Senior Living on the Suncoast

Parkinson's Disease w/ Dr. Domingo

January 11, 2021 Steve Bennet-Martin, Dr. Angelo Domingo Season 1 Episode 43
Senior Living on the Suncoast
Parkinson's Disease w/ Dr. Domingo
Show Notes Transcript

Steve Bennet-Martin sits down with the Suncoast CARE Awards Doctor of the Year, Angelo Domingo, to discuss Parkinson's Disease.

News and Updates:
January Marketing Mania for Professionals- January 28th at 11:30 at HarborChase of Sarasota

Topics Discussed- Defining Parkinson's Disease, early signs of the disease, the role of dopamine in the disease, how it can affect your memory, Lewy-Body dementia, what confabulation is, and more.

Support the show (http://www.patreon.com/happylifepod)

Steve:

Hello there everyone. And welcome to senior living on the Suncoast. I'm your host, Steve Bennet-Martin and I'm happy to bring you the only senior centered podcast to assist us all. As we navigate the complex systems of aging together, up and down the sun coast of Florida. My mission with this podcast is to help make sure that the rest of your life is the best of your life, which means today we'll be talking with Dr. Angelo Domingo, the Suncoast best doctor of 2020 as voted on by all of you, as he talks about Parkinson's disease and associated behaviors with it. Before we get into that though, this episode is being released on Monday, January 11th of 2021. So we will start with some quick news and updates for our area. First of all, I have the pleasant news for professionals in the area that I have gotten the blessing from hardest to podcast and have it kind of be presented by hardest. So before I was able to, or I was restricted to doing interviews and planning for the podcast feature episodes on Mondays only. So now I'll have the opportunity. If it is someone. Through work or that I meet through work. I'm able to also interview them during the work week as well, which will certainly help make future guest requests a lot easier to coordinate. So if you're interested in that, make sure you reach out to me at happy life pod at, at gmail.com. In addition to that seniors blue book is attempting their first. In-person marketing mania in Sarasota County on the 28th of January at 1130 at Harbor chase of Sarasota right off of Proctor road, they are going to be doing a parking lot party. So it is socially distant and responsible and COVID aware and all of that, but it will be a great chance to connect to everyone. So if you are looking to attend that, the best thing you can do is just check out the seniors blue book website. Similarly, that's also where you can find yourself. With all of these senior living and care updates, education that are going on through the week virtually through their website we still are not doing any sort of large education talks throughout the community yet. And so, so online continues to be the best way to view those. And many of them are up on the page and evergreen. So even if you're not tuning in, when they air something, you know, On a day at a certain time, you can always go back through their YouTube page or their Facebook to watch those videos as well. So that is our quick update for the area for the week. And let me transition over to our special interview Enjoy. Our guest expert for today. Dr. Angelo Domingo is a Yale university school of medicine, fellowship trained neuropsychologist in pursuit of his goal of being one of those professionals who helps improve the quality of life for the chronically medically ill and their caregivers. He has provided not only some amazing care up and down the Suncoast, but also education and awareness. Welcome to the show Dr. Domingo.

Dr. Domingo:

Oh, thank you, Steven. It's a pleasure to be here.

Steve:

And in addition to that long list of your background, you actually are also our doctor of the year as voted on by our listeners in the senior living community, in our area. So, congratulations.

Dr. Domingo:

Thank you. That was a very humbling award to receive much appreciated. Thank you.

Steve:

Oh, for the listeners. Why don't you tell them a little bit about yourself and how you came to work with seniors in our industry?

Dr. Domingo:

Sure. So I've always been drawn to. Working with the chronically medically ill in my, in my training at Yale neurosurgery, we saw mainly epilepsy cases, cases of individuals who had dementia or hydrocephalus, which is, you know, increased pressure in the brain. And it's not only did it fascinate me, but. I felt like I could have a huge impact in the quality of life for those individuals and their caregivers. So that's how I got drawn to the field. And then when I left Connecticut, after my fellowship and moved down to Florida, I was doing exclusively neuropsychs testing for quite a while. And after, after a few years of that, it just started to bore me and I entered more and more into the treatment field and ended up working in long-term care settings. With the chronically ill. And that was how, how my career really took off, was working, working in those types of settings. Before I opened my private practice, a Parkinson place.

