September 19, 2016

My Kathmandu Family Returns to Nepal To Celebrate Nivah's "First Feeding"

As I wrote in my last post, my love affair with Nepal -- which started in 2001 -- has generated two sets of relationships that are so close and loving that I think of them as my "Pokhara family" and my "Kathmandu family."

Last time out, I gave an update on the Pokhara family. So today here's:

My Kathmandu Family
This family connection was born in a bookstore in Thamel, Kathmandu's tourist district. All my trips to Nepal -- over a dozen of them -- began and ended with a few days in KTM.

Every day I was there, I'd buy the latest edition of the International Herald Tribune at the same family-owned and operated bookstore.

I got to know the family quite well. The younger son, Nimesh, came to the U.S. to attend Truman University in Kirksville, Missouri. He worked in Ocean City, Md. during his college summers and often spent a few days at my house on his travels back and forth.

After getting his undergraduate degree at Truman, Nimesh enrolled in an MBA/Finance program at American University. AU is within walking distance from my house. So Nihesh stayed here.

He continued to reside here at the house as he began a career at the World Bank in downtown DC, an easy commute from the house.

From Friends to Family
Through these years, Nimesh and I became good friends. But I didn't think of us as family. That relationship began in March, 2012, when Nimesh married Bhawana in a traditional Nepali/Hindu ceremony in Kathmandu.

This was also a traditional marriage, since their parents had made the initial arrangements. But there was a modern twist: both sets of parents encouraged the couple to spend a lot of time getting to know each other. The parents said they wouldn't insist on the marriage if the prospective bride and groom didn't feel it would work.

Bhawana was finishing up her studies in an MBA/Finance program at the University of Wales satellite school outside Mumbai. She and Nimesh spent hours talking on Skype. As this picture shows, the arranged marriage became a love marriage.

Often during those happy festivities, I was treated like a member of Nimesh's family. One of the first things that happens in Hindu weddings is the trip that the groom makes to the wife's home for the "engagement." For upscale weddings in India, the groom often makes this trip riding an elephant.

September 16, 2016

My Pokhara Family's Comings and Goings

As readers of this blog know, I've had a 15-year love affair with Nepal and its people. It started with my first visit to Nepal in March, 2001. My London pals Terry and Patrick and I added a few days in Nepal at the end of our tour of India in February, 2001.

Our brief time in Nepal was divided between Kathmandu -- the crowded, bustling capital -- and Pokhara, the beautiful lakeside city surrounded by snow-capped mountains. Pokhara is the jumping-off point for treks in the Annapurna mountains.

I maintained email contact with several people I met on that trip. One of them, Ramesh Pariyer, invited me to return to Nepal in the fall and accompany him to his mountainside village for the celebration of Dashain, the country's biggest, longest, and most auspicious festival.

That journey was the most memorable and enjoyable trip in a lifetime filled with travel adventures. I returned to Nepal at least once -- usually twice -- every year until 2008, when my Nepal connection began to shift into reverse as more and more of my Nepali friends relocated to the U.S.

I now have many Nepali friends here and back in Nepal. Two of those local relationships have become so close that I think of them as my Pokhara family and my Kathmandu family.

Here's the Pokhara family enjoying an outing with me on the island in Pokhara's Lake Fewa. Left to right are Laxmi, Rahil, Ramesh, and the aging "white monkey," a moniker given to Westerners by some Nepalis.

And here they are more recently. The family is wearing Nepali attire, but the photo was taken near their apartment in Washington's Maryland suburbs. Above, Rahil was all dressed up to celebrate his third birthday. Below, he's as tall as his parents:

A Sad Farewell
Here's a shot taken a few weeks ago in my home office. With me are Ramesh's parents, who -- in their first trip outside Nepal -- had spent several months visiting Ramesh and his family in Maryland.

September 6, 2016

Peripheral Neuropathy and Parkinson's and Me

When I was diagnosed with Parkinson's disease (PD) in September 2009, my doctor prescribed the gold standard med -- carbidopa-levodopa (brand name Sinemet).

At first, I took two pills of the regular carbidopa-levodopa 25-100 three times a day, and the dosage has increased several times since then. Now, I take two pills of the extended release carbidopa-levodopa 25-100 seven times a day.

My disease no doubt will continue to progress, but I’ve reached the maximum recommended dosage of the drug. Recently, I've noticed that the Sinemet isn’t working like it used to. My "off periods" between doses have increased, and I certainly don’t walk as well as I did six months ago.

In addition, I'm having more frequent incidents of orthostatic hypotension and strange flare-ups of incontinence. Washington’s summer heat and humidity bother me more than ever, and -- for the first time -- I'm experiencing occasional bouts of depression.

I'm not a happy camper. Questions abound.

Is some of my malaise due to the lingering effects of my shingles attack? Since I’ve clearly had PD for at least ten years, are these troubling developments simply signs that the disease is moving into its final stages? 

Are things going on that my doctors and I haven’t yet identified?

