Friday, May 30, 2014

Window of Opportunity excerpt


Living with the Reality of Parkinson's and the Threat of Dementia


Smashwords Edition
Copyright © 2013 Kirk W. Hall
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without the prior permission of the author.
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Other books by Kirk Hall

Carson and His Shaky Paws Grampa (Innovo Publishing, 2011)
Carina and Her Care Partner Gramma (Innovo Publishing, 2013)
For more information or to order, visit


To my wife, Linda, with all my love
To all my brothers and sisters in the Parkinson's community


Reader comments

National Parkinson Foundation Medical Advisor
Professor of Neurology
University of Florida

Kirk Hall delves into the frightening possibility of developing dementia as his Parkinson’s disease progresses. Candid, insightful, and forward-thinking, Kirk demonstrates through his book and his advocacy that cognitive impairment in Parkinson’s disease is not an end to life, but simply a turn in the road that must be negotiated and accepted, but not surrendered to. Window of Opportunity is a must-read for anyone concerned about cognition in Parkinson’s."

Angela Taylor
Director of Programs
Lewy Body Dementia Association

“I just opened the first chapter about 2 hours ago and couldn’t stop….I just finished it. It is an excellent book!” 

Carol J. Walton
CEO, Parkinson Alliance

"Window of Opportunity" is a unique, first-hand account of the "in between time" that comes upon acceptance of a diagnosis and before succumbing to an illness. This thoughtful, unflinching narrative explores the author's journey from his diagnosis of Parkinson's disease in 2008 through his research into the mysterious threat of cognitive dementia in his future.

When my mother was diagnosed with Lewy body dementia, I searched for a book like ‘Window of Opportunity.’ It is a touchstone for those struggling with a dementia diagnosis and the people that love and care for them.” 

Leigh Ramsey
Daughter who lost her mother to LBD

“Just finished reading the manuscript and can truly say what a wonderful book this will be for so many people…PWP, family members, caregivers. It was an easy read, honest, ‘story like’ which, for me, lends itself to being a page-turner. You could truly hear your voice, the passion and desire, to help educate others.”
Cheryl Fortunato
Daughter of an LBD patient

Your book is an excellent piece of work. I particularly enjoyed reading about your history and your approach to handling the difficult things God has allowed you and your family to face.  The chapter on faith was inspiring and very humbling. I can only imagine how useful this book will be to a large number of folks who are facing similar situations.”

Rich Carnahan, Ph.D.
Stephens Minister
Retired Aerospace Engineer

“Window of Opportunity is the story of one person’s journey through the initial signs of cognitive impairment brought on by Parkinson’s disease and the uncertainty of a future that might include dementia. Kirk Hall, only 58 at the time he began noticing small signs of mild cognitive impairment, tells his story with directness, candor, sensitivity and humor.  He describes the long and seemingly endless visits to doctors seeking answers to his disturbing symptoms and the confusion caused by conflicting opinions about the progression of his disease. His copious notes on his symptoms and mental state allow him to describe in vivid detail his slowly coming to grips with disability and the increasing lifestyle changes required to offset progressive cognitive difficulties.  He shares the internal struggle, anxiety and stress that uncertainty causes, not only for himself but for his family as well.

The book is a tribute to someone who is able to maintain a positive orientation despite the threat of something as devastatingly frightening as dementia.  It is also a journey of discovery as Kirk transitions into the healing aspects of giving back to the Parkinson’s community through helping others and sharing his story. Indeed the reader will take away important insights into the importance of keeping a patient journal, patient self-advocacy, and shared decision-making. And, perhaps most powerful of all, are the insights into how a potentially disabling diagnosis can be a “window of opportunity” to contribute in a meaningful way to the body of knowledge about a disease and to help others on the path.”

Diane Cook
Leader, LEAP Parkinson's Support Group
People with Parkinson's Advisory Council, Parkinson's Disease Foundation
Colorado State Director, Parkinson's Action Network
Senior Patient Advocate, ProjectSpark Foundation

“When Jim and I met Kirk Hall at a Parkinson’s conference in Colorado, we were impressed with his obvious intelligence and knowledge. When I read his book, that was confirmed, but most of all, I was impressed with his courage and determination. Like others facing dementia, he found himself alone. Even his wife could see only the positives at first. Yet, he motored on, seeking a diagnosis that fit his symptoms. In the meantime, Kirk’s book shows that he did all of the physical things that help to keep dementia at bay—things like exercising, yoga, eating right and decreasing stress. But he did more. He moved closer to his grandchildren, increased his focus on spirituality and reached out to others, teaching and sharing. And then he started writing, joining that small group of men like Dr. Thomas Grayboys, Rick Phelps and Charles Schneider who tell about dementia from the inside out. As caregivers, Jim and I can only write about dementia from the outside in. We join all dementia caregivers in our gratefulness to men like Kirk who give of their very soul as they tell us what it is like to feel dementia encroaching. Thank you, Kirk, for your heartfelt story. We recommend it to not only all PD and LBD caregivers, but to the medical community as well.”

Helen & James Whitworth
Authors, A Caregivers Guide to Lewy Body Dementia


The first time I met Kirk Hall was in November of 2008. In retrospect, I think it is fair to say that this meeting shaped both of our lives in ways that neither of us would have predicted at the time. I think it is also fair to say that it began a relationship that has moved far beyond what I learned about in medical school classes on communication as the "doctor-patient relationship."

I was just four months into my grown-up job as an assistant professor of neurology at the University of Colorado following more than ten years of school, residency, and fellowships. Despite all this preparatory work, I was still very much in the midst of figuring out what I was doing with my career. Still, I was not totally without direction. Having done fellowships in behavioral neurology (the neurology of problems with thinking, memory, and behavior, particularly dementia) and movement disorders (the neurology of problems with motor control, including tremor and Parkinson's disease), I was committed to doing work at the crossroads of these two fields. Being done with training meant that it was now up to me to determine what that further work would look like. I had just started doing research on non-motor symptoms in Parkinson's disease. Although this may sound focused, non-motor symptoms refers to any and all symptoms other than shaking, slowness, and stiffness (e.g., thinking and memory problems, hallucinations, depression, anxiety, constipation, pain, fatigue, insomnia, etc.).

