Personal Parkinson's

DBS for Parkinson's - Play it again Sam

The neurosurgeon confidently walked into the exam room where Carolyn and I sat.  He introduced himself and he was very personable and quite enthusiastic about my forthcoming DBS (Deep Brain Stimulation) surgery.  I was very impressed by him and after only a brief talk I was ready to pack my bags and go where he was going.  He used an analogy in which he compared Parkinson’s to a dense fog which begins slowly and then closes in around you making it impossible to see or think of anything else. He said he had found that DBS surgery could push the fog back so that at least for a period of time there can be remarkable relief of the motor symptoms of Parkinson’s.  The tiny tip of the leads act similar to a pacemaker which controls the abnormal movement generated deep within the brain by Parkinson’s. He brought us back down to earth when he shared the side effects or how things can also go  awry.  Side effects, though not frequent, are very real.

The surgery scheduled for the next day appeared to be straight forward and the surgeon was very confident that my combination of “Tremor Predominate” Parkinson’s and youthful demeanor would add up to a successful procedure. He had told us to expect two sided lead placement, one for each side of the brain.  I would be awake and sedated for at much of the procedure and would be requested to give the right sided "go" permission after placement of the left lead was complete.

After a partial night’s sleep I got up the next morning, a bit groggy and believed that I was ready to go. My preparation had included nothing to eat or drink since the prior evening and no meds. The surgeon had been precise and accurate in his depiction of how things were to proceed but as he knew there is an endless number of ways people can react to surgery. After the first side lead placement the surgery was suddenly stopped.

I recalled being responsive to his request for my desire to proceed and at the same time battling for a chance to breathe.  The battle for respiration seemed to go on a long period of time but  it may have been only the briefest moment.  A dangerous drop in the saturated oxygen in the blood stream had occurred.  The surgeon made a command decision to stop the surgery immediately and he swiftly closed the incision he had made for placing the right side leads.  I was taken for a routine CT  scan. I also had a precautionary chest x-ray and I was now was wheeled to recovery where I would remain until the sedation drugs worked their way out of my system.

The surgeon stopped by and peered into my bed while I was in recovery and gave me enough information so that I would know that the surgery not gone perfectly and had been cut short. He would see me later.

I was returned to the neurologic ICU as do all DBS patients for a mandatory, one night stay.  It was here that I had an emotional and teary reunion when when wife Carolyn and daughter Claire also joined me.  I was uncomfortable and did not feel like moving as the hours began to tick away.   It came over me in a haunting manner again and again that somehow I had failed and now I faced a more complex pathway out.

The surgeon returned that afternoon and gave me the options, one of which included a second surgery to place the right sided lead.  Another might be to program the left sided lead and then to see how that does by itself.  In a bit of a post op fog I hung on to the disappointment of the earlier part of the day.  He then carefully examined both tremoring arms and was delighted with the strong “honeymoon” effect I was getting in my right hand.  The honeymoon effect is a calming of tremors caused inexplicably by simply moving a lead or leads into place.   This indicated nearly perfect location of the left side lead.  I still remained somber but these small but important details began to reveal that many things had gone right.

Through the night I dozed a few hours at a stretch between pain pills.  I was released the following day, tired, exhausted and desired not to think about DBS surgery for the time being.  It seemed that a second surgery existed out there beyond the mile marker and like a shark ready to pounce, it was a danger I wished not to think about.

At the same time I have been fortunate enough to to have been given a resilient frame of mind all of my life.  Now it is one week after the surgery and I am beginning to believe that with God’s help I can manage to endure a second surgery to place the other lead.  I can then focus on the fun stuff such as programming the controller to take over and do its job.  It can then be entered into the battle against Parkinson's.  The incredibly fine staff at the neuro science center have already made calls exploring options with me for a second surgery and a date has been set (April 29).  They have not forgotten me, rather they are systematically putting things together.

I like that feeling and soon enough I think that I will be ready once more to pack my bags and jump aboard the same train the surgeon is on and pray that the one who counts is guiding the way.

To be continued!

Still Shaky in Coupeville

Countdown to Surgery

The big and powerful 737 was running  East  when the pilot banked it and turned sharply amidst turbulence over the Atlantic.  Turbulence that was strong enough to bounce us around as we made the turn, making me feel uneasy.  Carolyn reached for my hand and squeezed gently signaling that if this be the end I am with you and then closed her eyes and communicated she was ready to a much higher authority.  Once the maneuver was complete, we had reversed directions and were in line for our Eastern approach to Fort Lauderdale International airport.  The plane lost altitude rapidly and touched down with powerful bumps that had me wondering how long a set of tires might last on this thing.  The rocky touch down may have signaled a rapid rate of descent and approach but the pilot was in control and followed it up with powerful reverse thrust and braking to slow the silver bird.  Slowing with a force so powerful that we would have slammed into the seats directly ahead of us had we not been securely belted in.  Now after all of this, we were finally ready for a more peaceful taxi to the airport gate.

Carolyn and I strode off the plane and into hustle of the Fort Lauderdale airport several thousand miles from home.   It felt like we were in a whole new world where clear blue sky and warmth were common events in the midst of winter.  We were prepared to spend the next couple of weeks here in Hollywood, Florida at our eldest daughter and son in law's home.  Our intent was to have some quality time with grand kids, take long walks on the beach and rest up for deep brain stimulation 
surgery.  Add to that the joy of Cuban coffee, a good beer now and then and I feel rested right now just thinking about the days in front of us.  After all, in the weeks ahead looms a momentous step: Deep Brain Stimulation Surgery.

