Parkinson’s learning module aims to enhance nursing care

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Parkinson Canada has just launched its latest online learning module, especially designed to help nurses learn how to assist patients in managing their Parkinson’s symptoms at every stage of the disease. We encourage people living with Parkinson’s and their care partners to share this news with their health care team, especially nurses at their family doctor’s office, in long-term care facilities or at movement disorder clinics.

“Parkinson’s is a complex neurological disease and is best treated by a team of health care professionals,” says Grace Ferrari, Senior Manager, Education & Support, for Parkinson Canada.  “Nurses have a great deal of interaction with patients, so they can offer meaningful tips on managing medication and the symptoms of Parkinson’s disease to get the best results,  reduce the impact of any side effects, and improve quality of life.”

The module Parkinson’s Disease: From Diagnosis to Advanced Stage Disease is accredited* by the Continuing Nursing Professional Education (CNPE) office in the Ingram School of Nursing at McGill University and focuses on nursing care strategies for all stages of Parkinson’s. In the early stage, nurses should be aware of the priorities at the time of diagnosis. As the disease progresses, symptoms have an increasing impact and nurses need to be able to make a clinical assessment of non-motor symptoms, motor fluctuations and medication timing.

Case scenarios highlight the changing role of the nurse in the ongoing care of a Parkinson’s patient with a focus on cognitive impairment and the involvement of the interdisciplinary team in creating a comprehensive treatment plan.

After completing the module, nurses will be able to:

  • Identify and understand the clinical symptoms of Parkinson’s disease
  • Conduct appropriate nursing assessments and interventions
  • Apply theory to clinical practice and understand and appreciate how the nurse’s role complements the interdisciplinary care team
  • And, neuroscience nurses will be able to build capacity for comprehensive inter-professional care in the treatment of Parkinson’s disease.

Two of the module’s developers from the Montreal Neurological Institute Lucie Lachance RN, MSc., Clinical Nurse Specialist and Jennifer Doran, BN, CNN(C), Nurse Clinician,  delivered much of the module’s content for a Parkinson Canada workshop at the 2015 Canadian Association of Neuroscience Nurses conference. Positive reaction to the workshop confirmed the demand for more training and led to the development of a Parkinson Canada online learning module for all nurses.

“This learning opportunity definitely fills a knowledge gap in nursing, especially among nurses who are not working in neurology,” says Gigi van den Hoef, RN, nursing consultant and a member of Parkinson Canada’s Medical Advisory Committee. “And with the aging population, and the increasing incidence of the disease, more nurses are going to be caring for patients with Parkinson’s.”

Simply learning the language of Parkinson’s can be daunting for patients and their families, says van den Hoef: dystonia, rigidity, dyskinesia. Nurses have a role to play as educators and in helping patients navigate their new reality of living with Parkinson’s.

Gigi van den Hoef will be helping to get the word out to nursing organizations across the country. “The bottom line is that we want to help enhance nursing care for all Canadians living with Parkinson’s,” she says.

Nurses can register for the online learning module by completing the online registration form. The fee of $40 includes the cost of issuing a certificate and provides funds to develop other Parkinson Canada education resources and to fund research.

* Accreditation of the learning module
This event meets the criteria for accreditation established by the Continuing Nursing Professional Education (CNPE) office in the Ingram School of Nursing at McGill University and is approved for a maximum of 2 hours of accredited continuing professional education. The CNPE office is endorsed by the Continuing Professional Development (CPD) office in the Faculty of Medicine.

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Bringing the brain back to a healthy balance

Dr. Natasha Radhu
Dr. Natasha Radhu

Increasingly, scientists studying the brain believe one of the reasons abnormalities and diseases develop is the result of an imbalance in two types of circuits, or processes, which regulate the flow of information among brain cells.

At the Toronto Western Research Institute, neurophysiologist Natasha Radhu uses Transcranial Magnetic Stimulation (TMS) to study those two processes – the brain’s excitatory and inhibitory circuits. She investigates whether an imbalance in the circuits in the motor cortex, the section of the brain that governs movement, is connected to Parkinson’s disease. Radhu has recently been awarded a Porridge for Parkinson’s (Toronto) Basic Research Fellowship of $80,000 over two years from Parkinson Canada Research Program to pursue this research.