Kirk was also at a crossroads in his life. He too was at the beginning of a journey that would involve the meeting of behavioral neurology and movement disorders. And despite the fact that he did not choose the medical conditions that led to our meeting, he too was faced with the dilemma of how he was going to live his life with them. Kirk was referred to me by the movement disorder neurologists who were taking care of his tremor to deal with his non-motor symptoms, which at that time included changes in thinking and memory, fatigue, and depression. Although I'm sure my notes from that visit contained a wealth of medical information, including his physical examination and neuropsychological test results, I don't think those notes (or most medical records, for that matter) captured what was really important in our interaction as people.
To begin with, the notes imply that I (the physician) am the expert and Kirk (the patient) is the beneficiary and subject of my knowledge. I think one of the many values of this book is that it turns this common wisdom on its head. Kirk lives with the symptoms I read and write about. He is an expert on this subject because he is the subject.

I remember that Kirk was anxious, and that his anxiety was centered around the changes he noticed in his thinking and memory. Scared may be an even better word for what he felt, as it implies a normal reaction to something scary rather than an abnormal reaction to something that should be easy to accept. For many people, the prospect of losing one's memory, of someday not recognizing your spouse and children, is more frightening even than death. Kirk was not afraid to be vulnerable and share his fears with me then, and he was equally candid when I invited him to speak as part of a patient roundtable discussion in front of 60 doctors and other health care providers. This vulnerability has been one of his many gifts to me and the Parkinson's community, a gift that was a driving force for this book: to take those parts of Parkinson's that are scariest and talk about them openly.

I remember reassuring him at that time that he did not have dementia and that I expected he would have many good years ahead of him. I think it was during this discussion that he first brought up the idea of writing a few books and that I first encouraged him to do so. I could tell him he had a window of opportunity that he could choose to use, but neither of us could know how long it would last. Kirk didn't just take the opportunity, he ran with it. Since that meeting he has led two Parkinson's support groups; written three books; and become an advocate for Parkinson's research, a blogger, an advocate for patients, and a national speaker. This book is important not just for the messages it contains, but as a message itself: an inspiring example of opportunities seized from a place where many would have given up hope.

Kirk is a deeply spiritual man who values his faith and draws upon it as a source of strength and inspiration. To talk about such things in our secular age seems taboo, particularly in a book on a medical topic. But despite the increasing use of technology in medicine, doctors ultimately take care of people, not diseases. When dealing with serious, progressive, and life-altering illnesses, caring means asking people about their hopes and fears, understanding their beliefs, and helping them reconnect with their sources of strength and meaning. This type of work is not currently well supported in our medical system, as it (of course) takes time, has no insurance billing category, and is not for the weak of heart.

Since my first meeting with Kirk, I have gone on to obtain grant funding to better understand the causes of dementia in Parkinson's disease, with the goal of developing improved treatments, and have started one of the first team-based palliative care clinics for Parkinson's disease in the United States. Kirk has become a local and national leader as a patient advocate. I am proud to write the foreword to this book and hope that Kirk inspires you as much as he has me.

—Benzi Kluger, MD, MS
Associate Professor of Neurology and Psychiatry
Director, Movement Disorders Center
University of Colorado, Denver
August 2013


I was diagnosed with Parkinson's disease (PD) in 2008 at the age of 59. I am now 65 years old. A neurological exam in 2012 confirmed that I had also developed amnestic mild cognitive impairment (aMCI),[1] a condition characterized by memory (amnestic) problems more severe than normal based on age and education but not serious enough to affect daily life. This condition often precedes Alzheimer's disease,[2] Lewy body dementia,[3] or Parkinson's disease dementia.[4] Clearly not good news, but not really a shock either, due to cognitive symptoms I had experienced since shortly after my PD diagnosis.
I first had the idea to write this book during the summer of 2009 and have been wrestling with it, to one degree or another, ever since. I'm not sure why I thought this was a good idea. One of the reasons may have been that it was important to me because of my fears about my own future. Since then I have had the opportunity to meet many people with Parkinson's (PWPs) and have consistently found that, for many of them, fear of developing dementia was their primary concern.

Most people know very little about PD unless they have had family or friends with the disease. Even then, their knowledge is generally limited to the impact of PD on motor functions, such as trembling or slowed movement (bradykinesia). Few know about the non-motor symptoms related to PD or are aware that, for many PWPs, these are often more troubling than motor symptoms. High on the list is the slowed thinking (bradyphrenia) that comes with the PD package for most, if not all, PWPs. Few subjects strike fear into our hearts like the fear of cognitive decline. Will it progress to dementia? If so, what does that look like? Are we talking about Alzheimer's or something else? Might I end up unable to communicate with or even recognize those I love most? What is the prognosis for this condition?

Until recently, cognition problems associated with PD had been discussed mostly in whispers and behind closed doors by both the medical community and PWPs. Even now, this subject is only beginning to get the attention it deserves. It remains a topic that many doctors are reluctant to discuss, making it difficult for PWPs, care partners, and families to get direct answers to their questions.

During the summer of 2008, I mentioned my concerns about the cognitive problems I had been experiencing to a "veteran" PWP (she had nine years under her belt at that point). She suggested that I read a book titled Life in the Balance[5] about Dr. Thomas Graboys, a highly regarded and successful cardiologist in Boston, and his experience with both PD and Lewy body dementia.

I was struck by the unflinching honesty and courage that it took for Dr. Graboys (with the help of Peter Zheutlin) to write his book. In describing the context for how he became aware of having these diseases, he freely admits that he wishes he had communicated differently with loved ones and associates. He talks about how these diseases, in different ways, affected his relationships at many levels, including those he had with patients. He mourns the opportunity missed by many colleagues in this age of industrialized medicine to develop personal relationships with patients that provide comfort to patients as well as a very useful context for providing a superior level of care. He includes heart-wrenching notes from family members who share the very real emotional impact on their lives made by the changes they saw in Tom. In the chapter titled "End Game," Tom speaks to the undesirable options he may be faced with (including assisted suicide) and his own internal debate about the right course of action for all concerned. I admire that, even after all he has been through, Tom chose a message of hope, courage, and perseverance, as well as the importance of finding a purpose, for the final chapter of his book.

Though we have never met and my only interactions with him have been a few short emails, I consider Tom to be a friend—perhaps because we have shared similar illness experiences and seem to agree on a wide range of subjects, but even more because of the ways in which he has provided me with encouragement and support. In April 2009, I sent him an email thanking him for writing his book and shared how much it had helped me. I also told him about a writing project I was working on at the time (a personal memoir). He has given me permission to share his incredibly inspirational and motivating return email, which provides a window into the impact of his dementia:

From: Graboys, Thomas Barr,M.D.
Sent: Monday, April 06, 2009 11:02 AM
To: Kirk Hall
Subject: RE: thank you

Bravo tto you mr hall and congrates on comoleting 8 chapters..writing as your
can onlyimprove your will be a legacy to your famiry.keepit up so
important to keep your mind and body stimultated...keep it up!

