You're beautiful...

"You are imperfect, permanently and inevitably flawed. And you are beautiful." -  Amy Bloom

Understanding Parkinson’s disease

THE most common reaction for most people first diagnosed with Parkinson’s disease would be one of disbelief. This would quickly progress to denial. Family members and friends would also be equally affected by the news.

It would be understandable if the first question that crops up is: “How are we going to cope?”

That denial kicks in almost immediately for many Parkinson’s sufferers and their families is a given. However, getting over the denial is a crucial if a sufferer and caregiver want to cope with the consequences of a positive diagnosis of this disease.

So it is paramount to learn as much about the disease, and understand how treatment can help sufferers improve their quality of life.

What is Parkinson’s disease?

Parkinson’s disease (PD) is a brain disorder that occurs when certain nerve cells or neurons in the brain die or become impaired. When this happens, these cells no longer produce a chemical called dopamine, which facilitate the smooth, coordinated function of our muscles. When about 80% of these neurons die or get damaged, that’s when Parkinson’s makes an appearance.

One of the misconceptions about Parkinson’s disease is that it’s a disease of old age. It’s not. Just ask Michael J. Fox, who was diagnosed with the disease when he was 30 years old.

The tell-tale signs include tremors, slowness of movement, rigidity, difficulty with balance, small, cramped handwriting, stiff facial expressions, a shuffling walk, muffled speech, and depression.

There is a misconception that Parkinson’s is an old-age disease but, in fact, about 15% of people diagnosed with Parkinson’s come from the 50-year-old and below age bracket. The disease strikes anyone regardless of gender, age, social status, culture, or profession.

And it gets worse as the process of diagnosing the disease is difficult, at best, as there is no one simple test when it comes to confirming the presence of Parkinson’s. A doctor can only arrive at a diagnosis for the condition only through a patient’s medical history and a series of physical examinations.

Magnetic resonance imaging (MRIs) and blood tests can help rule out other conditions that have similar symptoms, but those who are suspected to be suffering from Parkinson’s should seek out a neurologist who specialises in Parkinson’s Disease.

Parkinson’s is also not just a movement disorder as patients can also suffer from a long list of non-motor symptoms such as depression, confusion, hallucination, anxiety, and dementia as well as intestinal disorders, loss of sense of smell, and sleep disturbances.

It is also believed that several non-motor symptoms such as loss of sense of smell, depression, sleep disorders, fatigue, anxiety, and constipation may precede the motor symptoms of Parkinson’s by a few years, and thus can be considered as early symptoms of the disease.

Can it be treated?

Parkinson’s remains an incurable illness. Due to the progressive loss of brain cells, Parkinson’s progresses with time, resulting in gradual and inevitable deterioration of the initial motor symptoms. As the illness advances, the non-motor symptoms such as psychiatric disorders also become more frequent, especially during the advanced stage of illness.

In addition, many patients also develop involuntary body movements and suffer reduced effects of medications towards the later stage of the illness. All these complications result in long-term disability in Parkinson’s patients and in almost all aspects of life – physical, mental, occupational, and social.

There are, however, a number of effective medicines that help ease the symptoms of the disease. Most symptoms are caused by a lack of dopamine, and medicines most commonly used will attempt to either replace or mimic dopamine, which help to reduce tremors, lessen rigidity, and improves slowness of movements associated with Parkinson’s disease. Several new medicines are also being studied that may slow the progression of the disease. Many promise to improve the lives of people with the disease.

Medications used in the treatment of Parkinson’s disease in Malaysia

When it comes to treating Parkinson’s disease, there are different classes of drugs used at different stages of the disease – most often in combination or sometimes on its own depending on the severity of the condition, the age of the sufferer, and tolerance to medication. Initial treatment is individualised.

The classes of drugs used are levodopa, dopamine agonists, COMT-inhibitors, MAO-B-inhibitors, and anticholinergic drugs. Constant monitoring by the neurologist, patient and caregiver is crucial in determining the right dosages and types of medications to treat the condition. And each case is unique.

For early (initial) to moderate stages of Parkinson’s (five to 10 years), most patients (especially younger Parkinson’s patients) are prescribed dopamine agonist drugs such as ropinirole and can live a reasonably good quality of life while delaying the onset of motor complications or dyskinesia and the need for levodopa treatment. Levodopa will be used at a more advanced stage.

Dopamine agonist medications help to enhance the activity of dopamine in the brain to relief the symptoms of Parkinson’s. As the disease advances, they can also be used to treat motor fluctuations.