TMS involves using a magnetic coil to generate an electrical pulse that stimulates brain cells. Radhu and her colleagues position the coil over the motor cortex in the brain of people with Parkinson’s disease. The pulses cause the muscles of the person they are studying to twitch – twitches the researchers measure. By exciting or inhibiting the muscle twitches, the researchers can indirectly measure the excitatory and inhibitory circuits in the brain. She’s comparing the measurements from the people with Parkinson’s to those of people without the disease.

“It’s a balance of these two (circuits) which indicate healthy brain functioning,” Radhu says.

Radhu measures the degree of movement that occurs in people with Parkinson’s when TMS stimulates their motor cortex while they are on levodopa medication, and when they are off it. She’s testing her theory that when people are off medication, and experience tremors, stiffness, or freezing of gait, she will see increased activity in the excitatory circuits in the brain. At the same time, the inhibitory circuits that stop or calm the flow of information to brain cells will be less active.

Radhu believes her work will demonstrate that when the two circuits are not balanced, people with Parkinson’s disease can’t calm the rapid signals to the area of the brain that directs movement.

By studying the way levodopa affects and changes the brain, Radhu hopes to see how effective the medication is and whether it improves symptoms. She also hopes this measurement of brain activity could eventually diagnose Parkinson’s disease.

“If we’re able to say that certain medications can restore these calming mechanisms and bring the brain back to its healthy balance, we could recommend using these medications more,” she says.

Watch our interview with Dr. Radhu and read about other researchers recently funded by the Parkinson Canada Research Program.

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Everyone wins with Parkinson SuperWalk

Lorne Collis, cheering
Lorne Collis, cheering.

We know that most people take part in Parkinson SuperWalk, because they, or someone they care about, is living with Parkinson’s disease. The friends, neighbours, and colleagues of walkers, help out by making pledges to those who walk. Walkers and donors all become Everyday Heroes for those living with Parkinson’s, who are inspired by the contributions of people in their communities and the hope for a cure.

In keeping with our Everyday Heroes. Extraordinary Hope theme we’re again offering our Everyday Heroes contest as part of Parkinson SuperWalk. This year, we’re also naming a ‘National Hero.’ The person you nominate has a chance to lead their local walk as our Parkinson SuperWalk National Hero for 2016! We’re excited to bestow this title and honour on one of our Everyday Heroes for the first time this year. Visit the Everyday Hero contest entry page, share the name of your Everyday Hero, and one sentence about why they are your Everyday Hero. Nominate your inspiration today.

As an added incentive to enter the contest, nominators have the chance to win one of four weekly and one grand prize, provided by our contest sponsor Otago RealLifeFood. Entries will be randomly drawn for a weekly prize of three nutritious, chef-prepared, meals for two for a day and a grand prize of an entire week of dinners for two.

Continuing our Everyday Heroes. Extraordinary Hope theme, our national sponsor Burnbrae Farms is offering a $250 gift basket as the prize for the Eggstraordinary Hope contest. You can enter by completing the form found here or liking a contest post on Parkinson SuperWalk or Burnbrae Farms Facebook pages until August 1.

And finally, congratulations to Lorne Collis of Brampton, Ontario, who won a $500 Roots gift card in our Super Friendraiser draw by sending 156 emails requesting support for his Parkinson SuperWalk efforts through the online participant centre.

We’re grateful to each of our sponsors who have made it possible for us to offer these three meaningful opportunities to win. We know that all of our participants have their own Everyday Heroes that motivate them to walk, and to support Parkinson SuperWalk. We look forward to reading about your own Everyday Hero in our contest and to hearing your stories in person this September.

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World Parkinson Congress 2016

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A packed schedule of scientific presentations, workshops, plenary sessions, roundtables, discussions and posters, as well as unmatched opportunities to network and socialize with the international Parkinson Community, the World Parkinson Congress 2016 (WPC 2016) is an event you’ll never forget. WPC 2016 will be held in Portland, Oregon from September 20 to 23.

