The Shaky Times
-- Online Edition --
May 2018
Here's what's below:
May Meeting Speaker
Special Program for Caregivers

A Very Special Thank You

Parkinson's Treatments and Dental Care

3 Ways to Address Your Stress

How to Treat Fainting

Donation Acknowledgments

Library Corner

Exercise Class Schedules

Meetings, Announcements, and How to Contact Us
May Meeting Speaker

Saturday, May 19, 2018

Presentation: Therapies in Parkinson’s Disease
Speaker: Dr. Cameron Dietiker

Dr. Dietiker is an assistant clinical Professor of Neurology at UCSF, where she sees patients at the Movement Disorder and Neuromodulation Center as well as in the Huntington’s disease and Ataxia clinics at the Memory and Aging Center. She has expertise in DBS and Botulinum toxin therapies for the treatment of various movement disorders and is active in ongoing clinical research trials at UCSF for Parkinson’s Disease, Essential Tremor, and Huntington’s disease.

Medtronics is providing the food, catered by Ed-U-Catering, Cindy Gershen's Mt. Diablo High School Students. 

Presentation at Caregivers Support Meeting (9-10 am in Sanctuary)
Current Theories on Predicting PD Progression and
the Stress of the Unknown
by UCSF Parkinson’s Disease Clinic and Research Center

This is part of an educational program series, designed specifically for caregivers of patients with Parkinson’s Disease.

A Very Special Thank You
Dear Friends and Members,

I once read, somewhere, that we often take for granted the very things that most deserve our gratitude. This is true for several volunteers among us. However, it is especially true of Sandy Clark ! Sandy served as a group leader for the women with PD for over 8 years. Besides helping and reaching out to several women members with PD, she cultivated a core group of team members from the women’s group, who guided and assisted her. She frequently met with this group over a cup of tea or lunch. When she felt it was time to hand over the responsibilities, she did so in a remarkable way: one of the women from the group was selected and, without leaving a vacuum, the transition went smoothly and the group was placed in good hands.
Sandy, we Thank You and appreciate your hard work and dedication to PNMD. Your humbleness and kindness touched many. We wish you nothing but good luck, good fortune, and happiness. We hope you don't forget us and visit us often!

Abraham Raja,
Co-President (PNMD)

Parkinson's Treatments and Dental Care
Regular dental care can minimize the risk of experiencing pain and discomfort, but most importantly, it can reduce the risk of infection. Understanding medication side effects is an important step to improving dental health.

Q: Which Parkinson’s-related medications cause oral side effects?
To understand medication’s side effects, you must first understand the critical role of saliva in relation to oral health. In addition to keeping the tissues inside of the mouth healthy and moist, saliva washes away harmful bacteria and acids on the teeth. When saliva production is significantly reduced, this equilibrium is disrupted and causes a potentially substantial impact upon oral health such as tooth decay. Anticholinergic medications, used to treat resting tremor in Parkinson’s, commonly cause dry mouth symptoms (xerostemia). Medications such as amantadine, typically prescribed to reduce Parkinson’s-related dyskinesia, are not considered anticholinergic medications, but do have some “anticholinergic effects” that can also cause dry mouth. Individuals using Carbidopa/Levodopa or MAO-B Inhibitor medications, used to treat Parkinsonʼs motor symptoms, have also reported symptoms of dry mouth. Medications taken for common non-motor Parkinsonʼs symptoms such as anxiety or depression, orthostatic hypotension and urinary incontinence may also cause dry mouth. There are also less common medications used to treat non-Parkinsonʼs related symptoms such as allergy, cold, diarrhea and nausea that can cause dry mouth.
Review your medications with your physician. Your physician may recommend alternative medications, changes to the medication schedule or changes to the dosage in order to minimize dry mouth symptoms. Do not change your medication regimen without consulting with your physician.