However, as the physical disability of Parkinson’s patients become more severe with time – after 10-15 years – many of them have difficulty carrying out daily activities despite taking maximum medications – a combination of many of the classes of medications.

Also, it has to be emphasised that Parkinson’s patients can only expect up to 90% level of improvement even with the best medications. Parkinson’s treatment cannot completely compensate for the dopamine deficiency in the brain. It is important that Parkinson’s patients be realistic in their expectations – there are no ideal medications for this illness. When the illness advances, and when patients’ symptoms are no longer well-controlled with medications (e.g. uncontrollable tremors), brain surgery can be effective in relieving the main symptoms of Parkinson’s such as slowness of movement and tremors. Currently, surgical treatment or Deep Brain Stimulation (DBS) surgery is available in Malaysia, but the treatment is costly.

Living with the treatment – its side effects

The side effects generally associated with Parkinson’s drugs are nausea, vomiting, and dizziness. The most serious side effects are involuntary body movements, which usually manifest as uncontrollable and unpredictable jerky body movements, and are triggered via prolonged use of levodopa.

The problem about the involuntary body movements is their irreversibility – once they have started, they persist for life. They are also an important cause of social stigma, as Parkinson’s patients frequently feel embarrassed by the stares of the general public – the involuntary body movements make Parkinson’s patients look “odd”.

As such, levodopa is best avoided during the early stages of Parkinson’s in order to prevent the development of the involuntary body movements or dyskinesia.

This has led to the suggestion that dopamine agonists should be used for initial treatment in newly-diagnosed Parkinson’s patients. A dopamine agonist drug has longer duration of effect on brain cells than levodopa and reduces the “wearing off” phenomenon while improving the 24-hour control of symptoms when taken regularly.

Dopamine agonist drugs can cause side-effects such as nausea, dizziness, sleepiness (sleep attacks), confusion, and low blood pressure. Fortunately, new medications like ropinirole appear to have a significantly lower frequency of side-effects and perhaps future drugs will lower the frequency even more.

Still, it is very important for Parkinson’s patients to follow a schedule of medications strictly, especially the timing of medication. Medications have to be taken at regular intervals in order to avoid or minimise the “on” and “off” periods.

When medication wears off, patients will experience stiffness and trembles – the “off” period. These fluctuations occur during the more advanced stages of the disease when the effect of medications is no longer sustained or consistent.

Other possible treatments

The discovery of Deep Brain Stimulation (DBS) surgery in the late 1990s was a major breakthrough in the treatment of Parkinson’s. The improvement in the symptoms of Parkinson’s following DBS surgery is dramatic. This surgery is suitable for those in the advanced stages of Parkinson’s after the effects of medications have diminished.

Apart from DBS surgery, there have not been many breakthroughs in treatment for Parkinson’s disease.

Stem cell treatment (through transplantation) for Parkinson’s has received a lot of attention recently. However, stem cell treatments overseas have not been proven effective. Many technical issues still need to be resolved before it can be recommended to Parkinson’s patients.

There are too many issues attached to stem cell treatment, namely on ensuring the survival of transplanted brain cells and the use of aborted human foetus. The procedure itself is also very expensive as it requires the highest level of technology and medical expertise.

For further information on Parkinson’s, please refer to www.lloydtan-trust.com, the official website of Lloyd Tan Parkinson’s Trust Fund.

"Everything is just as it needs to be. And if we would forgive, our minds and hearts would open and we could see another possibility."

—  Iyanla Vanzant

Gratefulness can be a winning business strategy

Gratefulness can be a winning business strategy
A study, which began in 1986, of a group of nuns from the city of Mankato in the United States who have outlived many others, has astonished the world. The most surprising result, of this Nuns of Mankato Study by David Snowdon, is the discovery that the way we express ourselves in language, even at an early age, can foretell how long we'll live and how vulnerable we'll be to Alzheimer's decades down the line.
Snowdon found that the nuns who had expressed the most positive and gratitude-based emotions in their writing as girls ended up living longest, and that those on the road to Alzheimer's expressed less gratitude and fewer positive emotions. His conclusion: If you want to live longer, be positive and show gratitude.
Throughout history, gratitude has always been high on the list of virtues. Cicero, the Roman philosopher ranked gratitude as the chief of all virtues, parent to all others. I concur with Cicero and apparently science does too.
Research by Jeffrey Froh, shows that habitually grateful people have more energy, optimism, social connections and happiness. They're less likely to be depressed, envious, greedy or to become alcoholics. They earn more money, sleep more soundly, exercise more regularly and have stronger immune systems.
Science can now prove that gratitude improves psychological, emotional and physical well-being. “A lot of these we learned in kindergarten or from our grandmothers, but we now have scientific evidence to prove these findings,” Froh adds. If gratitude does all that, why is there absolutely no focus on it in business or in our lives?
A few weeks ago, we erected a “Gratitude Board” in our office, and some began excitedly posting messages of gratitude to others. Others scoffed at the board, shaking their heads at why others were posting soft mumbo-jumbo messages. And again, I wondered, since gratitude is scientifically proven to make employees more productive, why do people scoff at its usefulness and what is its place in business?