Steve:

Yes. I mean, I can say that that is how I met you as, when I was working in the communities and seeing you do your education. Talks around town because, you know, after for me working in a memory care for three or four years at the time and hearing the same education over and over again, go into your talks. I remember like I was engaged in interested and it's, it's hard for, you know, to find engaging speakers sometimes. And so you were definitely one of them. And so I'm glad that you found us in our little community.

Dr. Domingo:

Oh, well, thank you. I do try to keep it engaging. I try to keep it. Understandable to the layman and you know, humorous at times when it can be, because it's such a, an emotionally demanding topic.

Steve:

It certainly is. And the topic that we're going to be talking on today and touching more on in this episode is Parkinson's disease and its associated behaviors. And I chose that because right now, as you mentioned, you are very closely tied to Parkinson place. And we had Alex on an earlier episode, but can you give us a kind of a brief definition of what Parkinson's disease is for those who might not be familiar?

Dr. Domingo:

Sure. It Parkinson's disease in it's in the beginning of the condition. Is a breakdown of the dopamine producing neurons in the midbrain, specifically the substantia nigra, which is just a fancy word for black stuff. Literally it means stuff in Latin. Wow. So in the reason that the substantial Niagara is black is because it it has a high density of iron. So one of the hallmarks of early Parkinson's disease is this leakage of iron out of the substantia nigra, as it breaks down into other parts of the brain in terms of behavior. The initial, the initial symptoms of Parkinson's disease involve a resting tremor. So what that means is when people go to do something with their hands, the tremor tends to stop. But when their hand is at rest, The tremor becomes more pronounced, then usually it's a pill rolling tremor. So it would be as if you put a pill between your, your forefinger and your thumb and you were rolling it around. Oh,

Steve:

I never thought of it that way or heard that comparison, but you're right.

Dr. Domingo:

Yeah. And there was balance problems that occur. There can be flattening of assets, which means people aren't as, as facially expressive as they normally are. And there can be a slowdown in, in thinking. Yeah.

Steve:

And so, I mean, I'm guessing those are all early signs that you'd recommend at that point, if you, or your loved one are experiencing that you'd schedule an appointment with their doctor.

Dr. Domingo:

Oh most definitely. Yes. But at the core, at the core of the condition, it is death of the cells that produced opening. And eventually, eventually it causes death to the cells that respond to doping.

Steve:

Yeah. Yeah. And so what would you, what are some of the most common forms of treatment for Parkinson's.

Dr. Domingo:

Well, you know, the forms of treatment haven't really changed much in decades. We administer, well, I shouldn't say we, I'm not an MD, but the MD will administer dopamine. In, in some form or another. So cinema is usually the first line drug and that's carbidopa levodopa. It's two forms of the precursor to dopamine. So what happens is, you know, dopamine itself can pass the blood brain barrier. So that's a protective barrier between the brain and the rest of our circulatory system to keep talks and out of our brain. And dopamine is unable to pass. But the precursor molecules to dopamine L-DOPA, that's able to pass the barrier. So the medications are essentially L-DOPA and then once the L-DOPA passes, the blood-brain barrier, our body does the rest and converts it into dopamine.

Steve:

All right. And so, in addition to the, the shakes and tr and tremors you know, as the disease progresses, are there any other symptoms or things that people might want to really be watching out

Dr. Domingo:

for? Oh, most definitely. So often when you hear doctors speaking about the effect of dopamine in Parkinson's, they're often talking about motor symptoms, but dobutamine is involved in all a whole host of functions

Steve:

that makes you happier.

Dr. Domingo:

Yes. Sova mean can, can make you happier. It reinforces what we would consider adaptive behavior. So whenever we do something that is, you know, good and healthy, then we get this natural reward, which is a release of dopamine. So things like eating, drinking. Sleep, when we're tired going to work, getting up, getting dressed in the morning, having sex, all of those things release dopamine to one degree or another.

Steve:

Well, it sounds like I really liked this dopamine.

Dr. Domingo:

It's really, it's really nice to have. And. Addictive things like gambling, shopping, sex, drugs, those usually are addictive because they released lots of dope for me.