Q: How can medications improve oral health?
Generally speaking, medications for Parkinson’s can improve oral care and oral health by improving movement and motor control. These medications allow people with Parkinsonʼs to move with more precision and less effort which facilitates better oral care. Deep brain stimulation treatment (DBS) often provides a similar effort which facilitates better oral care. Deep brain stimulation treatment (DBS) often provides a similar effect by improving movement that can lead to better oral care. There are no specific medications prescribed directly to improve oral health. However, your dentist may recommend special oral care devices, as well as specialized toothpastes or oral rinses. For example, an oral rinse called chlorhexidine gluconate can be very effective when used
in conjunction with brushing and flossing. Chlorhexidine is preferable to many over the counter mouthwashes because it does not contain alcohol, which can exacerbate symptoms of dry mouth and irritate oral tissues. Please note that this oral rinse requires a prescription from your dentist.

Q: How do Botulinum Toxin injections affect oral health?
In some instances, medications can be prescribed to control excessive saliva or drooling (sialorrhea) for people with Parkinsonʼs. Sometimes these medications are not effective enough to satisfactorily control drooling. In that case, your physician might suggest injections of botulinum toxin. Small amounts of botulinum toxin are
injected directly into the salivary glands inside the mouth in order to temporarily shut down saliva production. Typically, botulinum toxin is injected into the parotid glands and/or the submandibular glands. Parotid glands are activated during chewing and submandibular glands produce a significant amount of saliva (Kalf, DeSwart, Borm Bloem and Munneke, 2009). These injections can be an effective approach to addressing drooling and can provide relief for up to 3 months at a time. Another benefit may include keeping dentures properly sealed and reducing breakdown of the skin in the corners of the mouth. Occasionally this approach can simply be “too effective” at reducing saliva production, causing dry mouth. As previously outlined in this article, dry mouth caused by lack of saliva can have a negative impact on oral health.
Suck on sugar free hard candies or chew sugar free cinnamon (not mint!) gum to initiate saliva production.

Q: How can occupational therapy treatment improve oral health?
Occupational therapists specialize in improving fine motor control with exercise and adaptive modifications. By following instructions and recommendations from your occupational therapist, you can improve your ability to perform oral care and many other common daily activities (often referred to as activities of daily living or ADLs). Consider asking your doctor for a referral to an occupational therapist to see if there are ways to improve your ability to brush and floss your teeth. Incorporating adaptive tools into your dental routine can also improve your oral care. For example, electric toothbrushes are an easy way to incorporate adaptive tech into your daily routine. As an added bonus, many of these toothbrushes have handles that are easier to hold and grip. A number of electric toothbrushes offer timers that beep every 30 seconds to remind you to move on to another “quadrant” of your mouth so you brush for the recommended length of two minutes. Another simple way to alleviate symptoms of dry mouth is to stay properly hydrated. Every healthy adult should drink 8 to 10 pint-sized glasses of water each day in addition to incidental liquids obtained through food and other sources.
Keep a water bottle with a tight-fitting lid nearby so you can take small sips throughout the day to increase your water intake. This additional hydration will also improve medication efficiency and potentially improve symptoms of orthostatic hypotension (lightheadedness that can appear after standing).

Resources: M.Cicci`u, G. Risitano, G. Lo Giudice, and E. Bramanti, “Periodontal health and caries prevalence evaluation in patients affected by Parkinsonʼs disease,” Parkinsonʼs Disease, vol. 2012, Article ID 541908 2009. Kalf, B. J. M. de Swart, G. F. Borm, B. R. Bloem, and M. Munneke, “Prevalence and definition of drooling in Parkinsonʼs disease: a systematic review,” Journal of Neurology, vol. 256, no. 9, pp. 1391– 1396, 2009. 2010. Sheffield and J. Jankovic, “Botulinum toxin in the treatment of tremors, dystonias, sialorrhea and other symptoms associated with Parkinsonʼs disease,” Expert Review of Neurotherapeutics, 3/18/18, 4A39 AM Page 5 of 6 vol. 7, no. 6, pp. 637–647, 2007
3 Ways to Address Your Stress
Stress is a fact of life — but it doesn’t have to bring you down. You can get ahead of it by learning healthy ways to manage it. While you can’t control what worries, concerns, or annoys you, you can control how you react. Thatʼs the secret to mastering stress management.
What’s stressing you out?
  Everyone experiences stress in different ways and for different reasons, but there are some causes that most everyone can identify with. In fact, these are the top 5:* Money, Work Relationships, Personal health problems, Family health problems. These are all common issues, so itʼs not surprising that so many people feel the effects of stress. The good news is, youʼre not alone. This means there are resources for support and tips to help you cope.