Words that matter: It’s when you feel terrible, that it is the best time to write thank-you notes. Businesses should write a note of gratitude to customers without anything else on the agenda.

What is Gratitude?
Gratitude means counting your blessings, being thankful, and acknowledging everything that you receive. It is living your life as if everything were a miracle, being aware incessantly of how you have been blessed by others. Gratitude shifts your focus from what your life lacks to the richness that is already present.
As simple as it sounds, gratitude is actually a multifaceted emotion that requires “self-reflection, the ability to admit that one is dependent upon the help of others, and the humility to realise one's own limitations,” claims Emmons, another gratitude researcher.
Gratitude is not for the “intellectually lethargic.” Emmons postulates that gratitude is discordant with feelings of victimhood or entitlement. “Far from being a warm, fuzzy sentiment, gratitude is morally and intellectually demanding. It requires contemplation, reflection and discipline. It can be hard and painful work.”
Emmons, together with psychologists McCollough experiments, confirms gratitude results in higher reported levels of alertness, enthusiasm, determination, optimism, creativity and energy. Additionally, grateful people are more likely to help others and faster progress toward achieving personal goals. The study revealed that practising gratitude increases happiness levels by around 25%. If only we could improve happiness levels at the workplace by 25%, we may be on to unleashing a high performing team capable of achieving great results. Aren't these the type of people we need in our businesses?
Gratitude cures
Froh's research team found that the more grateful students had more friends and higher GPAs, while the more materialistic had lower grades, higher levels of envy and less satisfaction with life. “One of the best cures for materialism is to make somebody grateful for what they have,” adds Froh.
Founder of Berkshire Hathaway, Warren Buffett, one of the richest men on earth, ascribes part of his success to his grateful nature. He has frequently expressed his gratitude for having been born at the right time and place and for the wealth that he has been able to create. Even though he is rich, he has not an ounce of materialism in him, and he shows his gratitude by giving back his accumulated wealth to society.
Last year, as part of our Talent Acceleration programme, we took a group of Malakoff high-potential talent to visit the LaFarge factory and to meet its CEO, Bi Yong Chungunco.
Gratitude and happiness
Bi Yong, is an incredible leader, who is well-loved by her employees. As she spoke to our team, she showed extreme humility and gratefulness in every aspect of her life, in spite of having so many obstacles thrown her way.
Having lost her husband and having to face tremendous issues being a woman in a male dominated industry, her positivity drove her to succeed against the odds.
Listening to her reinforced my belief that if we are to reach happiness (which is the goal for many people), gratitude needs to be a core virtue we practice. We tend to forget that happiness doesn't come as a result of getting something we don't have, but rather of recognising and appreciating what we do have.
Being grateful also forces people to overcome what psychologists call the “negativity bias” the predisposition to dwell on difficulties, frustrations and inequalities rather than positive blessings.
A few weeks ago, I interviewed Marshall Goldsmith, a top business coach for The Leaderonomics Show. Throughout the interview, Goldsmith kept repeating his gratefulness of how good things happened to him “by accident”. Being grateful keeps him positive and when you are in a positive frame, positive things tend to happen. The Law of Attraction states that if you are in a negative frame, you tend to attract negativity.
So if you are in a traffic jam and you become negative, the traffic jam becomes worse. However, even if you are in a bad situation and you are positive, generally more optimistic things tend to “accidently” happen, Goldsmith clarifies.
Gratitude in business
Business leaders may understand the importance of gratitude but how does being grateful add to their numbers. We have already seen how gratitude drives employee productivity, increases workplace happiness and energy-levels. And now we are finding that gratitude also helps expand “wallet-share.”
Numerous businesses have actual grown by showing gratitude to their customers. Instead of going after new customers and increasing market-share, businesses that have gone back to old clients and thanked them, and developed deep relationships, saw a huge increase in profitability. Expanding your “wallet-share” is getting your customers to buy more of your products and to buy other products that you offer, which they may not be buying at this point in time.
Gratitude does not mean sending your clients a letter with a sales hook like, “To thank you for being a special customer, we're giving you 20% of all our XXXL orange shirts from now till we make our sales quota.” People see through those insincere gratitude letters.