My best, 
Thomas B. Graboys, MD
Professor of Medicine
Harvard Medical School

Tom also mentioned in that final chapter that he was very encouraged by improvement in cognitive function and mood he experienced after taking Namenda (memantine)[6] (a drug prescribed for moderate to severe dementias). When my wife and I visited the National Institutes of Health's National Institute of Neurological Disorders and Stroke (NIH/NINDS) during October 2012 for me to participate in PD clinical research, they conducted a full review of my condition. With regard to my aMCI, the doctors recommended Namenda in conjunction with the Exelon patch[7] (which I had started using in September 2011). At my next appointment with my movement disorder neurologist at the University of Colorado Hospital in March 2013, Dr. Benzi Kluger recommended that I add Namenda to my regimen; he said that some patients were finding the use of Namenda in conjunction with the Exelon patch to be helpful. I remembered what NINDS had told me and the positive comments from Dr. Graboys and agreed to give it a try.

I have been taking Namenda since April 2013 and have experienced noticeable improvements in clarity, acuity, mood, and working memory.[8] I had been getting discouraged about whether I was ever going to be able to write a book that would meet my expectations, but now am reasonably confident that Namenda has provided me with a "window of opportunity" to complete this task that has come to mean so much to me. Eventually I realized that this was just another example of God's presence in my life.

This book focuses on my personal experience with PD and related cognition problems, but it includes information and ideas that I hope will be interesting or useful to PWPs and their families. While it is not my primary objective, I hope it will also provide useful insights to the medical and research community.
At some point on this journey, I began to realize that what I was experiencing was not all bad news, and I want to emphasize this. My fears about the future were knocked off center stage by the opportunities I was being given to meet and develop relationships with other PWPs and care partners as well as other people in the PD world, including individuals employed by PD organizations, doctors, and research scientists. Thankfully, I realized that I was being given an opportunity to at least try to have a positive impact on others in my position. This, in conjunction with my faith and the love of my family and friends, has made a world of difference in my outlook. I truly feel extraordinarily blessed.

Chapter 3: The Elephant in the Room

Nine months after our Mt. Elbert mountain climbing experience, in May 2008, I was in a business meeting in Colorado Springs. At that time, I was marketing director for an agency that provided marketing and advertising consulting for organizations throughout the United States. This meeting was not all that different from hundreds I had attended (or led) in my 38-year career. However, the circumstances were different in that I had been diagnosed with Parkinson's disease (PD) about a month earlier. I had made an appointment during April 2008 with a movement disorder neurologist[9] (MDN) at the University of Colorado Hospital (UCH) for an evaluation of my essential tremor[10] condition (a troublesome condition involving potentially debilitating "action tremor"), which was the only thing to which I could attribute the intense fatigue and disproportionate reaction to stress I had been experiencing. Much to my surprise, I was told that I now was dealing with early-stage PD in addition to ET.

During the course of that May meeting, I started having trouble "processing" the things I was hearing and became literally unable to participate. At that time, I did not really know what to expect with regard to PD symptoms, other than having been told that "everyone is different" in terms of their symptoms. Like most others, I spent only a few minutes with my doctor following my initial diagnosis and was basically on my own until my next appointment in three months. I decided that I would learn as much as I could about PD, through books, other PWPs, support groups, doctors, and the Internet, hoping that this would help me to better understand the changes I was experiencing. In the coming weeks and months I would learn a great deal that was enlightening and helpful, but found very little information pertaining to cognitive issues.
The problems with processing and storage of verbal information continued. It seemed that I would do OK for a while and then gradually just "shut down." This would have been distressing in any case, but was even harder to accept based on the experience I had in managing high levels of responsibility where meetings were a way of life.

One day I was working at my desk and answering the phone while others were at lunch, working on my computer and taking a variety of messages at the same time. I must have reached an "overload" point when I looked for a message I had written for one of my co-workers so that I could leave it in his office for him. I checked all over my desk, on the floor, in the wastebasket and couldn't find it anywhere. Finally, I decided to check in his office, though I had no recollection of taking it there (around the corner and down the hall). I opened his door and there it was on his desk.

I had an interview with another company during this time. It was a company I had been interested in for several years, so part of me was looking forward to it. However, I didn't feel particularly comfortable about going to the interview due to the problems I had been having. Plus, I knew that the stress of a new job (if I got an offer) was not going to be a good thing. I rehearsed for the interview quite a bit because I didn't trust my memory. Unfortunately, another strange "memory event" occurred while I was driving to the interview. I knew that a turn I had to make was coming up. I couldn't remember anything else until I became aware that I didn't know where I was. I had no recollection of passing the point where I was supposed to turn. I kept going straight and eventually made it to the right place, but was a little bit late (not my style). I went through the interview process, but did not do well and did not get an offer. In hindsight, that was for the best.

The theme of "sensory overload"[11] keeps coming up in my attempts to describe the nature of my problems. During a vacation in California with my wife, one of my sons, and his four children, we spent a day at Disneyland. I was still having a good time during the "Jungle Cruise" (one of my favorites at Disney World, which we had been to twice many years ago). However, toward the end I started to sense that same "overloaded" feeling, and I began to process more slowly until I literally became totally dependent on Linda to lead me from one venue to the next. I guess I should not have been surprised that this happened, given the crowds of people, high volume of ambient noise, and so much other concentrated sensory bombardment.

On a variety of occasions going back to the first year I was diagnosed, my doctors described me as a "high-functioning" patient. (I suspect that this may be their code word for "pain in the neck" because of all the questions I asked.) Still, I have been told that intelligence and level of education are thought to play a role in delaying progression of cognitive/memory problems connected with PD.[12] This subject was addressed at the World Parkinson Congress[13] in Montreal during October 2013 by Dr. Janis Miyasaki, who stated that, while typical patients tend to deteriorate at a fairly steady rate over time in terms of their ability to function at previous levels, high-functioning patients tend to deteriorate much more slowly over time and then decline more precipitously.

Obviously, the potential for onset of PD-related dementia is my "elephant in the room." It took an epiphany of sorts to stop focusing on the possible unpleasant outcomes associated with this information. Dr. Kluger's practical suggestion was that I should "keep doing what I'm doing" and "hope for the best." It was time for me to take ownership of the situation and decide what to do next.

Thursday, May 29, 2014

Parkinson Association of the Rockies Vitality Walk

Event Logo

Vitality Walk

Enhancing Lives With Every Step


On Sunday, June 1st join the Parkinson Association for the 12th Annual Vitality Walk in Wash Park in Denver or Sandstone Ranch in Longmont - or Choose to Snooze! 

