Musings on the Therapeutic Side of Golf for Movement Disorders

In Health on October 20, 2008 at 2:26 pm

Last year, or the year before, I played golf with a man I had never met who had Parkinson’s Disease. At first he was fearful of telling me why he could play some holes like a pro, and others like it was the first time. I guess he decided that I would understand, perhaps because I wasn’t critical, I wasn’t trying to teach him the game. The conversation that followed made me much more aware of the dimensions of this disease, and of the difficulties we all face, sooner or later, in trying to deal with our finiteness.

I told him I might someday immortalize him in a short story. He requested that I not identify him because he has enough problems without telling the world how “different” he has become. We agreed to use the fictitious name, Sam. I also included some observations (and attributed them to Sam, making him more like a composite) by two other Parkinson patients whom I have since met on a golf course. (Many physicians who specialize in movement disorders recommend golf as excellent physical and mental therapy.)

Sam was diagnosed 14 years prior to our conversation: he was 73 when I met him. The others (call them George-1 and George-2) were also male: George-1 was 62 and had few outward symptoms; George-2 wouldn’t reveal his age, but looked to be in his 80’s, and his symptoms were more pronounced. He only played 9 holes. Later I would understand how important those 9 holes were. They gave him something he could point to, even if only for a little while, and say, “It isn’t over, yet.”

Quotation marks in this blog only mean that I tried to use the words and phrases of the speaker, but some time has passed and I only have cursory notes (jotted down following each game). If I got it wrong, I apologize to Sam, George-1 and George-2, wherever you are, (and to the reader) for any misinformation in the article. However, I have a confidence level of 90-95% that it accurately reflects the intent of the participants, which was to talk about the things you won’t find in a book.


Sam: Parkinson is often referred to as the “nuisance disease,” as though it were only a matter of inconvenience. I can assure you it causes more than inconvenience in the average household. But because it has a very slow rate of progression, and even this is masked by some of the current drug treatments, it sneaks up on us slowly, allowing us to remain in denial for a very long time.

Graham: How long have you had the disease?

Sam: About 14 years. Yes, … I think that’s right. It sounds right.

Graham: You aren’t sure?

Sam: Sure I am sure, but I forget everything for a while, then it comes back.

Graham: You mean recall is slow?

Sam: Yes, that’s it. “Recall.”

Graham: You don’t appear to have dementia, but I notice you are slow to respond.

Sam: I do everything slower. I read slower, I talk slower, I dress and walk slower. Sometimes my legs freeze up and won’t move at all. Everything is affected … including thinking. Sometimes my brain locks up. I get it eventually, but people assume I’m retarded, so I don’t always try to join in.

Graham: Has there been a change in any of your mental abilities?

Sam: You mean, uummm … It’s coming, just a second.

Graham: For example, your “reasoning abilities.”

Sam: That’s it, “reasoning” … no, I can still reason, but I have lost memory skills. My IQ was tested a few months ago, and I haven’t lost much more than the average adult my age. I just process slower.

Graham: What was the actual diagnosis, and what are the symptoms the doctor used to determine the diagnosis?.

Sam: Idiopathic Parkinson’s Disease.

Graham: Idiopathic?

Sam: It’s the most common type. It means cause unknown.

Graham: They don’t know what caused it?

Sam: No. And that’s a problem.

Graham: Hold on a minute. I don’t understand. Isn’t Parkinson caused by pesticides getting into our drinking water?

Sam: Possibly, it certainly is one of the suspects, but the disease has proven to be more complex than originally thought.

Graham: How so?

Sam: We used to think the loss of dopamine producing cells was the cause. We now know that several genes, perhaps 6 to 8, and a few chemical messengers (including dopamine and norepinephrine) are involved. But we remain focused on dopamine because the dopamine system is involved in all of the major symptoms, and we have effective medicines for these symptoms. I take a lot of medicine.

Graham: What’s that about? I mean if you don’t know what causes the disease, why would you throw so much medicine at it?

Sam: Good question, but the answer is still symptoms. Parkinson symptoms can be very debilitating. There is no cure, and there is no medical procedure that can delay the progression. If we don’t know the cause, we can’t know the cure. But we do know the symptoms, and we can and have minimized them.

Graham: Can you tell me … ?

Sam: Wait. Let me finish. While there are no known medicines that can delay progression, coffee in moderation and even smoking cigarettes in moderation have been shown to slow progression. Nobody knows why, but for me it explains why I worked my way up to drinking 2 pots of coffee a day before my system couldn’t take it any more.

Graham: I guess you pick your poison with those choices.

Sam: Literally. And what makes it worse, dopamine, like all chemical messengers has more than one use. It not only affects fine motor movement, it also is used in the pleasure centers of the brain to reward behaviors. When we take our drugs, we can’t restrict delivery of dopamine to only the movement circuits, we also deliver a hit to the reward circuits. The result is, for some patients, the medication (especially the agonists) creates a stimulus for arousal, and sometimes inappropriate behavior. Only 5 or 10% act on these drives; more accurately, the reporting rate is under 10%.

Graham: Are we talking aphrodisiac?

Sam: Officially, no one in the business of medicating Parkinson patients would suggest what seems to be implied, and would be quick to point out that another behavior influenced by the drug is gambling, so maybe the issue is that the drug raises risk-taking thresh-holds.

Graham: I guess it depends on whether or not you can choose your poison.