Steve:

And so just out of curiosity, how would things like that then affect someone with Parkinson's? If it's not from a lack of dopamine,

Dr. Domingo:

Things tend to be what we call a motivated or unknown. They, they can be sort of blah, about everything. And yeah, one of the things I hear a lot from my caregivers is, you know, usually it's the wife coming in about the husband and they'll say, you know, my husband's just would sit on the couch and watch TV all day. If I didn't tell him what to do. And that's in part because they're not getting that chemical hit from doing things that they would normally do.

Steve:

Yeah. Oh, that, that makes sense.

Dr. Domingo:

Okay. Another issue that occurs with, with Parkinson's disease is, is a called frontal disconnection. So. It's as if the connections have been caught between a a sufferer, his frontal lobe and the rest of their brain. So what happens is they're not really able. To problem-solve in the same way or think out of the box, it's almost as if they're on autopilot. So one of the other major complaints I get from from caregivers is, you know, I can have a conversation with my husband and he understands me and he responds appropriately and then he walks away and it's just, the conversation never happened. You know, I had a, I had a client once who asked me, she said, you know, I can sit my husband on a, on a stool to eat his breakfast and I can tell him, don't get up. Don't get up. I gotta go take a shower, please don't get up. And he'll tell me he won't get up. And then before I get to the shower, I hear thoughts and he's on the floor. And that's because. It's hard for people with, you know, moderate to advanced Parkinson's to adjust their behavior, to changing circumstances. So with that husband, I had a 20, 20 minute conversation with that husband about why it's dangerous for him to get up. And it wasn't me telling him why it was dangerous. It was him explicitly to me. Why he was dangerous for him to get up. And then I distracted him for about a minute. And after that minute, I said, well, what would you do if you were eating your breakfast and you dropped your spoon on the floor and he looked at me and he said, well, you bend down and pick it up.

Steve:

Yes. That certainly is a bit of a disconnection for sure. And I mean, that, that, that is part of, I know that. When I was working in the memory care community, we needed to have Parkinson's disease because we did in training because some, you know, oftentimes they might end up needing memory care in some of those later stages. So like what other signs might happen that would require some memory care?

Dr. Domingo:

Well, unfortunately, one of the other common symptoms with Parkinson's disease is hallucinations and psychosis. Not everybody gets that. But if someone is hallucinating and is distressed by their hallucinations or they become paranoid and delusional and think that people are trying to hurt them. That that can be an issue that would require somebody to be in a facility. Another issue is wandering or aggression, you know, can be accompanied by aggressive behavior because people are scared and they don't understand what's happening.

Steve:

Yeah. I mean, and are all of these problems kind of manifesting because of the lack of dopamine or are there other reasons that happen as like your body is going through the stages that might cause these things to happen?

Dr. Domingo:

Those are from other reasons, those are because of Lewy bodies. Usually Lewy bodies are chunks of protein that get lodged in the midbrain. And they interfere with cognitive functions and sometimes also people can become paranoid if they're over-medicated and they're given too much for me.

Steve:

Oh, okay. Yes. And I mean, when you say Lewy bodies, I mean, I've heard of Lewy body dementia and worked with people with that diagnosis as well. Are they related then? Are they the same? Are they different?

Dr. Domingo:

Well, it's my understanding that it really is an issue of semantics. So if, if a person starts to manifest psychiatric symptoms first, like psychosis or paranoia hallucination Then they're given a diagnosis of Lewy body dementia, the motor symptoms develop first, and then the psychosis comes later on. They're given a diagnosis of Parkinson's dementia with Lewy bodies. Wow.

Steve:

Well, you learn something new every day.

Dr. Domingo:

Yeah. So they're very, very closely related.

Steve:

Before we get into the managing symptoms, also, you keep on mentioning it. You know how a lot of times it's the wife talking about the husband now is Parkinson's disease. Something that happens more common in men, or is it because we typically in healthcare see wives caring for husbands in general, just more because of the roles.

Dr. Domingo:

It says a car Kerr more often than men, and also women are more likely to come in for help. Well, yeah,

Steve:

there is that as well. I know my husband would rather rub dirt in a wound and say, it's all right, then get help sometimes.

Dr. Domingo:

Yes, I have seen that before.