A business may show their appreciation by offering chocolate with the bill, or other simple thank you gestures but it needs to come across as genuine or its better not to show gratitude at all. People see through fake motivations. Gratitude is a precursor to trust and trust is a powerful driver for loyalty.
“Gratitude motivates positive reciprocal behaviour,” says Professor Raggio. If a customer believes that a business has his best interests at heart, that customer is more inclined to develop a long-term relationship with the business.
And don't just show your gratitude once a year during festivals or at annual customer appreciation dinners. Instead, build it into your daily and weekly customer plans and policies. Customers are more likely to come back, give referrals, write positive reviews online, or perhaps be willing to pay more later on.
Author John Kralik started writing appreciation notes to his staff and clients and quickly saw a link between his thank-you notes and his business thriving again. I personally write handwritten thank you notes and many have kept those notes for years, using them to gain inspiration. It's when you feel terrible, that it is the best time to write 10 thank-you notes.
When employees notice that you thank them for their efforts, they will naturally work even harder to please you in the future. Recognising the work of an employee improves their performance. And a sincere compliment will always improve your workplace connections and satisfaction.
Being grateful
Dale Carnegie believed that the desire to be appreciated is a “gnawing and unfaltering human hunger.” Think about your many contributions to the people around you.
Do you get thanked enough? Does the gratitude-to-criticism ratio you experience feel right to you? You can change the ratio by acknowledging those who help you daily, from the barista who made your coffee to your employee that got you the report on time.
Gratitude can change people's lives but it takes mental toughness and discipline. Here is my top-10 gratitude checklist for you to become a more grateful person:
● Set-up a Gratitude Board in your office and home and watch gratefulness flow.
● Keep a Gratitude Journal. Count your daily blessings and jot down at least 3 good things that happened to you each day. You will be surprised how blessed you are.
● Mind Your Language. Don't use negative words, even when talking to yourself.
● Pause deliberately throughout the day. Stop what you are doing and look for things to be grateful for. You will start seeing blessings everywhere.
● Write a gratitude letters to people who have exerted positive influence in your life.
● Have a monthly “Gratitude Visit” to someone you have been grateful for in the past and personally thank them.
● Make a vow to practise gratitude. Psychologists believes that “swearing a vow to perform a behaviour actually increases the likelihood that the action will be executed.”
● Don't count sheep. Instead, count your blessings as you fall asleep review events and people you are grateful for during the day.
● Write a note of gratitude to your customers. Don't put anything else on the agenda other than expressing your thanks and appreciation.
● Put gratitude on your calendar schedule time to send thank you notes to clients, employees and to say thank you to your family and friends.
Final thoughts
In spite of knowing gratitude is good, everyone, from business leader to student, suffer from “Gratitude Deficit Disorder.” We all receive much more condemnation than gratitude. We are hungry for genuine appreciation. We want to know that we matter, that our efforts are making the world a better place. Mother Teresa once said that “there is more hunger for love and appreciation in this world than for bread.” She is right.
And your customers, suppliers, employees, co-workers, friends and family need gratitude. There is a global hunger for gratitude. Feeling gratitude and not expressing it is like wrapping a present and not giving it.
So, instead of being world-class complainers, why not challenge yourself to start off today showing your gratitude to your employees, customers, friends and family. You may just end up living as long as those nuns of Mankato.http://mystarjob.com/articles/story.aspx?file=%2F2012%2F4%2F30%2Fmystarjob_features%2F20120430163515&sec=mystarjob_features

Second chances...

"Second chances come along all the time. It's up to us to recognize them." - Katherine Russell Rich

In pursuit of happiness...

"I've come to believe that seeking happiness is not a frivolous pursuit. It's honorable and necessary. And most people forget even to think about it." -  Goldie Hawn

get it right...

If you get the inside right, the outside will fall into place. - Eckhart Tolle

***SLEEP***

"Sleep is that golden chain that ties health and our bodies together."
  - Thomas Dekker

Contentment

Quash the urge to improve, to be better. It only makes you feel inadequate.
And then explore the world of contentment. It’s a place of wonderment.

‘Contentment is the greatest treasure.’ ~Lao Tzu

Courage, like fear, is a habit....

"Courage, like fear, is a habit. The more you do it, the more you do it, and this habit—of stepping up, of taking action—more than anything else, will move you in a different direction." -  Tony Robbins

[Kindness]

"[Kindness] is a most edifying form of instant gratification." - Krista Tippett