Though our trip had been planned many months in advance and the steps toward DBS had similarly begun many months ago the events that scheduled them back to back with a Florida trip fell in place last week.  After last week's appointment with my neurologist we agreed to move ahead with surgery. I had placed a call to the DBS surgical center at Swedish Hospital and told them that I was ready.  With this call the wheels of what seemed like a massive freight train began to turn, picking up speed with each passing day.

Thursday late afternoon I was called back by their scheduling clerk and real times and dates were agreed upon:

2/26 Thursday 2015

Final fasting blood work and physical exam. Which means, no liquids or food after midnight.  Same day1230: MRI brain scan. An image to look for excessive brain shrinkage which could allow movement of my brain and complicate placement of the wire leads.  The image also would provide the surgeon with a map for guidance to subsequent placement of the leads into the deepest part of my brain.

3/03 Tuesday
DBS

3/03-3/04 Tuesday and Wednesday 
Observation in ICU for one night and then hopefully home to sweet Whidbey Island.

3/11 Wednesday 
Back to Swedish for outpatient surgery for placement of controller and batteries directly in my chest wall somewhere beneath the clavicle or collar bone.

For the time being still Shaky in Coupeville

Preparing for Deep Brain Surgery at The Swedish Neuroscience Institute

We sat waiting patiently while my Parkinson's doctor, a neurologist and movement disorder specialist reviewed the results of my tests that had been ordered and completed as a part of the requirements leading up to Deep brain surgery or DBS.  DBS is the surgical process where wire leads are threaded through the skull and then are placed deep, to nearly the center of the brain.  Once turned on the stimulation provided at the end of the leads provides a blocking action on cellular output from the targeted area and can have a remarkable effect on certain Parkinson's symptoms.  The tests I have been undergoing are required to rule out existing conditions that are contraindicated by DBS.  Primarily we are speaking of dementia and "poor response to drug therapy"  The doctor had these results assembled in a folder including: cognitive and memory tests,  my off of drugs movement testing, my on drug movement testing.  She also had the conclusions drawn from each of these tests by those who had worked with me when they were given.  I already knew that each of these professionals had advanced a green light for surgery.  Now my neurologist was ready to share her conclusions with my wife, Carolyn and Myself.  Her recommendation would be based on their notes, and those of  her own and others from nearly 5 years of my being seen for symptoms of Parkinson's and now approaching 4 years after diagnosis.

Carolyn and I have a very high regard for my neurologist and we believed that she had not only applied her considerable expertise to my care, additionally she also honestly cared about me.  Both of us were ready to put a lot of confidence in the conclusions she had arrived at and what she might say.  She started with, "I still believe that you are an excellent candidate for DBS."  No surprise, this was an opinion she had been repeating since nearly the beginning.  It was much more impactful now that I stood on the threshold of having such surgery.  She let that soak in for a minute or so and then went on to discuss what we might or might not expect from the surgery.  The effect of surgery is primarily on the motor or movement symptoms of Parkinson's.  I have a variant of Parkinson's known as "tremor predominate" which means that my primary symptom of tremors could be expected to respond well to deep brain stimulation.  The underlying cause of Parkinson's and other symptoms of the disease itself will continue.  She went on to say that "you may expect the surgery results to be as good as your best "on" drug therapy."  In other words at full drug dose and when the disease is responding optimally to drugs, it is similar to DBS surgery results.  The difference is that I could take fewer drugs and would not be as heavily burdened by the side effects of drug therapy. The roller coaster of drug therapy can be effectively smoothed since DBS stimulation is active and operating all the time, 24/7.  Unfortunately some drug therapy usually remains after surgery but the quantity is likely reduced and occasionally may be eliminated.

It became time for questions and I quizzed her "I am doing pretty well with drug treatment and I have read that tremor predominant Parkinson's often moves slowly.  So why would I want to undertake such a major procedure?"  She explained that in observing me for the past several years and seeing my drug list grow that she could not say my disease was slow moving.  She went on to say that she had some patients who were progressing more slowly and some who were progressing more rapidly.  I was average and at this rate I could expect significant disability within 5 years.  Her intent I do not believe was to frighten me but to put me in touch with reality.  The truth is that Parkinson's is a relentless disease from which there are no remissions.

We finished with discussing which receptor site in the center of my brain would best be targeted for the goals I have with the surgery.  The neuro surgeon at the Swedish Neuro Science Institute in Seattle, would place the stimulator leads in one of two sites.  The process must be done twice.  Once for each side of the brain since both sides of my body are affected.  knowing that I desired very much to reduce drugs as much as is possible she suggested that the surgeon be instructed to place the lead in an area called STN or sub thalamic nucleus.  At this location excellent results have been achieved after surgery with drug reduction.

Though she is not a surgeon, many details related to surgery and the post operative tuning of the implanted leads are all under my neurologists care.  Amazingly she is even willing to alter her schedule to assure her availability for follow up or for tuning appointments. It does take several months of tuning the output of the stimulator to achieve optimum results.

After returning home, I placed a call to the nurse practitioner at Swedish, simply stating that I want to move ahead with surgery.  She called back the following day and sounded delighted with our decision.  She reinforced that my youthfulness and excellent overall health profile helped boost my status as an excellent candidate for the surgery.  Final scheduling of the surgery will depend on the surgeon and the staff at Swedish Neuro Science institute.  I am expecting an early or late March date.

Still Shaky in Coupeville

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