Canada is well represented by a number of speakers, researchers, health professionals and people living with Parkinson’s and their care partners. Parkinson Canada is proud to sponsor the Stanley Fahn Young Investigator Award, to be presented for the first time at WPC 2016. Named after the WPC founder and world renowned Parkinsonologist, the award will be given to one outstanding abstract submitter whose work is deemed cutting edge, novel and shows great promise. The selected person will be invited to be part of the Hot Topics presenters to present their work and will receive an all-expenses-paid participation in WPC 2016.

WPC 2016 participants from Parkinson Canada will also be at booth 508 in the exhibition space. Come by for a visit. For all the details, and to register, visit www.wpc2016.org.

Presented by the World Parkinson Coalition, the World Parkinson Congress is the only global Parkinson’s conference that brings together the entire Parkinson’s community – people with Parkinson’s disease, those who care for them, medical and health professionals, and dedicated researchers working toward a cure and better treatments. Parkinson Canada is a proud member of the World Parkinson Coalition and Canadians regularly attend and participate in the World Parkinson Congress.

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Working through Parkinson’s

Beyond the obvious financial benefits of a paycheque, work enriches our lives in many ways. It give us a sense of purpose and participation in the wider world. It provides us with a social life with colleagues, many who become friends. It enables us to keep stretching our minds as we continue to learn. All of these benefits of work are perhaps even more precious to people who continue to work after a diagnosis of Parkinson’s disease.

While the majority of people are diagnosed close to retirement, many people, especially those with young-onset Parkinson’s disease (YOPD), are still in the prime of their working lives with families to support. Can they continue to work? For how long? Should they tell their employer? How will colleagues react? How will they and their employers adapt to their changing capabilities?

We spoke to five individuals living with Parkinson’s who are still working. Just as everyone’s Parkinson’s journey is different, so is everyone’s capacity to continue to work and the unique accommodations and adaptations that they and their employers make. Continue reading to learn about Miles, Jeannine, Wayne, Elaine and Chris’ personal journeys.

Miles Wilwand and Tanya September
Miles Wilwand and his wife Tanya September

Miles Wilwand

Diagnosed at 45, Miles Wilwand is now 50 and working at the main office of a public utility in Winnipeg. His diagnosis came soon after he landed a full-time job in the mailroom. It was a new working environment for him. He’d spent most of his working life as a meat cutter — a career he had to abandon following a hand injury. Today, at the utility he works in print services, a position that requires less walking than his previous one.

Miles shared his Parkinson’s diagnosis with his employer after about a year. “It was a huge weight off my shoulders,” he says.

Some of his colleagues were surprised when they learned he had Parkinson’s. Miles had always been so active, biking and running. And he was so young. A few of them knew a little more and would mention Muhammad Ali and Michael J. Fox.

Gradually, his mailroom position began to take its toll. His Parkinson’s affected his right arm and leg. He got constant injuries from his rigid muscles. But, his work delivering mail did mean he had contacts throughout the company. At one point he learned they were looking for someone in print services and he switched departments. He learned some new computer skills and earned a slight raise in pay.

“In some ways my earlier hand injury was a blessing in disguise. I can’t imagine I’d still be working if I was still in the meat packing business,” he says.

Over the years, Miles has made changes outside of work that keep him both physically and mentally in shape – and able to keep working. He is sure to take his medication on time, keeping his pill container on his keychain. He and his wife live in a condominium and he uses the on-site gym to keep active. He does stretches every morning and paces himself. He still walks and bikes and he just started taking a boxing class. And he is careful about what he eats.

Along with the steadfast support of his wife Tanya September, he cannot say enough about the importance of the Parkinson Canada YOPD support group he attends each month. “I learn things. I realize I am not alone. I feel blessed and thankful that we have this group in Winnipeg.”

Miles says his diagnosis was a scary moment in his life. His advice for others newly diagnosed: “Get off the couch. Get information. And find a support group.”