8:00am Registration Begins | 9:00am Walk Start | 10:00am Resource Fair

Registration: $30/adult | $10/child (ages 5-14) | FREE/child (ages 0-4) 


Every step taken by someone with Parkinson’s shows their determination to live well with this disease. Every step taken by friends, families, neighbors and co-workers supports those individuals and families who are affected by Parkinson’s disease. Walk the Vitality Walk to enhance lives with every step. People of all ages and dogs are welcome. 

Inspired Incentive 

• 170 individuals are diagnosed with Parkinson’s disease daily in the US 
• 17,000 Coloradans are living with Parkinson’s 

To help you set and reach your fundraising goals we are inviting you to be part of our fundraising incentive program. Every individual who raises $170.00 or more will receive a long sleeved shirt to proudly display the care they have for Coloradoans living with Parkinson’s. 

 Choose to Snooze and Make it Count! 

Not a morning person? Will you be out of town? Have to work? You can still support the Vitality Walk by registering as a Choose to Snooze participant. If your circumstance changes, join us in Wash Park or Sandstone Ranch. 

 Sign Up Today! 


(303) 830-1839 |

Saturday, May 24, 2014

Keeping A Journal

I started keeping a journal in mid-2008 for reasons that were unclear to me.  I did want to have a record of what I was thinking and feeling as well as the events taking place and dates.  As it turns out, this enabled me to include accurate information in my Window of Opportunity book as well as my personal memoir.  I think it was also helpful for me in terms of processing what was happening, keeping my priorities straight, and recognizing the joys (and heartaches) that are part of day to day life.  The journal entries were fairly frequent during the first couple years and then started to dwindle.  

During the course of my book writing, I divided my journal entries into categories and eliminated the personal family stuff.  This may be of interest to someone at some point, so I thought I would "put it on record".  The categories I chose are cognition concerns, faith, and writing.

Cognition concerns

August 12, 2008

My fear is that I am not only looking at a future coping with PD, but that I may be dealing with some form of dementia (not uncommon in late stage PD, but certainly not an expected side effect at this point).  This is based on what I have been experiencing (that led to my having to stop working) as well as test results.  If it is some form of dementia (which includes Alzheimer’s), how fast will it progress?  What will the prognosis be?  Linda and I have been talking about a special trip for our 40th anniversary next year.  Should we take the trip this year?  Should we sell our house and move closer to the kids as we have been talking about.  Should Linda retire?  At what point will I be unable to live with her if my condition declines?

Am I blowing this out of proportion?  Am I imagining things?  It doesn’t feel like it.  However, I need to keep gathering information that will allow us to make informed decisions.  Meanwhile, I want to make good use of this “window” if that is what it is.  I want to write stories about my life for Kevin & Brian.  I will check out some vacation ideas for October for Linda and me.  Plus I want to take some time to just enjoy life and my family.  It gives you a different perspective when you think that the window may be closing sooner than later.  I can only imagine how that perspective will change if I find out that this is true.

September 10, 2008

I was still worn out on Monday when I drove into CS to drop off the check from the sale of the Adam’s Place unit to Steve (our financial advisor).  Was proud of myself for remembering that I was close to Sam’s and could take the Subaru in to have the tires rotated.  The bad news is that I had brought Little Fox with me for the trip into town (I like to bring him with me when I can so he doesn’t have to be alone) and forgot all about him when I went into Sam’s to have them do the work on the car.  Fifteen minutes later I was walking around in the store when it occurred to me that Little Fox was in the car.  I walked outside and they had pulled the car into a bay, put it on a lift and started taking the tires off.  Poor Little Fox was scared stiff.  The mechanics let him out (undoubtedly wondering why I would subject him to something like that) and we waited outside until they were done.  No harm, no foul.  Just another indication that I am not thinking clearly.

October 8, 2008

I am still not sure what is going on with me, but my educated guess (after reading “Life in the Balance”) is that I may have PDD (a combination of Parkinson’s and Lewy Body Dementia).  I hope I am wrong.  It just sounds like I have the same symptoms he did in the early stages.  If I start having fainting spells and/or violent dreams (body movements, etc., associated with dreams) it will be confirmation.  I am having what I would call “weird” dreams every night.  Plus intermittent bouts of confusion and reduced acuity.  I have read that the average life expectancy for people with this disease is eight years.  I have also read that the range is 2-20 years with a “typical” range of 4-7 years.  If this is the case and it comes to pass, I will be glad that Linda will have the extra financial security of my life insurance ($250,000).

October 16, 2008

The weird dreams continue.  It seems clear that something is going wrong upstairs.  Is it just the PD or something more?

October 30, 2008

Well, I survived the neuropsychological exam at NJMC on Tuesday.  I wanted to get it over with but I was convinced it would turn me into “a pile of goo”.  So I went into it with some anxiety.  Linda and I met with Brian Hoyt (Ph.D. in neuropsychology) and his assistant, Jenny (looked like a student), who administered the test.  We talked for about an hour about background stuff (employment, education, work with doctors, symptoms I am experiencing, etc.) and then I talked with them alone for about 15 minutes before the testing started.  Gave them all the written material they asked for-again lots of background stuff relating to memory, cognition, personality, health, etc.

The testing was much more extensive than I received at Dr. Grabert’s office though it was clearly going down the same road.  Some of the tests were identical (picture recognition, red-green-blue lists) and some were similar (same test, different content-story exercise, graphic design recall, number/letter recall).  Many completely new tests including small motor skills (put shaped pegs in cribbage-type board with both hands-took a long time with left hand), design duplication with blocks.  Did very well with vocabulary and picture recognition.

The story and word recall involved too much information too fast and, as before, I did not do well.  I told them at the wrapup that I know I did well on some things, probably OK on others and poorly on some.  They told us up front that this would be a “check-up” on all areas of my brain.  So now the question is, what is not functioning normally, what does it mean and where do we go from here.  At this point, I do not feel that this is going in a good direction.

January 2, 2009

The NJMC neuropsych results finally arrived on 12/31.  While there were many positives in terms of the state of my cognition, the report included some extremely troubling news.  The testing confirmed my problems with processing/retention of information received verbally (stories/groups of words).  Information processing/concentration was mildly impaired/average.  Verbal learning was moderately impaired and verbal memory was mildly to moderately impaired.  Verbal list free recall was below average.  Verbal list recognition was mildly to moderately impaired.  Verbal fluency (animal naming?) was below average.  Fine motor coordination was moderately to severely impaired (right hand) and severely impaired (left hand).