Sam: All I know is that I have a much higher interest in sex than before I got the disease. You might think this is not much of a problem, but you would be wrong. My wife no longer trusts me because she knows its the drug, not me. She is angry at me a lot. This isn’t just a viagra-type drug, which works on the mechanics of sex. It’s a drug that turns up the libido, and simultaneously undermines the ability to perform.

Graham: They get you coming and going.

Sam: Double whammy. Particularly the agonists.

Graham: As interesting as this is, we still haven’t talked about the set of symptoms used to diagnose the disease.

Sam: I knew I was forgetting something, I’m sorry.

Graham: No problem.

Sam: There are over two dozen symptoms associated with Parkinson, but there are only three main symptoms: tremor, rigidity and bradykinesia. Parkinson tremor is most active at rest. If you have tremor in an arm that you are moving, chances are you have the yips, not Parkinson. Rigidity is stiffness in the muscles. They get harder and tighter, making it difficult to move about and maintain balance, causing postural instability. Bradykinesia is a slowing down of normal movement, and in advanced cases becomes akinesia or lack of movement.

Graham: So the main symptom is loss of motor movement?

Sam: You could say that, yes, but you can also have involuntary movements, or dyskinesias, which are caused by the drugs used to manage bradykinesia. For me, there are other problems that scare me more than losing the ability to move around. That’s the easy part. For a very long time, we can use walkers, motorized carts, or some other means to get around. It isn’t very pretty, but you can milk it for all its worth.

Graham: What would be worse to you?

Sam: The hard part is that Parkinson is a disease that takes away your ability to communicate. It affects speech, which gets softer and softer until you can’t be heard. It affects hand writing, which gets smaller and smaller until you can’t read it. It affects your eyes in a variety of ways, which makes it more and more difficult to read printed material. So while you are becoming more and more dependent on others to help you get around, you are becoming less and less able to communicate with them. You are alone, trapped in a body that is sentenced to watch its own death, unable to connect with either your world or the people in it. Ultimately, it destroys your personality, your relationships, and everything that you spent a life time building. To me, that is the closest approximation to living in Hell I can imagine.

Copyrighted © 2008 by Tad Laury Graham

  1. many of the first people,greet each other by saying yatahe. so yatahe graham. some of the tribal people will say yatahe, peace to you. i dont understandyour definition, but then i didnt understan why my granddaughters teacher call me a puckered shoe instead of aishinabe. our mocassins where puckered but how could she say my name is a shoe. lol i am CHIPPEWA so please if you teachabout us MAKE US PROUD! again LOL

    • You don’t need me to make you proud. You have every right to be proud without asking me or anyone else for permission. As for the shoes, you are not the names that people sometimes call you, nor are your shoes the names that they may be given. If a rose by any other name is still a rose, then why would your shoes be an exception? However, I offer the following for your consideration: people in my tribe often speak in analogies, comparisons, and other indirections to test the waters. There is the possibility that she may have thought she was befriending you. She probably meant no harm, and you may want to test the waters before jumping in (see, even I do it). My suggestion would be to make sure she truly isn’t a friend before casting her in the role of an enemy.

  2. Yatahe –

    I didn’t realize that you were one of the “original people,” or I would have known that you already have the courage and strength of character to see this through. While I may never fully understand the ways of the anishinabeg as you have said, I nonetheless respect what you must do, and my heart goes out to you for the difficulties that lie ahead. Know that somebody cares, and that I will send good thoughts from time-to-time. I do this out of respect, not pity, in memory of an Anishinabe who helped me repair my motorcycle, when it broke down in North Dakota more than 30 years ago, a long way from home.


  3. dear mr graham thank you for all your good wishes but before i read anymore, i must find a oneness in my spirit. Get back to my rez great spirit, mother earth. its time for healing cant read anymore, have to feel anishinabe with my Ojibwa family .you have a great way with your words mr graham but the people have that quiet way, anishinabe way. our people are so different mr graham, but i hear your thoughts keep writing,peace sam. yatahe ps. i must admit i wont be reading how bad it can get, not strong enough. YET

  4. Dear Will Forbes

    I hope that I have not done anything to discourage you from fighting the battle with Parkinson. It is true that the end is pretty much the same, but the journey can be whatever you decide to make it. I have read a number of books and articles since writing this blog, and the one thing that I have come to understand is that attitude plays a significant role in how well the patient does.

    If you want to understand how bad it can get, I recommend that you read “Shaking Up Parkinson Disease: Fighting Like a Tiger, Thinking Like a Fox,” by Abraham Lieberman, MD (Jones and Bartlett Publishers, 2002). But before you read the negative view, please read “What Your Doctor May Not Tell You About Parkinson’s Disease,” by Jill Marjama-Lyons, MD (Warner Brothers, 2003).

    I could suggest others, but you can’t go wrong starting with these books. I also suggest that you get in touch with local Parkinson organizations to take advantage of their expertise and educational seminars. Both The National Parkinson Foundation and the American Parkinson Disease Association can provide you information on how to find local support groups.

    If you haven’t done so already, contact them soon at and, respectively.

    Sincerely Wishing You the Best,
    The World According to Graham

  5. dear sir thank you for your honesty. we meaning my hushband has just been dx by the mayo.i have just read the letter that jim has bradykinesia. so i been on the internet for 3 hours and have come across your article. i feel in my heart a great saddness. i know myand jims comfort and courage will come from God.but the road looks long andhard. bless you will peace forever

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