Effects of stress
Too much stress can take a toll on your body, mind, and behavior. Signs can include: Feeling tired and drained, A sense of being overwhelmed, Anxiety (including panic attacks), Hopelessness, Loneliness, A lack of motivation or focus, Trouble controlling your temper.

Simple ways to address your stress
Everyone gets overwhelmed sometimes. But too much stress can be hard on your health — so itʼs important to find ways to offset those negative effects. These healthy habits can help you stay cool under pressure, even when you’re pressed for time.

1.      Work that tension out
Symptoms of stress can create a vicious cycle between your mind and body. Exercise helps to break this cycle by relieving tension and releasing feel-good brain chemicals.
2.      Take a break to breathe
When you start to feel overwhelmed, try a few minutes of deep breathing. Breathe in for a count of 5, hold for 5, and exhale for 5. Repeat 10 times or until you start feeling more calm, grounded, and focused. Unplug to recharge. Your phone needs time to recharge, and so does your brain. Disconnecting from digital noise for a little while each day can help you feel calm, sleep better, and spend more time on activities that nourish your soul.

Looking for more stress-fighting strategies? Visit management. *American Psychological Association, “Stress in America: The impact of discrimination.” Stress in America™ survey, 2016.
How to Treat Fainting
Written By Michael Greger M.D. FACLM on March 20th, 2018
Syncope, otherwise known as fainting, is the sudden, brief loss of consciousness caused by diminished blood flow to our brain. About one in five people experience this at least once, and about one in ten may have repeated episodes of syncope, causing millions of emergency room visits and hospitalizations. Though fainting can be caused by heart problems, it is most often triggered simply by vasovagal reactions, such as standing (because blood pools in our legs) or strong emotions. “Under certain circumstances, such as blood donation, syncope has important medical and societal significance” as fainting may, for example, prevent donors from wanting to give blood, again. Indeed, more than 150,000 people experience fainting or near-fainting spells each year when they donate blood.

Speaking of the medical and societal significance, what about fainting while driving? It goes without saying that losing consciousness while driving can pose a serious threat to both the patient and society. Of a group of individuals getting tested for syncope, 9 percent reported they had lost consciousness while driving. When syncope happens repeatedly, drugs and surgery are used, such as installing a pacemaker. But such “therapy is expensive, efficacy is questionable, and adverse effects are common.” In fact, “results of most drug treatment trials have been disappointing” and the “value of implanting pacemakers has been repeatedly questioned, and now there is evidence of their lack of effectiveness.” So, what do we do? According to one study, “In Italy, the older generation of general practitioners advised patients prone to fainting to carry a wooden egg (used in the old days for darning socks) and to apply muscle tension by gripping the wooden egg forcefully as soon as a faint was imminent.” These folklore stories inspired an Italian cardiologist to apply arm muscle tensing to combat vasovagal fainting, but it had not been put to the test until recently. About a minute before losing consciousness, most people about to faint experience so-called prodromal symptoms—that is, they feel dizzy, queasy, or break out into a sweat, signaling they are just about to blackout.

When that happens, there are a number of maneuvers shown to successfully abort the impending episode. One is called isometric arm counter-pressure, where you grip one hand in the other and exert pressure, trying to pull apart your arms, and continuing to do so until the symptoms go away. How successful is it? Patients were shown how to do it and reported it was successful 99 percent of the time. Safe and effective, isometric arm counter-pressure is proposed to be the new first-line treatment for those who start to feel faint. You can see a picture of this move in my video How to Prevent Fainting. Leg crossing and muscle tensing have also been shown to work. You cross your legs and squeeze them together as you tense your leg, stomach, and butt muscles. Safe, inexpensive, and effective, no wonder researchers propose having patients try this before having a cardiac pacemaker surgically implanted. Squatting is another maneuver if all else fails.