Most concerning was a comment in the summary regarding a review of my recent brain MRI noting that “given the degree of atrophy another neurodegenerative process such as Alzheimer’s disease, Lewy body dementia, or a frontotemporal dementia may be involved” in addition to any degenerative process associated with PD.  This information is very different from what we were told by Dr. Kluger in November.  Not surprising as he was dealing with partial information (I was very upset at the time because of this).

Clearly these cognition/atrophy issues are a bigger concern right now than my PD which is still being described as “early stage”.

I left a message with Dr. K to discuss next steps.

I have spent a good deal of time on the internet today gathering information relative to potential issues raised in this report as well as terms that Linda and I didn’t understand.  I can’t say that there are any real rays of hope-almost all the news is bad related to this atrophy issue.  My sense is that I am looking at another 2-10 years, some of which may be in a very debilitated state, possibly requiring that I be in a nursing home.  I doubt that the atrophy is related strictly to the PD (with no dementia component) as it is so mild at this point.

We’ll see what Dr. K recommends as next steps.  Don’t know if this will qualify me for disability or if the situation is still too tentative (the atrophy deal doesn’t sound very tentative).  The months ahead will likely be challenging for Linda and me with some important decisions to made regarding her retirement, where we will live, etc.

January 22, 2009

The journey continues.  I am glad to have Lenore on board with regard to my health problems.  I have shared some detail with her and she has given me some feedback and articles from a neurologist at OSU.  She has agreed to keep my information confidential.  All the feedback I have gotten so far is that my situation is potentially serious buy inconclusive at this time.  At the same time, it is clear that these “mind problems” are difficult to diagnose.  Because I am intelligent, it seems that I may have more “mental inventory” to use up before issues become more apparent.  In most cases, a specific diagnosis cannot be made until an autopsy is done.  Based on what I have read, my guess is that I have FTD/MND rather than true PD.  Turns out that FTD is about as common as AD and strikes people 45-65 years old.  Not much memory deficit (my memory overall is still good).  Motor symptoms similar to PD.  Will have to watch out for the behavioral symptoms.  They mention overeating (I have put on about 15-20 pounds over the last 5 months).  Looks like this one progresses quickly with death occurring about 1.3 years after diagnosis.  Clearly, we are not at a point where a diagnosis can be made.  Hopefully never.  Perhaps it will turn out to be some type of static condition and the atrophy will not get worse.

January 26, 2009

I have had a couple of incidents lately where I have said some mean things to Linda.  The first was when we drove to Vegas.  I was very tired, despite sleeping at least a couple hours in the car, when we got into town.  I was having trouble with the Mapquest directions and made about 5 mistakes in a row in interpreting them, which upset me.  I became irritated with Linda for no good reason and had to apologize later.  Then yesterday when we were watching Dani & Kaya while the rest went out for dinner, I overreacted to what I took as criticism from Linda at the dinner table regarding dealing with Dani.  It ended up escalating and we both said some nasty things.  Once again, I was extremely tired at the time.

January 29, 2009

I started feeling yesterday (and feel again today) that my clarity/acuity is slipping again.  It was giving me problems in August, but seemed to improve in September/October and stayed OK since then.  I thought it might be related to either the acupuncture and/or my B12 regimen.  I had reduced my B12 to one/week based on the feedback from Jeff Fisher’s neurologist colleague.  I am going back to 1/day to see if that helps.

February 9, 2009

We had our Denver doctor appointment last Thursday.  Here is an email I sent to Berni:

Hi Berni & Hank-

We were pleased with the outcome of the appointment yesterday, all things considered.  I had only seen this doctor once before-I was switched to him because my previous doc's specialty is movement disorders only.  This new guy has that and also cognition/other neurodegenerative stuff.  After talking, reviewing the neuropsych results, examining me, and reviewing the MRI's, he said he does not agree with either the previous doc or the neuropsych exam regarding atrophy and potential for the other nasty stuff at this time.  Of course, this was huge for us.  On the PD front, that is now to a point that he prescribed selegiline (5mg starting 1/day then 2/day after 2 weeks).  This is a PD med.  He thought this would potentially help with the tremors, fatigue, and cognition.  Other action steps:
-  he is having me meet with a doc in the interactive medicine department to discuss strategies to address fatigue and other issues
-  he told me to increase my COQ10 from the current 300 mg to 800 mg daily
-  continue B12 1000 mg/day and other supplements
-  he had me add L-Carnitine to my supplement regimen
-  he wants me to do at least 30 minutes of cardio exercise 5 days/wk

He also gave me his email and asked that we stay in touch regarding any issues, how I am doing with the meds, etc.  This was also huge for us because we have felt "on our own" so much for a while now.  It is very comforting to be able to communicate with him in between appointments.  Our next appt. will be in 3 months.

He encouraged us to start the SSDI paperwork.  He said it is possible that I may feel well enough to work after the meds kick in, but that was not a sure thing.  He said that would take a month.

Nothing much seems to be a sure thing with PD.  It affects everyone differently, it seems.  There was an excellent PBS program on PD a couple nights ago called "My Father, My Brother, and Me".  Predicting how individuals will react to meds seems also to be a crapshoot.  Also meds that have been effective can lose their effectiveness as the disease progresses.  That rate at which it progresses varies from person to person.  All that said, it is a more hopeful option than the other stuff we were looking at.

Naturally, we hope that your folks reaction will be at least similar.  However, I want to know what they have to say either way.  Please don't tell them to stop the presses because we got this more encouraging news.  We have had conflicting reactions from folks that know their stuff at a number of points along the way already.

Thanks to you and Hank for your prayers and support.


February 26, 2009

Sometime recently I mentioned to Linda that I think my assets up north are headed south.  I just don’t know if the destination is South Carolina, South America, or the South Pole.  I continue to experience periodic “events” that are not normal.  When we were playing golf with the Moore’s last week, I was playing a Titleist 3 golf ball and had another in my pocket.  After teeing off, I checked my pocket and was surprised that there was only one Titleist 3 in my pocket.  It took me a few moments to realize that the other was out in the fairway.  Yesterday, I sent an email to my choir director giving her information on when I would be available to sing, looking at the calendar as I wrote.  Luckily I copied Linda, who emailed me to let me know I had given incorrect dates.  A short time later I was working on my book.  When I was done, I looked over what I had written and had to correct a number of goofy mistakes, including haven given 1970 as the year Brian & Sybil were married (in fact, it was 2000).

I have still not heard back from USC, but regardless of what they say, I know something is going wrong “up north”.  My intuition since learning about the PD diagnosis (that one blind-sided me) has been correct.  It will likely take some time to have this confirmed and receive some type of diagnosis.  Meanwhile, we will just have keep making the best decisions we can knowing God is in charge.