Jeannine Alain
Jeannine Alain

Jeannine Alain

When Jeannine Alain, convinced her husband Ted to move from Victoria to Saskatoon in 2014, the plan was to ease into retirement close to her sisters. She promised him they’d take a vacation each winter to somewhere warm. Parkinson’s was not part of the plan.

They spent the first six months renovating their home and Jeannine prepared to set up shop as an independent caregiver/companion to the elderly. She set up her business, took some first aid courses and started looking for clients. Ted also worked part-time. They were looking forward to semi-retired life in their new community.

A year after moving to Saskatchewan, at age 56, she received her diagnosis of Parkinson’s disease. She recalls her first visible symptom was a tremor in her left, index finger. It moved to two other fingers and then her left wrist. Fortunately her gait is not affected and medication helps relieve the tremors. She does have trouble sleeping.

“At first I was really down for a few weeks,” recalls Jeannine. “Then I joined a Parkinson’s exercise class and a local Parkinson Canada support group. Now, we all go out to lunch as a group and ‘shake together.'”

As an independent caregiver, Jeannine sets her own hours. She currently has about five clients and sees most of them on Tuesdays and Thursdays. On the other days she keeps active. She works on the house, practices mental visualization while walking 45 minutes three times a week, takes her Parkinson’s exercise class and a Tai Chi class. And takes care of her business.

She needs to renew her client base because as a caregiver to the elderly, her clients eventually die. “It’s the sad part of the work.” All of her clients and their families know she has Parkinson’s and that she is able to perform her duties. “It’s better and easier for me that they know.  I feel it makes me even more conscientious.”

This past winter Jeannine and Ted took a road trip to Washington, DC and then on to Florida and back. “It was great, but it took a lot out of me. It also made me wonder how much longer I’ll be able to enjoy such adventures,” she said tearfully.

It’s been just over a year since her diagnosis and for now Jeannine intends to continue her work helping others as long as she is able, and to keep active. She keeps informed about Parkinson’s research and treatment innovations and is hopeful about the future. Her advice to others is “to get out there. It’s tempting to hide away and become isolated. Stay active.”

Wayne Fiander
Wayne Fiander

Wayne Fiander

For 22 years Wayne Fiander, now 48, has been working full-time for the same printing firm in Hamilton, Ontario. For 13 of those years he has also been living with Parkinson’s disease. In the early years, he worked his way up to become the plant manager for the firm. Today, he operates a number of printing machines. He lives in nearby Thorold, in the Golden Horseshoe.

When he first noticed the tremor in his left hand 13 years ago, Wayne thought that maybe he’d damaged his ulnar nerve, and he’d try to hide his hand. Eventually, the tremor was too strong to hide. When he received his Parkinson’s diagnosis, he told his employer and took a three-month leave of absence. At the time, his two children were five and three years of age.

“It was lot to process. I had to start medication and learn ways to get the tremor under control,” says Wayne.

When he returned to work, his employer and his colleagues were very supportive. “Everyone had known me and worked with me for nine years. Some of my colleagues felt bad for me. But my employer told me that I was a valued employee and that they wanted to keep me on.”

Wayne moved to a less stressful position, running printing machines, and thankfully did not have to take a cut in pay. He works full-time, usually on a regular day shift from 7 a.m. to 3 p.m. and occasionally the afternoon shift from 3 to 11 p.m. to cover vacations.

He’s pretty active, on his feet all day, and drives the 35 minutes to and from work. He finds that the more active he is, the better his muscles function. He’d always been pretty athletic, playing tennis and basketball.

As his disease progressed over the next 10 years, his medication increased until he was taking 15 pills a day. It was getting more difficult to control the shaking and manage the machines at work. It was harder to manage daily chores like buying groceries. Wayne’s balance was being affected and he was experiencing freezing. He was now 45 years old.

He was accepted as a Deep Brain Stimulation (DBS) surgery candidate at Toronto Western Hospital and took a four-month leave from work. It took time to calibrate the implanted device and adjust his medication, but the surgery was a success for Wayne and he returned to work.

