilly wind from stiffening your neck and beating merciless at your ears.  The kind of day that signals a change in the salmon fishing, drawing the furtive Coho salmon into Puget Sound from the Pacific.

The weather looked as if it might be ready to moderate a bit,  so I picked out my spot among the other fishermen who were casting their lines out from the shoreline and I began the familiar rhythm of casting and retrieving a curious lure called a buzz bomb. The wind was blowing in toward us and I had to cast almost directly into it.  I did not get far with these casts which wanted to trail almost horizontal to the white capped waves being driven in toward shoreline.  "Darn, This isn’t going to work"  I thought.  And yet after just a few feet of retrieval I actually felt powerful  live action at the end of my line.

Salmon fishing on Keystone spit.  Whidbey Island September 2014

It was clear to me and maybe to the fish as well from the beginning that both the fish and I had a fight ahead.  I was held up a bit by my tremors that were magnified by the resistance and action of the rod and reel.  The salmon was held up by a barbless hook stuck in his lip.  I tried to set the hook and reeled line in with my left hand which resisted the power of the fish in a kind of jerky movement as if it were a broken gear.

The fish reversed course and began taking line out with a powerful stream as he made a frantic dash out toward open water.  I braced the rod against my stomach and held on with both hands which now began to rapidly shake and weaken against the strength of the fish.  He put on a show of power and beauty as he turned and jumped, trying to shake the hook loose.  His beautiful and nearly vertical jump had put his silver sides on display, identifying him as a Coho.  He swam toward me and I frantically reeled line in. I got another glimpse of the fish as he rolled near the surface and then began another strong dash away from me. I should have known that I had to let the "big boy" run this time, but I was impatient and tried to match strength of line and rod against him.  I should have known that reeling and trying bring the fish in against such power, stretches, twists and weakens the line.   Again He swam in toward me and I picked up the slack line as best I could and in spite of my mistakes I still had him. As time passed my arms weakened I was beginning to believe that it was a fight I was certain to lose.

Help and encouragement came from fishermen along the shore.  A guy positioned his net for me to use should the fight reach that point.  Someone yelled for me to slowly walk back up the shore and I did, which brought the fish ever closer to the rocky beach.  But dang, just as he reached shoreline he must of got a glimpse of me, the enemy.  He rolled once more, spit out the barbless hook and then was gone to return to the depths of Puget Sound. 

The battle of the salmon was finished for now and left me feeling more than a bit depleted. I returned to casting and retrieving my line, still savoring the powerful battle I just had the privilege of taking part in.

After many more casts, I had begun to think about going home when a curious man walked up to me and placed himself right in front of my face.  I noticed the abnormal and rather constant movement of his head which was in a kind of syncope with his hands, which told me more than a bit about a different kind of battle apart from salmon he had been waging for some time.  He said that he was looking for some fishing equipment he had lost somehow that morning and we talked briefly about fishing for salmon and then he paused, looked at my hands and was rather direct when he asked me if I had Parkinson's.  "Yes", I admitted.  Then he shared that he was diagnosed in 1995 and that for him it has gone very well.  "I rode my motorcycle until just a few years ago and for many years I gave "inspirational talks to various groups" he said.  It is more difficult now, "I have problems with aspiration pneumonia" he continued.  He went to explain the problem he has with pooling saliva running into his lungs as he sleeps. Before he left he wrote out his name, address and phone number on a small note sized piece of paper and finished our conversation by handing it to me and saying "call me anytime, even if you just need to talk."

Was this a coincidence?  Maybe.  But then again, maybe not.

Shaky in Coupeville

  

The Winds of Change Are With Us

Come gather 'round people

Wedding Day 1977

Wherever you roam

And admit that the waters

Around you have grown

Bob Dylan

There are periods of life when things appear to be finished.  I feel like the last new era has dawned and is destined to go on forever. I think to myself, my time has finally arrived and "this is it!"

There was the 70's.  A period of time when the college years were left behind and I moved into the era of youthful early career.  I was one of the "fair haired boys full of dreams and promise."  I thought to myself "Hey, it is always going to be this way, isn't it?"  

The 80's approached and I found love and there was a wedding and babies.  I would always be a young father and "why wouldn't I think that?" 

I ushered in the 90's and the pace picked up.  The kids were in school and I had a home to keep up.  And oh yes there were bills to pay.  I thought, "now this is the real stage of life that will not end." Of course it ended and the truth that  I was beginning to see was that each stage simply moves faster than the last. Each bringing things I never thought possible in the previous one. 