March 12, 2009

We got a voicemail from Berni Thursday evening telling us that the doctors at USC had completed their review of my MRI’s.  I believe she said that there was a neurologist, neuroradiologist, and neurosurgeon involved.  They all agreed that they saw nothing for me to be concerned about.  The atrophy they saw was normal for someone my age.  Of course, this is the news we had been hoping for.  It doesn’t explain the cognition issues that exist, but it does give us hope that I may not be looking at the bad news dementia-stuff that Dr. Hoyt mentioned in his neuropsych report.  So we can focus on the PD and continue to work on sorting out the other stuff.  We’ll see what happens at our next appointment with Dr. Corbin on March 23.

I read somewhere that nothing strikes fear in the hearts of older people like Alzheimer’s.  I am sure that cancer and heart problems are right up there too.  However, the idea of gradually losing the ability to think clearly, remember things and people, and take care of myself (whether it be due to AD or one of the other dementias-all of which are terminal) is scary.  Not only for me, but for Linda and my family as well.  I hope this will not happen, but I can’t help but remember what Dr. Graboys said in his book about his medical team saying he didn’t have dementia and then changing their mind a year later.  Either way, it is in God’s hands.

March 19, 2009

I am becoming more fearful about the possibility of some type of dementia based on the way I have been feeling.  I mentioned my continued “fogginess” to Dr. Kluger via email and he recommended that I start on Aricept, an Alzheimer’s medication also used to treat symptoms of folks with MCI and slow progression.  Further internet research has indicated that there is significant risk for development of Alzheimer’s in people who have been diagnosed with amnestic mild cognitive impairment (AMCI).  Apparently, 10-15% of patients develop AD within the first year and that % continues in subsequent years. 

I wrestle with how much to share about what I am learning and feeling/fearing with Linda.  She is afraid I am pushing ahead too fast and reading into things too much.  She is afraid I will give up and not do the proactive things that are in my control like exercise and losing weight.  She accuses me of being too caught up in “doom and gloom” and being too quick to believe the worst.  I know that this is a real danger and I try to protect against it.  However, I feel compelled to learn everything I can so I can advocate for myself.  We sometimes (like yesterday) end up in disagreements that are emotionally charged, which is normal.  However, we agree that it is important to keep communicating.

I wrote an email to Kev and Brian today to update them on the details of my latest health information, retirement, SSDI, and moving plans.  I have held off on some of the health stuff as it has seemed speculative.  However, it now seems to have enough substance that I wanted them to be “on board”.  I don’t want them to worry (though I am sure they will).  I would want to know if they were dealing with problems, so I feel that should work both ways.  There is no need for Linda and I to go through this alone.

March 24, 2009

Dr. Hoyt from NJMC called on Friday in response to my questions regarding the atrophy issue.  Turns out he had not seen the MRI’s and was going by what Dr. Klepitskaya had reported to him.  This puts to rest the debate regarding whether or not my July ’08 MRI showed atrophy.  The only one saying “yes” is Dr. Klepitskaya (“no” votes from Dr. Grabert, Dr. Kluger, and USC).  This is good news.  The bad news is that Dr. Hoyt confirmed that AMCI frequently leads to dementia.  Based on his comments, about 25% stay the same and “less than that” improve.  I deduce from this that 60+% get dementia.  Other credible information is less optimistic than that.

This information is starting to sink in, but not sure I have yet totally “wrapped my mind around it”.  Like other new important health news (i.e. my initial PD diagnosis), my mind keeps coming back to it.  Reminds me of how my tongue keeps returning to the empty spot in my mouth when I have had a tooth pulled.  I talked with Judy Heller at church on Sunday.  She was the first one at church I told about my PD diagnosis last year.  Her husband, George, has been diagnosed with Alzheimer’s.  As with my PD diagnosis when I was anxious to talk with Cookie Hertel about her experience, I am interested in hearing whatever Judy and George can tell me about their experience even though there is a chance I won’t advance to dementia.  To some this may seem masochistic, but as I have said before, I prefer to know what to expect in the event it does happen.  At least up to a point so Linda and I can make informed decisions regarding moving, travel, etc.  Judy’s first comment was not to put off things we want to do such as travel.  She said that she and George would be glad to spend time with Linda and me to share their experience and what they see ahead. 

March 31, 2009

We went to lunch with Judy and George on Sunday after church at the Village Inn in Monument.  We talked for three hours and covered a lot of ground.  They were very open about sharing their experience and gave us some insights into what we might expect if I am diagnosed.  They were told that a “typical” timeframe for AD to “run it’s course” is 3-8 years, though it could be longer.  They advised us to not put off things we want to do and to be sure our legal paperwork is in order.  It bothers me that George is very “fatalistic” about his situation and is not inclined to fight it.  We think he is 68.  He spoke of a significant family history with the disease, including his father.  They have three children in Denver, but they don’t seem as “close” as we are with our kids.  They have had a troublesome relationship with their daughter in particular.  I shared with them that I want to be as proactive as possible because I want my family to see I am doing whatever I can to prolong my time with them.  For my own part, on one hand I am not anxious to exit for many reasons but on the other I would like Linda to get my life insurance in order to ensure her security.

Meanwhile, I continue to experience “fogginess”/impaired acuity and “memory events”.  Any of the events by themselves would not be a big cause for concern (i.e. senior moments).  However, taken collectively in conjunction with the amci diagnosis, it is worrisome.  For example:
  • Last Thursday night during the night (after it had snowed all day) I wondered whether I had turned off the water and unhooked the hose after cleaning the hot tub the previous week (if the hose is left on and there is a hard freeze, the pipe could burst).  I checked the next day and, sure enough, I had left the water on and the hose hooked up.  Luckily, the connection was not water-tight so that there was a light mist at the connection which kept the pipe from freezing (and created an interesting array of icicles).
  • Last week I wrote an email to church regarding the job search informational meeting Susan and I wanted to hold the following Monday.  I am very careful and reread what I write in these situations to ensure accuracy.  The date I provided to have sent out to the congregation was for the previous Monday.
  • I was writing about Brian and Sybil’s wedding recently and wrote that it took place in 1970.  Of course, it took place in 2000.
  • Last year when I was still working, I was doing my work plus answering the phone.  Of course, it is difficult to stay on task when this is happening.  I took a message for a co-worker and went back to work.  A while later, it occurred to me that I better take the message over to my co-worker’s desk before I had a chance to forget, but I couldn’t find the note at my desk.  I checked underneath the desk, in the wastebasket, etc., but couldn’t find it.  I had no recollection of taking it to his desk already (which involved getting up and walking out of my cubicle and around the corner about 50 feet, opening his door and putting it on his desk), but decided to check anyway.  Sure enough, that’s where it was.
  • Last August I was at the doctor’s office getting a blood test.  I met someone there from Oakland (our old town in NJ).  She had a son Kevin’s age and we talked about them.  I was sharing about Kevin’s involvement in sports and could only remember that he was on the tennis and soccer teams.  It took me about 30 minutes before I could finally remember that he was also on the hockey team for 4 years.
  • I was talking with Kevin on our deck last summer and asked him when Bonnie and Dennis would be leaving to go back to Phoenix.  He seemed alarmed and told me I had asked that question 5 minutes earlier.