Wayne knows that DBS in not a cure for Parkinson’s and it does not stop the progression of the disease. He gets plenty of rest, eats well and keeps active. “I’m productive and I’m pretty pleased with my work life and enjoy the daily social interaction,” says Wayne. “Everyone’s circumstances are different, and I’ve had a supportive employer. I believe the fact that I was a valuable employee before my diagnosis had an impact on them wanting to keep me on. I think it has worked out well for both of us.”

Elaine Goetz
Elaine Goetz

Elaine Goetz

When Elaine Goetz, 55, started working at Library and Archives Canada on a casual basis eight years ago, her supervisor already knew she had been diagnosed with Parkinson’s the year before. She’s the person who told Elaine about the opening and suggested Elaine apply.

Not long afterwards, a full-time position opened up and Elaine entered the competition process and got the job. Library and Archives Canada in Ottawa is a federal institution that acquires, preserves and makes available Canada’s documentary heritage. Visitors enter through security and then head upstairs to the second floor reception area where Elaine spends about half of her working day. There, she registers them and checks their photo ID, before they gain access to the collection.

Elaine also has a work station on the third floor where she processes  requests for information – everything from a copy of a grandfather’s will to an inquiry about native status and from genealogy records to historical photos of Ottawa to be hung in a local restaurant. Requests come in by fax, email and snail mail and Elaine sorts and directs them to the appropriate department for a response.

Elaine’s main motor symptoms affect her balance and stiffen her muscles, but she has been fortunate that her medications have kept up with the progression of her disease with few side effects. But, four years ago, she found herself very tired all the time and experiencing some mental health symptoms.

“My children were younger then. I was dealing with a chronic illness and having difficulty facing the fact that I was unable to be superwoman living with Parkinson’s disease,” she says. Anxiety and depression are both common non-motor symptoms of Parkinson’s disease with up to half of people experiencing these symptoms. With documentation from her doctor, Elaine was able to reduce her work week to four days a week for 18 months.

Elaine has been back at work full-time for more than two years now. “I’m in a much better place now mentally,” she says.  She attends a Parkinson Canada support group and raises funds for research in Ottawa. Everyone at work is aware of her involvement in the cause and she believes her efforts also raise awareness of the disease.

She is active physically too, doing yoga and swimming. She finds staying active keeps her more physically and mentally fit.  During her spring performance review she asked about having an ergonomic assessment of her workstation. With a note from her physician, she has had the assessment and hopes to soon have an adjustable work surface that will enable her to sit and stand to do her work. This accommodation in her workplace should help alleviate her muscle stiffness.

Elaine’s openness about her Parkinson’s has the added benefit of encouraging awareness in her workplace too. She was recently featured in a Healthwise Ottawa article about YOPD and with her permission, her boss shared the story with the staff. She tells people that Parkinson’s is the “designer disease” – different for everyone. She knows people who have had it for 25 years and are still mobile and productive.

Elaine is hopeful about the future with the current research taking place around the world. And she tries to stay positive. “I try not to dwell on what may happen. If it does happen, you only end up experiencing the grief twice,” she says.
For now, Elaine intends to “continue working for as long as my body will let me.”

Chris Hudson
Chris Hudson

Chris Hudson

When Chris Hudson was diagnosed with Parkinson’s disease at 41, he was a professor in the school of optometry and vision sciences at the University of Waterloo, as well as practicing as an optometrist in the school’s clinic. Not long before, he’d been fast-tracked through immigration from the UK, because of his unique research skills and he’d already landed a faculty position at Waterloo.

Today, he is still a professor at the university, but no longer practices as an optometrist. His work is mainly lecturing and research activities. He also works as an adjunct professor at University of Toronto, co-leading the ocular research team of the ONDRI (Ontario Neurodegenerative Disease Research Initiative) study.

In between these two realities, Chris faced a nightmare called Thoracic Outlet Syndrome or TOS. TOS is a group of disorders that occur when the blood vessels and/or nerves in the space between the collarbone and the first rib (thoracic outlet) become compressed. This can cause pain in the shoulders and neck and numbness in the fingers. His TOS led to a three-year leave of absence from work.