Now I am older and find myself in a late stage of life among the silver eagles.  I ask myself, "How did I ever become a 65 year old man with Parkinson's?"  There is no answer to that question, so I decide it best to leave it behind and move ahead.  Parkinson's is a disease that has threatened to take away from life as it moves ahead at its insidious pace.

I want this to be a message of hope and I believe that the "Times They Are a Changin".  These changes are being ushered in by fair winds that promise to help many.  Medicine is moving alongside Parkinson's at a pace not dreamed of just a few years back.  Browse the links I have included and I hope you, as I have, will find encouragement.  These are links to only a small sample of an explosion of new information being discovered about Parkinson's and shared instantly by way of the personal computer.

And accept it that soon
You'll be drenched to the bone.
If your time to you
Is worth savin'
Then you better start swimmin'
Or you'll sink like a stone
For the times they are a-changin'.

Come writers and critics                     

Who prophesize with your pen

And keep your eyes wide

The chance won't come again

Don't speak too soon
For the wheel's still in spin
And there's no tellin' who
That it's namin'

Read more: Bob Dylan - The Times They Are A-changin' Lyrics | MetroLyrics 

From Bob Dylan "The Times They Are A-changin"

Still Shaky in Coupeville

Parkinson's Vaccine Looks Promising

Phase 1 trials in this Fox foundation funded study were intended to ramp up the body's own defenses against the damaging effects of alpha synuclein.

Deep Brain Stimulation Improves Survival in Severe Parkinson's Disease

Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to improve motor function, motor fluctuations, health-related quality of life, and to reduce medication usage and drug-induced dyskinesia in patients with severe PD refractory to medical therapy.

Intel Explores Wearable Devices for Parkinson's Disease Research

Intel Corp plans to use wearable gadgets such as smart watches to monitor patients with Parkinson's disease and collect data that can be shared with researchers.

One-Two Punch for Parkinson's

Researchers from the Florida campus of the Scripps Institute have found a dual-inhibitor compound expected to counter Parkinson's in 2 separate ways simultaneously. 

Bee Venom Acupuncture shows promise in Parkinson's

Both acupuncture and bee venom acupuncture showed promising results in improving symptoms among patients with Parkinson's disease in a small new study.

Regular brisk walking helps Parkinson's patients make strides
Regular brisk walking may improve motor function, mood, tiredness, and fitness in patients with mild-to-moderate Parkinson's disease, a new study suggests.

Mowing and thinking

I cranked up the engine of the old church lawn tractor, shoved it in gear and pulled away from the storage shed.  I usually ask myself about this time, "Why do I do this?"  I don't really know why, but I feel better by donating a couple of hours a week to the church across the summer months.  The high engine noise  produced by the lawn tractor combined with a noise dampening headset pretty much closes the rest of the world off and I think of many things.

I continue to be bothered by the death of Robin Williams.  The comedic genius took his own life last week and now with sadness we must say goodbye to an immense talent of my generation.  Worse, It was made known that he had suffered with substance abuse, bipolar disorder, probably depression and finally Parkinson's.

Depression.  A word that came up when Robin William's wife revealed that he had recently been diagnosed with Parkinson's.  Depression is linked with Parkinson's biochemically and the same pathways that produce dopamine are also associated with the production of serotonin. Serotonin is a chemical that is known to be essential to the maintenance of mood and prevention of depression.  The Fox Foundation has stated that in many people depression may precede Parkinson's movement symptoms for as long as 10 years.

I turned the tractor while fighting the very stiff steering of the old lawn tractor and started up the mowing line again. Depression is linked with suicide.  It is very important to know that it is something an individual cannot simply turn on or off.  Drug treatment can be helpful and may work along side Parkinson's meds.  I personally had to overcome a large bias against drug treatment it in order to say this.  For a long time I had thought that the drugs for depression were simply overused.  

The sun and summer warmth that accompanies it began to beat down on me and I broke out in a sweat as I jounced along, still mowing.  Identifying and treating depression should be a high priority in Parkinson's management.   The probing questions have come up for me in the neurologist's office and also in each of the research studies I participate in. These questions are aimed at identifying a pattern of down turned mood that has lasted without relief for at least two weeks.  

I made another turn with the tractor and this time was greeted by a breeze that pushed dust and clippings back on my face.  I thought of a difficult period in my life when I was still working when my wife was out of town and I felt isolated.Without her. I was clearly in danger of stumbling while feeling weighted down with many issues of my life.  I went for a walk and somewhere along the trail I began to think of suicide as a way out.  The seriousness of what I was thinking about shocked and troubled me when I thought of how many that might hurt.  I am thankful  that I was able to put the thoughts aside.