August 17, 2009

Linda and I went to see Dr. Kluger last Thursday.  I had become fairly convinced that I was experiencing LBD symptoms and was pushing him for a response so that, if he agreed, we could use that information for SSDI purposes.  At the exam, he made it clear to me (for the first time) that 30-40% of PD patients experience some type of cognition problems.  Also, I had read a John Hopkins memory white paper a few days earlier and realized that I fit the description of MCI, not dementia.  While this doesn’t mean I am out of the woods, it is a great relief!

September 11, 2009

I need to get back to my writing on the new book.  Meanwhile, I found more interesting information online last night on PD and cognition in a textbook from 2004.  It talked about PD having a prodromal phase of up to two decades before symptoms become overt.  Prior to that, different things can show up especially under stress.  I have documented my experiences in the 90’s that fit that description.  Also, my experiences at Global and Navpress are consistent with this.  Lots of good info on cognition.  Seems that this is a problem with many PD folks, especially those who get it after 60 and even more so at 70+.  Talked about life expectancy of 10 to 15 years from PD symptom onset with faster progression where primary symptoms are stiffness/slowness as opposed to tremor.  I have all three, but Dr. Kluger describes my tremor as mild-this is clearly my resting tremor.

September 29, 2009

Dear Dr. Lieberman:

I am seriously considering making an appointment with your organization to discuss my cognition issues.  However, since I live in the Denver area, I would like to share information with you in advance to help you determine if you think this would be advisable and, if so, who I should meet with.  I do have a place to stay in Phoenix.

I was diagnosed with PD in 4/08 and am now told I am in H&Y stage 3.  I quickly developed cognition symptoms and took a neuropsychological exam in 10/08.  The diagnosis was aMCI.  I am working with Dr. Benzi Kluger at the University of CO Hospital who specializes in movement disorders/cognition issues and Dr. Brian Hoyt, Staff Neuropsychologist at NJMC.  I will attach a list of current meds and supplements.  I have an appointment scheduled with Dr. Kluger on 11/19 and Dr. Hoyt is working on an appointment for a new neuropysych in November to establish a new baseline.  I will attach a summary of the results from last October.

I have discussed with Dr. Kluger and Dr. Hoyt my interest in a second opinion relating to my cognition issues and they agree this is a good idea.  My goal is to get a better handle on what I am dealing with, if possible, and identify any opportunities for treatment.  Your Shaking Up book’s chapter on dementia was of particular interest.  I would like to share my sense of where I see myself with regard to what you describe as the features of dementia:
  • Confusion:  I have come to describe the way I feel as mildly to moderately inebriated.  Periods of concentration or any stress accentuate this and result in my being more easily confused.  This shows up in a variety of ways, including uncharacteristic confusion with math calculations.  Maintaining attention as well as processing verbal info has been a problem for over a year.
  • Memory loss:  Memory relating to verbal info is a problem and was verified by the neuropsych.  I have trouble keeping track of appointments and tasks without the help of lists and a personal calendar.  An example of this occurred last week when a friend asked if we could meet the next day.  I said I was wide open, but later realized I had two appointments that morning which I had forgotten.  This is not an isolated example.
  • Unusual behavior:  For about the last nine months I have had problems with irritability and angry outbursts of unusual intensity that subside quickly.  I also have been having very vivid and, sometimes, scary dreams since about 7/08, long before I started taking any PD meds (started with selegiline 3/09 and just started sinemet 8/09-tried requip during 7/09 but had to stop as it made me too tired).  I take Wellbutrin, but I am prone to mood shifts.
  • Daytime drowsiness:  This has been a problem since about 2/08 that caused me to cut back my work as a Marketing Director to part-time.  Even after that, I would have trouble staying awake on my drive home from work.  I stopped working 8/08 primarily due to fatigue, acuity issues, memory issues, and shakiness that were all amplified by any stress.  I have had to cut back on exercise even though I know it is a very good thing.  A few hours on the computer or anything that involves concentration leaves me tired and “fuzzy”.  I typically take one nap each day lasting anywhere from 30-60 minutes and still sleep about 9 hours each night.  I use a CPAP and have made sure it is set and working properly.

I have an opportunity to meet with a neurologist/psychiatry specialist in Wheatridge, Dr. William Wagner, who was recommended by a friend.  I may do this in addition to a meeting with your group pending your reaction.

I appreciate your consideration of this matter and realize there is only so much you can discern based on what I am telling you.  In any case, thank you for your book and the important groundbreaking work you have done for so many years.

By the way, I also am a person of faith.  I rely on God and know He is in control, but believe that He wants me to wrestle with this and be proactive.


Kirk W. Hall


August 12, 2008

Most importantly, I need to remember that God is in charge and that He will help my family and me through this difficult time.  Reading “The Shack” has helped remind me that God does not plan for bad things to happen to us and that we can depend on Him to be a light when times are dark.  I look forward to the promise of everlasting life as a result of Jesus’ sacrifice.  However, I don’t know how to deal with the agony of the thought of leaving Linda and my family.  I guess I will have to accept that they will be in God’s hands and that we will be together again one day in heaven.

August 14, 2008

It occurred to me in the middle of the night (a message from God?) that I need to be spending less time worrying about my situation and more time caring for others.  I know that lots of people are praying for me.  I plan to spend more time praying for other people, especially friends and family.

As I was writing this, a friend from our church choir (Barbara Carlson) came to the door to drop off a prayer shawl (for me to wear on good or bad days to symbolically surround me with God’s love) that had been made for me by the prayer ministry at church.  Some might think this was coincidental.  I know it was not.  God has chosen to let me know that He is watching out for me through the kindness and prayers of others.  I am totally humbled and thankful that He and my friends would do this for me.  What a great sense of comfort.