Is there anything we can do to prevent the symptoms in the first place? Do we have to wait until we’re dizzy, clammy, and nauseated? Well, also cheap, safe, and effective, simply drinking water can prevent fainting. If you know that needles, for example, make you woozy, five minutes before you get stuck, chug down two cups of water, which can dramatically stabilize blood pressures within minutes in people who are predisposed to fainting, and it has similar effects in normal healthy adults. 

The fact that acute ingestion of water exerts such profound effects may be exploited by blood donation programs to help prevent people from fainting. It is also the current recommended treatment for so called blood, injury, or injection phobia, which is actually pretty common, affecting about 1 in 25 people, 75 percent of whom “report a history of fainting in response” to needle sticks. The problem is not just that they won’t donate blood. Avoiding anything related to blood, injury, and injections could pose a particularly serious threat if people neglect to seek medical care when necessary. However, all one may need to do is preload with two cups of water. “The knowledge that such simple self-help maneuvers are readily available and could be lifesaving should prove valuable and helpful in everyday life.”

Quench your curiosity about proper hydration with these videos: How Many Glasses of Water Should We Drink a Day? Does a Drink of Water Make Children Smarter? Can Dehydration Affect Our Mood? Treating Dry Eye Disease with Diet: Just Add Water? Club Soda for Stomach Pain and Constipation.

In health, Michael Greger, M.D. PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: 2012: Uprooting the Leading Causes of Death 2013: More Than an Apple a Day 2014: From Table to Able: Combating Disabling Diseases with Food 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killer.
Donation Acknowledgements
Thank you for supporting the work of the Parkinson's Network of Mt. Diablo!

  • Geoffrey Hayes
  • Mary Anna and Martin Jansen

In Memory
  • Eileen Kempker in memory of Harry Holsworth
  • Betty Gahr in memory of Leonard Gibbons
Library Corner
For the meeting in April, in addition to articles about common concerns that arise in managing Parkinson's Disease, there were several articles about cognition. Cognitive difficulties in Parkinson's include those associated with "normal aging,” mild cognitive impairment (MCI) and PDF-Dementia. The articles provide information about these categories and their management and will also be available at the May meeting. The special focus for the May meeting will be peripheral neuropathy and PD, another complex combination.

Besides articles, the library has several interesting books. A list of these books is available for you to peruse. Donations of books you may wish to share are accepted by the library. Books may be borrowed for a month by signing out on the sign-out sheet on the table. There are also brochures, DVDs, and other materials for your information.

The library opens at 10:15 a.m. and stays open for a while after the general meeting. Please take time to look at what is available that is of interest to you. If you have any suggestions, please notify the librarian.

Janice Ransley, Library Chair

PD Exercise Activity Classes


Boot Camp
Monday, 9:30-10:45AM, Murthy Jarugumilli, 925-864-2890
Thursday, 9:30-10:45AM, Carol Fisher, 925-566-4181
Dance Moves Me
Tuesday, 1:00-2:30PM, Debbie Sternback, 510-653-8362
Rock Steady Boxing
8 classes/week-call for times, Jimmy Greninger, 925-785-1272
Tremble Clefs
Thursday, 1:30-3:30PM, Michael Grupp, 925-451-3389

Please contact activity instructor for further details and fees.
2018 Dues - Still $50

PNMD annual dues are still $50 per household. About 60% of you have paid for 2018, but many have not.

If you're ready to pay your dues online, you can do so on the PNMD website right here . You can use your credit card or PayPal through our easy PayPal portal.

If you'd rather mail your dues, send your check to PNMD, P.O. Box 3127, Walnut Creek, CA 94598-0127.

If you are unsure whether you've paid for this year already, contact Sara Allen by phone or email - 925-296-0221 or

Thank you for supporting PNMD!
Announcements, Meetings and How to Reach Us
The Tremble Clefs
Mt. Diablo Tremble Clefs will improve the volume and clarity of your voice through enjoyable free weekly singing sessions. Don’t let your voice fade away. We meet Thursdays 1:30-3:30 pm in Lafayette. For more information please contact chair
Michael Grupp at (925) 451-3389.

