What does it mean to endure?

The theme of this month's Diagnote is endurance. How would you define the word endurance? What is encompassed by this term?

The Greek noun translated as endurance (hypomone) usually conveys courageous, steadfast or patient persistence that does not lose hope in the face of obstacles, adverse trials or persecution. It is the virtue that can transmute the hardest trial into victory because beyond the distress it sees the desired goal. The good book states it this way: "You have need of endurance" (Hebrews 10:36).

It is likely that all who read DVM Newsmagazine have faced, or are presently facing, obstacles that require a measure of endurance. Some of these obstacles can be readily resolved with the expenditure of comparably little effort. Other obstacles are persistent; despite an enormous amount of physical and mental effort, they cannot be resolved. They require sustained endurance.

What is Parkinson's disease?

Some of you may recall that I wrote about Parkinson's disease approximately three years ago. As I mentioned then, I learned in 1995 that I had Parkinson's disease, a progressive movement disorder. Please let me emphasize an important point. I have had Parkinson's disease for at least 15 years, but during that time, Parkinson's disease has not, does not and will not have me.

Thoughts on endurance (PHOTO: BRAND X PICTURES/GETTY IMAGES)

You may recall that Parkinson's disease is a slowly progressive neurodegenerative illness typically characterized by tremors, stiffness (rigidity), slowness of movement (bradykinesia) and difficulty with balance (postural instability). As in my case, not all people with Parkinson's disease develop involuntary muscle tremors. Symptoms of Parkinson's disease appear when there is insufficient dopamine in parts of the brain (e.g., substantia nigra). Dopamine is a neurotransmitter that allows neurons to transmit messages between each other and then to muscles, which, in turn, allows normal movement to take place. For reasons not yet completely understood, many of these cells die in people with Parkinson's disease. The remaining cells do not produce enough dopamine to permit normal muscle function.

What are some of the effects of Parkinson's disease?

At one time in my life, I was blessed with seemingly endless energy. I enjoyed challenging problems and relied upon my limitless energy to help solve them. However, living with Parkinson's disease for the past 15 years has forced me to adjust my priorities. I still enjoy challenges, but I have learned to accept the fact that my energy has definite limits. At somewhat unpredictable times during each day, my energy level falls, forcing me to take a break. That is partly related to the fact that, as a result of Parkinson's disease, all voluntary muscle movements require more effort than normal. It is frequently difficult for people with Parkinson's disease to get a restful night of sleep. As the effects of medications wear off during the night, muscle stiffness, muscle cramps and distracting paresthesia occur. I liken the sensation associated with paresthesia to the burning sensation you feel in your hands and feet after they are exposed to extreme cold or to the sensation of stepping on cactus thorns with your bare feet. As you might expect, a sleepless night tends to reduce one's productivity during the day.

Unfortunately, the medication I am taking (carbidopa-levodopa — also known by the trade name Sinemet [Merck & Co]; Sin means without and emet means vomiting) no longer works smoothly or consistently, even though I take it approximately every two hours. The medication is associated with troublesome side effects that typically occur when the drug is at therapeutic levels and include periods of jerky, involuntary movements (collectively called dyskinesia) that interfere with my normal gait. These side effects usually develop after taking the medication for several years and progressively interfere with mobility. They cause exaggerated muscle movements that also consume more energy than normal and sometimes result in muscle pain due to overuse.

Every muscle in an afflicted person's body may be affected to varying degrees. For example, when the beneficial effects of my medication are wearing off, the muscles involved in my speech are at times affected, and my voice sometimes becomes weaker and higher-pitched, which is sometimes misinterpreted as a sign of anxiety. This likely occurs because of weakness of my intercostal muscles and diaphragm. Simply put, I have not inspired enough air into my lungs to exhale and complete the sentence. Also, at times, I may not clearly enunciate words (slurred speech). When this pattern of altered speech occurs, I ask those participating in a discussion to ask me to repeat the words that were muffled or slurred. Unfortunately, some individuals avoid talking with me, apparently because engaging in conversation is too difficult.

Sometimes my facial muscles are also affected inasmuch as they don't function automatically (neurologists call this facial masking). Unless I remember to tell myself to smile, it may appear that I am uninterested or in a bad mood. But if and when an opportune moment occurs, I explain my situation to those who have an interest and let them know that I still enjoy taking part in conversations. Also, I tell them that I am smiling on the inside.

Can endurance help you?

Perhaps you or a family member are faced with problems that will become progressively more severe with time. What can you do? How can you keep a positive outlook? What can you do to sustain a reasonable quality of life? The quotations presented on page 10S about endurance have helped me to keep smiling inside and out. By so doing, I tend to block out Mr. Parkinson and find that my endurance and quality of life increase. I share these quotations with you with the hope that they may bring some comfort to you, your family and your friends.

Epilogue

If we are guided by the enduring principle that there is greater happiness in giving than in receiving, then it is apparent that our greatest reward for doing is the opportunity to do more. In this context, happiness is a byproduct of doing things for others and not an end in itself.

In reflecting on the activities and accomplishments of colleagues, friends and family whom I have known during my lifetime, it is my conclusion that what we do for ourselves dies with us. In contrast, what we do for others lives on. Therefore, until the day arrives when our lamps of service are extinguished, let us continue to give of our talents, our empathy and energies on behalf of the welfare of others.

Dr. Osborne, a diplomate of the American College of Veterinary Internal Medicine, is professor of medicine in the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota.

For a complete list of articles by Dr. Osborne, visit dvm360.com/osborne.