Steve:

Yes. And so as the caregiver though, what are some, you know, everyone always wants to, especially with their loved one, to keep them at home for as long as possible. And so what are some ways to help kind of make your home more accessible for someone with Parkinson's disease to help manage the disease better?

Dr. Domingo:

So I I'll talk about that. And then I want to talk about if we have time, the reasons why home is not always the best place.

Steve:

Well, I work in a community, so I am fully on board with that conversation.

Dr. Domingo:

So ways that they can make their, their home safer are to pick up. Any and all floor mat area rugs on, unless they happen to be ones that are. Rubber backs like a bathmat in the, in the bathroom that won't slip or slide. Because really we used to say in law, in skilled nursing, that area rugs were the devil. Because they're so dangerous for people with balance problems, especially people with a shuffling gait, because blood can slip under the rug and get caught. Yes.

Steve:

The transition typically from carpet to non, unlike under different services, always hard for even I myself will trip over floor carpets left and right. So as with seniors, with walkers or gait issues, it's just, yeah. A very big hazard I can imagine.

Dr. Domingo:

Yes. And also cognitively people with Parkinson's have a difficult time with changing floor surfaces. They can sort of leave. If they're moving from one type of flooring to the next. So there are those issues. You also, you know, if your loved one is exhibiting notable, cognitive decline, you know, declines in reasoning and thinking and planning, then you want. To have the house alarmed in some way. So if they wander off or open, open a door, open the sliding glass doors, the back, you can hear, like, there'll be a a beep or a siren of some sort that will let you know. That someone is outside.

Steve:

Yes. I mean, the, those systems are important, especially if you have a wander, but I know that, you know, especially even nowadays with technology, there are even apps that can do that for you. In addition to having to, you know, go out and buy things. My maintenance director has it for his daughters, but I know it could apply the same way for, you know, your, your loved one that if you have, if they take their phone everywhere, you can always just download one of those tracking apps that can also alert you. If they leave a certain geo location.

Dr. Domingo:

Most definitely. Unfortunately, most people in that age group are not taking their phone with them everywhere they go, you know, my phone's attached to my

Steve:

hip.

Dr. Domingo:

Yeah.

Steve:

Yeah. I think that'll be easier a couple of decades from now, as that becomes a habit that everyone is ingrained in.

Dr. Domingo:

Exactly. But Parkinson's does tend to leave people. Much more cognitively intact than other types of dementia. So there are, there are strategies that can help someone with Parkinson's manage their own day to a certain degree. One of them is having a whiteboard where you would, the caregiver would list the day's activities. So their loved one can just look at the board and know what's happening that day. A big part of caring for someone with Parkinson's is managing your own expectations as a caregiver, you know, just because they used to be able to shower and shave and get dressed within 30 minutes, you know, a year ago doesn't mean that they're going to be able to do that now.

Steve:

Yes, no, I understand. And I mean, certainly expectations are hard and so what's some advice you would give to the caregivers.

Dr. Domingo:

So number one, leave plenty of time in the schedule. So if you know, your loved one takes an hour and a half to get ready in the morning, then you need to plan for them to take an hour and a half in the morning. You can say, you know, you need to hurry up. They don't know how to hurt. They can't. You need to discuss probably the night before and then the morning of what the activities are for that day what's what's plans. So your loved one knows what's happening. You need to only schedule, you know, like two things a day because. Parkinson's is an exhausting condition. So your loved one needs to rest. You want to provide encouragement and queuing, but you want to avoid an argument, you know, unless it's a safety issue or some grossly inappropriate behavior arguments does no good.

Steve:

Yes.

Dr. Domingo:

Thank you. Usually a way to manage that is to stop asking, you know, do you want to do your big exercises today? Do you want to go to the pool and say, now is the time when we blahbity blah. Now is the time when we do our exercises now is the time when we go to the pool and they still have the right to say no.

Steve:

But it encourages them to say yes, a little bit

Dr. Domingo:

more. Exactly. And they may get confused about how to go about something, like, especially going to a pool, because it requires a change of clothes if they're going to get in the water. And so you want to help them with that process.

Steve:

Yes. And I know that spouses, especially, but families oftentimes try and help as much as they possibly can and even longer than they should probably. And so what are some of those early signs that, you know, maybe living at home isn't working out and you should be looking into other options.