Peripheral Neuropathy
That last question brings me to today’s topic. In rereading some of my medical records, I was reminded that one of my PD doctors had wondered whether I was experiencing peripheral neuropathy (PN) in addition to Parkinson's disease.

A Google search on PN produced this info from the Mayo Clinic:
If autonomic nerves are affected, signs and symptoms might include:
  • Heat intolerance and altered sweating
  • Bowel, bladder or digestive problems
  • Changes in blood pressure, causing dizziness or lightheadedness
I certainly recognize those bullet points.

September 5, 2016

Happy Days Are Here Again... Temporarily

Over this Labor Day weekend, we're finally getting a break from Washington's Summer from Hell. We have enjoyed a few days with high temperatures reaching only the low 80s, and nighttime lows in the 60s. But come Tuesday, the temperature is expected to climb back into the 90s, and by Friday we may be up close to 100 again.

But this respite -- and my response to it -- encourages my hope that my energy and spirits will rise when the temperatures finally drop. On Saturday afternoon, I spent more time on my back porch than I had over the past two months.

And more enjoyable time, too. I must've spent an hour watching a deer with a full set of antlers feeding on my Joe Pye Weed foliage, drinking from the waterfall in my pond, and settling down on the path in the back of the yard for a siesta.

As you'll see, my photography won't win any prizes. Fortunately, the finger I had over my iPhone's lens didn't completely ruin this shot of the deer emerging to drink from the waterfall.

Throughout this encounter, I wished I'd learned how to capture close-ups.

I got off my back porch rocking chair and out into the yard to see how close I could get to the resting deer.

September 1, 2016

Parkinson's Nonmotor Symptoms

Earlier today, I shared a terrific article from September‘s Mayo Clinic Health Letter, which provided an excellent overview of Parkinson’s disease (PD). I was especially interested in the information about the "support drugs” that might enhance the effectiveness of carbidopa-levodopa (Sinemet), the current gold standard med for treating PD.

As a follow-up, I want to share another Mayo piece about the flip side of PD -- its nonmotor complications. I’ve written often about this subject, especially how the serotonin-boosting over-the-counter supplement 5-HTP has helped me deal with three common nonmotor issues people with Parkinson’s often experience: depression, insomnia, and constipation.

Here’s that article.

<>  <>  <>  <>  <>  <>  <>


When most people think of Parkinson’s disease, the signs and symptoms that come to mind are movement (motor) related, such as tremor, slowed movement and rigid muscles.

However, there’s another side of Parkinson’s symptoms — nonmotor symptoms. It’s increasingly recognized that nonmotor symptoms or complications may be as prominent as movement-related symptoms in the effect Parkinson’s has on your life. The good news is that many of these nonmotor symptoms are treatable or manageable. Treating them can have a major impact on how active and independent you can remain as you manage the progression of Parkinson’s disease.

Taking Action
It’s important for your doctor to determine if nonmotor symptoms may be related to dopamine drugs used to control movement symptoms. If so, fine-tuning your dopamine drug regimen may be an option for improving many nonmotor symptoms. Sometimes, this works with no unwanted effects.

However, there’s a balance point where benefits of adjustments must be weighed against the downside of possible decreased movement control.

Excellent Mayo Clinic Update on Parkinson's Disease and its Latest Therapy Options

I subscribe to many health newsletters. These two are my favorites:

This month’s issue of the Mayo Clinic Health Letter leads off with one of the best descriptions I’ve seen of Parkinson's disease (PD) and its treatment. I was going to summarize the article but decided to run it in full, below. 

I didn't learn anything startlingly new from the article. But the section on supportive drugs used to extend the benefits of carbidopa-levodopa -- for those of us with more advanced PD -- reminded me it was time to check some of them out. 

Here's the full text:


Parkinson’s disease is widely recognized but poorly understood by most people. It seems to be a bad disease, but then many people who can have it appear to be doing fairly well.

However, Parkinson's disease signs and symptoms progressively worsen, and the beneficial response to drug therapy is likely to diminish. In addition, Parkinson's disease can result in numerous other health problems — such as dementia, bladder and bowel difficulties, and sleep trouble. Working closely with your doctor can help you stay abreast of standard and newer treatment options as signs and symptoms change for you over time. It's true that people diagnosed with Parkinson's disease — most of whom are 60 or older — typically have many more active and productive years of life ahead of them. Drug treatment aimed at managing the better-known signs and symptoms such as tremor and difficulty with movement is often very effective for years.

Lost connections
The primary process that causes Parkinson's disease signs and symptoms is when dopamine-producing nerve cells in the brain die prematurely. Brain cells communicate with each other through chemical messengers called neurotransmitters. Dopamine is one of the main neurotransmitters in the brain.

In a healthy brain, ample dopamine is produced so that the brain cells can coordinate smooth and precise muscle movements. However, when dopamine-producing cells are lost, brain cells communicate abnormally with muscles, which can lead to impaired body movement.