AOPA Turbine Pilot Magazine - August 2017 - 26

FLY WELL

Sparring with Parkinson's

BY DR. JONATHAN M. SACKIER

The disease that affected Muhammad Ali
MUHAMMAD ALI WAS G.O.A.T.: "Greatest Of All Time"
in the boxing ring. Privileged to meet the late fighter, I
found him wickedly funny and dealing with Parkinson's
disease gracefully and courageously.
Dr. James Parkinson described the "shaking palsy"
in 1817, and French neurologist Jean Charcot further
characterized the disease, naming it for his British predecessor. In the 1960s the cause was identified: a brain area,
the substantia nigra (Latin for "black stuff"), contains
dark nerve cells that release a chemical called dopamine.
In Parkinson's these cells disappear, so replacing missing
dopamine has become a mainstay of therapy.
Affecting one in 300 people, and the fourteenth
leading cause of death, Parkinson's risk factors include
aging and environmental insults such as pesticides,
which interfere with dopamine production. Genetics

Accepting a Parkinson's diagnosis may induce
denial and anger, among other emotions. But with
treatment and support, life proceeds.

DR. JONATHAN SACKIER

answers members'
medical questions
through the AOPA
Pilot Protection
Services program
(www.aopa.org/
pps).

26 | AOPA PILOT August 2017

and repetitive head and neck trauma are factors, and
men are at higher risk-possibly because of the higher
propensity to engage in risky endeavors; estrogen is
protective, and causative genes are sex-linked.
The bout begins with tremors, initially in the lips,
tongue, feet, or a finger, then hand or entire arm when
at rest or held stiffly and not supported. Movement and
speech become slow and problematic, muscles stiffen
and become unresponsive, the face becomes mask-like.
Smaller writing (micrographia) is common; depression,
difficulty digesting, balancing, and maintaining body
temperature and blood pressure complete the slow,
progressive picture. Although not inherently fatal, the
knockout comes from conditions such as pneumonia
caused by immobility.
If your opponent might be Parkinson's, don your
gloves and enter the ring with the neurologist in your
corner. At the weigh-in, diagnosis is largely based on
clinical presentation, although natural aging can deliver
a split decision and mimic Parkinson's. Doctors can test
for a poor sense of smell, characteristic of Parkinson's
disease. As Parkinson's affects involuntary functions,
testing breathing, heart rate, and reflexes can be helpful.
Saliva samples are used to identify genetic mutations
that might help afflicted families. Brain imaging after

injecting a chemical that attaches to dopamine cells is
then seen with a single-photon emission computerized
tomography (SPECT) scan.
Occupational and speech therapy and lifestyle
changes help. Many are improved by medications
such as levodopa, which is converted to dopamine
in the brain. Segeline stops enzymes, which degrade
dopamine, and a range of anticholinergic drugs regulate muscle movement. Botulinum toxin can help
control tremors. Some patients are drug-resistant and
are candidates for deep-brain stimulation, whereby a
brain electrode is implanted and connected to a pulse
generator hidden under the chest skin. Although not
without risk, the effects can be dramatic.
Although common, "alternative" therapies such as
acupuncture and massage therapy have not been critically studied. One herb, St. John's Wort, effectively
treats depression and insomnia-and fava beans, consumed whole, increase dopamine levels. Research into
new drugs, other brain-stimulation methods, or stemcell therapies holds promise for the future.
Accepting a Parkinson's diagnosis may induce denial
and anger, among other emotions, so some patients may
avoid their doctor, fail to take medication, or not inform
their aviation medical examiner. This is not a wise course
of action, because with treatment and support, life proceeds. AOPA and the AME can help you with medical
certification. The FAA can grant a special issuance authorization if symptoms are well controlled on allowed
medications; currently, the only such medications are
those with the active ingredients carbidopa/levodopa.
Pilots are certificated annually and asked to provide a
status report from treating physicians each year for continued certification. For pilots flying under BasicMed,
Parkinson's disease is not one of the 11 conditions that
require a one-time special issuance medical certificate.
Ali's humorous ripostes were as admired as his athleticism, although it is tragic that the sport that made
him an international figure may have also pinned him
against the ropes. One of his quotes is so appropriate
here: "I done wrestled with an alligator. Tussled with
a whale. I done handcuffed lightning, threw thunder in
jail. I murdered a stone, I hospitalized a brick, I'm so
mean I make medicine sick."
If Parkinson's is of possible concern, get to a doctor
soon and try to knock out this opponent as early in the
fight as possible.
AOPA

http://www.aopa.org/pps

AOPA Turbine Pilot Magazine - August 2017

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