Robin Williams co starred with Robert De Niro in one of my favorite movies, Awakenings. The 1990 movie was based on the work of Dr. Oliver Sacks.  Dr. Sacks used L Dopa or dopamine in the 1960s to treat victims of encephalitis lethargica(A tragic group of patients from a 1917-1928 epidemic).  A condition that may result in a coma like, catatonic state that also may create Parkinson's related symptoms and can respond to dopamine for short periods of time. 

I finished my last round of mowing and I wheeled the mower in front of the storage shed where I fuel and prepare it for next weeks work.  I glanced up at the parking lot and could see Carolyn's image in the truck as she waits for me.  What would I do without her?  The drugs and tremors keep me away from driving and so she waits.

Shaky

Hands On Parkinson's

With Madeline on our way to Port Townsend

Introduction

When I started down the Parkinson's disease pathway just a few short years ago I had little knowledge of what was in front of me. I sampled a few things which were outside of conventional medical/drug therapy and quickly gave up on them, either due to a lack of will or lack of desire to commit money to the process.  One of the earliest of these attempts was massage.  In this blog I describe what happened when I sampled massage again several years later with different expectations and a different level of commitment.

Massage

The lights of the massage room had been dimmed to provide a soft and comforting environment.  The feel was completed with new age music playing softly in the background.  The massage therapist knew that I had been here for a massage once prior several years ago and then without explanation did not return. He looked up from his folder, that he had been reviewing since I had entered the room.  He now asked me why I had returned after such a lengthy period.  I shared that I had an extremely sore shoulder that had been with me for several months and that I hoped that just maybe massage might help that.  I added also that I hoped that I might also get some relief from my Parkinson's tremors since things were worse now than just a few years ago.  I find myself having followed the path of taking more drugs than I would really desire and wonder whether massage could least slow that process.  I failed to add another reason that ranked among things that were important, that is that my wife really believes that massage might help and that I had not given it a fair chance.  He said little that I can remember but wrote something down in his notes and closed his folder.  He told me where I could put my clothes, explained how to lay on the massage table and exited the room.  I removed my clothes as instructed and shakily climbed up on the massage table and covered myself with a flannel sheet.  Lying faced down just myself and the new age music in the background I tried to relax and waited for his return.

He did return in a few minutes and noticing my fluttering and tremoring hands went to work on them.  He explained that by stimulating accupuncture pressure points along the way as he massaged the large muscles he might have some impact on nervous outflow which in turn should relieve the tremors.  He continued massaging the major muscle groups while occasionally pressing hard on accupuncture points until it was a little bit uncomfortable but at some point he at least slowed the tremors.  Then he spent extra effort on my sore shoulder, massaging it deeply and rotating the arm itself.  I experienced some discomfort in this but I did not complain.  He ended with my feet and pressed deeply in the arches and pulled them until I could feel a stretching in my back. After nearly an hour he declared the session over and returned after I had dressed.  I told him that I felt well and perhaps even good but silently I had no illusions about lasting relief for either the shoulder or or my tremors.  The tremors had stopped during the course of the massage but were already reappearing like weeds that stubbornly return after being pulled.

I returned at two week intervals for a couple of months and have continued that up to the present time.  At each appointment the massage therapist asks how I have felt in the previous weeks at home.  He makes notes in his folder after my response and begins the massage with some adjustments to what he does.  It took multiple visits to achieve a state of muscular and mental relaxation that was significant enough to have an impact on my sore shoulder and my tremors, but it did come.  As the weeks passed the therapist spent extended time massaging tightened muscles in my chest, back and neck.  The excruciating sore shoulder was now minimally sore. With time and multiple visits I found that I could achieve  the kind of relaxation via massage that not unlike sleep, suspends the tremors completely for short periods of time.  My wife believes that the muscular relaxation has improved my posture as well. I could add that I also believe that it enhances the effectiveness of my medication.  For these things and for even a short period of time when I feel free from tremors, the massage at $60 is worth it.

  Now when each session is finished I feel completely relaxed as I get dressed.  I comfortably walk out to the front desk and write a check for the massage with handwriting that looks as good as that on checks I wrote some years ago.  Some tremor returns by the time I reach the truck but as I ride home I cannot deny that I feel good and the tremors at least for a short period are not significant. 

Shaky