Dr. Domingo:

So if you see that your loved one's cognition is declining at a, at a fair pace. And, you know, eventually you're not going to be able to manage them at home anymore. The tendency is for my caregivers to say, well, I'm going to keep them home as long as possible until they're pulling the hair out of their head. Right? Yeah. And my advice to that is you really want to please your loved one while they still have some capability to adapt and understand where they are and why they're there. So, you know, in the, in those middle stages, Of the disease, because what happens is, as the disease progresses, their ability to adapt to change is going to decline dramatically. But if they've been in a facility for a while, they'll have the opportunity as they decline, they'll have the opportunity to pull up those older memories. You know what the routine is, who these people are, why I'm here.

Steve:

Yeah. And I saw, I saw that firsthand when I was working at a assisted living that was not locked down or secured, but one of the residents had been living there for about nine or 10 years and developed dementia. And she never wants, tried to leave their front door to the point where when we would do outings or she needed to being to go outside, she was like, no, I'm not supposed to go through this store. And, you know, she's my, she might've been somewhere where if she moved once she already had that diagnosis, or if she moved again, she might exit seek. But because she had memories back when she had her cognition of it being a safe place and being her home, she never had to relocate to a memory care because, you know, even when she was confused, she knew exactly that she was still home.

Dr. Domingo:

Exactly. Could you imagine what it would be like waking up every morning and saying, why am I here? Who are these people I need to get out because I don't remember. And I don't know

Steve:

for Adam Sandler on 51st dates, so I can imagine it being hard for seniors making up that way every morning, being terrifying as well, especially in a community.

Dr. Domingo:

I cannot, I cannot make any claims to the scientific veracity of 51st.

Steve:

I do want to hear more about your affiliation with Parkinson's place in and the work you do there.

Dr. Domingo:

Oh, sure. So I am the sole psychologist, the sole mental health professional, really at Parkinson, and I provide the services. To the members to their, to their loved ones. I specialize in Parkinson's disease and caregiving for individuals with Parkinson's and other types of, of dementia is crock chronic neurological conditions. So. Parkinson place has been very good to me and I hope I've been very good to them.

Steve:

Yes. Well, I know when we had Alex on back in September, she spoke very highly of you and was very proud to have you as part of the Parkinson's place, family.

Dr. Domingo:

Aw. Well, that's great. They're an amazing facility and amazing group of people, and they provide an incredible service to this community that wouldn't wouldn't be provided otherwise, if they weren't, they didn't exist.

Steve:

I, you know, listeners, I'm sure you've loved hearing Dr. Domingo here. Talk about Parkinson's and we'll be having them talk more about Alzheimer's and other memory care in a future episode. But what are some other specialties or things you love talking about out in the community of professionals who are listening and might want to have you be a guest speaker for something.

Dr. Domingo:

Sure. I've given lectures on overcoming apathy and depression. I've given lectures on managing caregiver burnout. I've given lectures on caregiving strategies for the people with Parkinson's disease or people with Alzheimer's dementia. I've given talks on suicide prevention. Grief and loss as well. You know, uplifting topics. Yeah.

Steve:

Let's say you're just a, you're a bundle of sunshine orange. Yeah,

Dr. Domingo:

yeah, yeah, totally.

Steve:

And so whether you're a professional, a caregiver or a senior, if you, if they, someone might need your help, what's the best way to connect with you.

Dr. Domingo:

So the best way to connect with me would be through my website, which lists all of my contact information. It is Angelo F domingo.com. That's S as in Sam.

Steve:

Okay. Excellent.

Dr. Domingo:

Oh, sorry. Go ahead.

Steve:

And I will make sure I add that into the show notes as well. So if whoever, wherever you're listening, if you scroll to the, the information about the episode, you can click on over directly to the website.

Dr. Domingo:

Yes, and they can all reach me directly by contacting me at (941) 822-6122.

Steve:

Excellent. I will make sure I include that as well. And thank you very much, so much for your time, Dr. Domingo. Oh,

Dr. Domingo:

you're very welcome. I hope this was helpful.

Steve:

It's I'm sure it was for so many people and we will talk to you again real soon.

Dr. Domingo:

Okay. Bye. Bye.