Questions? Contact Amy Van Voorhis at

Is There Treasure In Your Driveway?

You can stop paying insurance and registration—and get a tax deduction.
Donate your car, truck or boat to PNMD . Just call: 877-999-8322

Important: Be sure to tell the operator that you wish to donate your car to Parkinson Network of Mount Diablo. Or just use this link for our dedicated online donation form:
If you have any questions, call the vehicle donation program at 877-999 8322.
Or contact Abraham Raja at
     General Meeting Information:

Board Meeting:
First Monday of each month, 10:15 a.m.. Hillside Covenant Church, 2060 Magnolia Way, Walnut Creek. Open to all members.

General Support Group Meeting:
The Parkinson Network of Mt. Diablo Support Group meets on the third Saturday of every month, from 9:00 a.m. to noon at Grace Presbyterian Church, 2100 Tice Valley Blvd., Walnut Creek. All are welcome and there is no charge. No RSVP’s needed.

Here is the agenda:

9:00 to 10:15 a.m. – Three concurrent Support Group meetings:

Men with Parkinson’s Disease Only: For men newly diagnosed or who’ve had PD for years: time to share, laugh, and learn from each other. Meeting location is the Fireside Room at Grace Church. Contact person is Derek Ransley, (925) 944-0162.

Women with Parkinson’s Disease Only: For women newly diagnosed or who’ve had PD for years: time to share, laugh, and learn from each other. Meeting location is the Library at Grace Church. Contact person is Rosemary Way, (925) 939-7665.

Caregivers Only: Caregivers discuss issues relating to their roles. Meeting location is the Sanctuary at Grace Church. Contact person is Norman Kibbe, ( (925) 935-9322 .

10:15 a.m. to 10:30 a.m.-Assemble in Oak Room. The PNMD Library, with books, flyers, videos, etc. is open at this time. Bill Clinch, Moderator, will introduce new members and make announcements.

10:45 a.m. to 11:45 a.m. (Oak Room) Guest speaker (See information above)

11:45 a.m. to noon Q&A, Wrap up.

General questions may be directed to Abraham Raja at (925) 939-4210 ; Lance Gershen, Program Chair (925) 932-1028.

Tri-Valley (Pleasanton) Support Group Meeting:
Meets second Saturday of the month, year-round, from 10 a.m. to noon at the Pleasanton Senior Center, 5353 Sunol Blvd., Pleasanton. This is a support group and learning session that is open to all who want to learn about PD. Facilitators are Norman & Jackie Bardsley, (925) 831-9940.

Contact Us

Web site: 
General Information Phone No.: (925) 939-4210
Co-Presidents: Abraham Raja (925) 381-0688 or
Lance Gershen (925) 932-1028 or
Past President: Howard Zalkin (925) 785-6670 or
Secretary: Beth Donegan (949) 680-9133 or
Publicity: Beth Donegan (949) 680-9133 or
Treasurer: Amy Van Voorhis (925) 932-5036 or
Membership: Ken Kuhn (925) 588-9837 or
Health and Wellness Program: Cathy Hostetler (925) 932-5285
Volunteer Coordinator: Cathy Hostetler (925) 932-5285 or
Information Technology: Sara Allen (925) 296-0221 or
Librarian: Janice Ransley (925) 944-0162 or
Program Chair: Lance Gershen (925) 932-1028 or
Tremble Clefs: Michael Grupp (925) 451-3389
Caregiver Discussion Group: Norman Kibbe (925) 935-9322 or
Women's Discussion Group: Rosemary Way (925) 939-7665,
Men's Discussion Group: Derek Ransley (925) 944-0162 or
Donations and Memorials: Please mail to P.O. Box 3127, Walnut Creek, CA 94598.
Newsletter Editor: TBD Please email submissions by the 15th to: Abraham Raja at
Disclaimer: This newsletter is published to increase awareness of problems related to Parkinson’s Disease. Neither PNMD nor its members make any warranty or assume any responsibility as to the accuracy, completeness, or usefulness of any information presented. The editor’s opinions are strictly his own.