Chris remembers the early years of his Parkinson’s as manageable. But, the TOS was very painful. It left his right arm impaired, the fingers of his right hand white and took away all the feeling in his right hand. Likely due at least in part to his Parkinson’s diagnosis, the TOS took years to diagnose and treat. Eventually, Chris had corrective surgery in Denver (which was not available in Canada at the time) and six months later he was pain free.

“I got to work out and got very fit, very quickly,” he says. “Then all of a sudden my Parkinson’s seemed to take off. Perhaps the TOS and its treatments had masked many of the Parkinson’s symptoms. By this time I was 47 or 48. I was struggling to walk. It was hard to get out of a chair. I was told I’d never work again. And I’d so recently gotten fit again. It was a setback.”

Chris got to work to beat back the Parkinson’s. He worked on his gait by using a metronome when he was on the treadmill. He worked on getting his arm swing back. He now exercises at least an hour a day and he’s particular with the timing of his medications and his diet.

“I find I live well with Parkinson’s,” says Chris. “Maybe it’s because I was so ill with the TOS, for so long. I find life now so much better. And my dexterity is still pretty good. Technology advances in the optometry profession have also helped. For instance, the retinal camera has made a big difference, by making the work less hands on. I can do most of what I need to do practically to demonstrate to my students in the clinic. And there are colleagues I can call on if necessary.”

Throughout his Parkinson’s journey his employer and colleagues have been quite supportive. “Perhaps because we are working in a health-care setting, people have been very sympathetic and helpful.” And he was a valued employee, difficult to replace.

He met with occupational health early on and the director of the school of optometry was very supportive in helping him return to work. He also had the support of his faculty association. “For others, at other companies, the reaction may be only as good as your line manager,” he says. “I’d encourage people with Parkinson’s to disclose their condition with someone in their corner present.”

Chris has been very up front and direct about his condition and its impact. He sent a personal email to all of his colleagues, explaining his Parkinson’s and what they might notice. On a more personal note, he also started up a Parkinson Canada YOPD support group in the area three years ago, which usually meets monthly in Guelph or Kitchener. He still attends.

And then there is his research. For more than 20 years he has been studying the rates of blood flow in the back of the eye as a reflection of general health. In the ONDRI study labs at Toronto Western Hospital and the Kensington Eye Institute, he and four students study the relationships between eye disease and brain disease. This work was recently featured in an article in the Globe & Mail.

“It’s been comforting to do the research I’m doing with ONDRI – looking at Parkinson’s disease on both a personal and professional level. It’s rewarding to make use of my skills in this way.”

Considerations if you intend to keep working

As an employee in Canada, you are not legally required to disclose your Parkinson’s diagnosis. However, if you are seeking accommodation in the workplace, you do need to disclose that you have a disability, and what your limitations may be.

Employment legislation, including accommodation, is regulated provincially like healthcare, so there are some differences from province to province. Accommodation can include modified job duties, work schedule and physical changes in the workplace.

There are limits to the accommodation you can expect from your employer. For example, a person in a wheelchair cannot be accommodated as a firefighter. There are also limits depending on the size of the company: a small, independent shop may not be required to build a wheelchair ramp or accessible washroom for an employee, if the cost would be burdensome to that business.

It is important for a person with a disability to be clear on how their own symptoms may affect their ability to carry out their job duties. Just as each person’s Parkinson’s journey is different, so too are a person’s needs to continue to perform his or her job. There is also an obligation for the employee to request reasonable accommodations.

It is highly recommended that you confirm conversations of disclosure with your employer (of your diagnosis or of your disability) in writing (email is acceptable) and save a copy of this mutual understanding in your personal files, away from work. There is a risk that some companies may pressure an employee to leave if they perceive that there is a ‘performance issue.’ You cannot make a claim of discrimination if you did not reveal your disability to your employer, and you need to have proof of this revelation. It is a good idea to continue to document for your own records any subsequent discussions you and your employer have concerning your capabilities.

For further information on this and related topics, contact our Information and Referral specialists at 1-800-565-3000 or info@parkinson.ca.

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