Since Carson will be with us this weekend, I made arrangements to sing at church (a duet with Pat Jahla) this Sunday.  I have not sung much all summer and miss it.  Part of me is afraid that I won’t be able to continue singing.  Anyway, I thought about doing a solo and what songs I might do, but a clear thought came to me that I would like to do my favorite hymn (Be Still My Soul) and that I would like Pat to do it with me.  She is a dear friend and we have sung together for 14 years, but never done a duet.  Pat has been dealing with serious heart issues for over a year.  Once again, I feel like God helped me choose this song.  Once I had picked it and looked at the words, I realized how appropriate it was for Pat and me to sing this as it is about being at peace and trusting God.

August 15, 2008

I tried out my prayer shawl this morning.  Felt good with the chill and dampness.  Or perhaps it was the comfort of the prayers built into it.  Probably both.  I prayed more than I have ever prayed before for everyone I could think of.  I feel God’s presence on a regular basis now.  I went to the library yesterday to pick up some DVD’s (including a cute-looking barnyard animated one that Carson should like, if he can come-he had stomach problems yesterday).  Two DVD’s that I hadn’t seen before were there- “Conversations with God” (based on the best-selling book) and “The Gospel of John”.  Watched the first one and thought it was great-an amazing story.

Was it a coincidence that these movies were sitting there waiting for me?  I don’t think so.  Was it my imagination that when I put that prayer shawl around my shoulders I felt close to God?  I don’t think so.  Was it just good fortune that I had this idea for a special dinner for Linda and me to celebrate our love and that it came together so nicely?  I don’t think so.  Was it just a fluke that I picked “Be Still My Soul” to sing without thinking about the message and then that it occurred to me that I should sing it with Pat (who I have never sung a duet with before)?  I don’t think so.  Was it nothing out of the ordinary that Barbara dropped off that prayer shawl just after I had written about the importance of praying for others?  In fact, let me be clear.  I truly believe the answer to these questions is no.  It was God at work in my life.

September 10, 2008

I want to capture something before I forget.  At my 9/4 acupuncture treatment, I was praying (for others as well as myself) and meditating about my situation when a thought came clearly into my mind:  “Be still and know that I am God”.  I continue to be amazed by God’s presence in my daily life.  I know I have my “antenna up” in a way that I never have before.  I want to work at keeping this message “front and center” in my life.

September 17, 2008

The stock market is in serious turmoil.  So much uncertainty with problems in the financial sector, high unemployment, the real estate problems, two hurricanes in the last month, high gas prices (coming down some-were under $3.50/gallon before the latest hurricane), election wrangling, ongoing terrorism concerns, inflation, weak dollar, war in Middle East, huge deficit, etc.

“Be still and know that I am God.”  I’m trying.

Speaking of election wrangling, it is so disappointing to see how this election is being conducted.  It has been this way for a while, but it hasn’t always been this bad.  Both sides are willing to say things that are either false or at least misleading.  It is all so negative.  Our country seems deeply divided and too many people are willing to take sides with only a superficial understanding of the issues and what their “candidate” will REALLY do to deal with them.  I guess it is a reflection of the personal angst over economic fears, the war, the threat of terrorism, the cost of health care, concerns regarding the future of social security, the rising cost of higher education, etc.

“Be still and know that I am God.”  How do people without faith get through times like these?

December 8, 2008

I am feeling very fortunate lately.  Kind of like I am in the eye of a hurricane in a protective cocoon.  The hurricane is the PD, economic stress, and the prospect of having to work again.  The cocoon is the love of my wife, family and friends, being able to sing, and receiving unemployment compensation.  Michael J. Fox said “I am a lucky man”.  I would say that as well, but I prefer to say that I am a blessed man because I know God is watching over me.

January 26, 2009

I picked out a Josh Groban CD at random for Linda and I to listen to about a week ago.  One of the songs on that CD is “You Are Loved”.  When I first heard that song (a couple years ago, I think), I really liked it and thought it would be a good song to do at church (but never did).  I did like it enough to download the sheet music.  I hear it as a message from God to a troubled world.  The timing seemed right to reconsider doing this.  I contacted our choir director and mentioned it to her.  When we met this Sunday to rehearse some other music, we talked about it.  She informed me that the theme for the next two Sundays at church would be love.  I guess this could be a coincidence, just as it could have been chance when I walked into that church in Michigan and heard the sermon about “building your house on rock” all those years ago.  I don’t think so.  I think I am supposed to sing this song.  I know I want to, in spite of the fact that singing solos is tough on my nervous system these days.

March 25, 2009

Looking back at the last couple of years, the road has seemed awfully bumpy as we traveled it.  In hindsight, it is clear that we have been unbelievably blessed.  In December, 2006, I found out I would not be receiving an offer for a position as Marketing Director at the Christian and Missionary Alliance that had been, for all intents and purposes, promised to me.  After all we had been through in the previous few years, including the failure of my career services business, an expensive legal battle with my former career services partner, and a series of jobs that only lasted a few months each, Linda and I were really down in the dumps.  I am sorry to say that we felt as though God had abandoned us and started to question our faith.

I can see now that He never abandoned us, and it was in this dark hour that a series of events began to unfold that now seem miraculous, though they were tumultuous at the time.  In February 2007, I was hired as Marketing Director at Navpress, a Christian publishing company.  The compensation was more than I would have received at C&MA and allowed us to pay off debt associated with the lawsuit that was threatening our financial security and an ongoing source of stress for both Linda and me.  I can honestly say that it was through no fault of mine that I lost this job after only 5 months (another huge bump at the time).  However, Navpress assured me that the elimination of my position was not based on poor performance (my performance had been rated excellent a month earlier and I had received a nice bonus) and provided a 3-month severance program.  At the end of September 2007, I was able to apply for unemployment and received payments in October and part of November.  I accepted a position as Marketing Director at the Zeal Group in late December that paid less than I had been making, but provided more than enough income based on our cash flow needs.  After only 3 months, I cut back to 30 hours per week the beginning of March 2008, for reasons I didn’t fully understand but attributed to stress.  In late April, I was diagnosed with early stage Parkinson’s.  I struggled more and more over the next few months and was able to negotiate an end to my employment on August 8, 2008 despite initial resistance from Zeal.  The negotiation involved elimination of my position (they were struggling and the Colorado Springs office is now closed), which allowed me to once again be eligible for unemployment.  I was able to re-open the claim from the previous year and collect on that through September.  Once again, fortune smiled as I was able to file a new claim starting in October (the qualifying period included much of my income at Navpress as well as Zeal so I was able to receive the maximum benefit).  This turned out to be crucial as the economy and our investments went south because we were able to live off our cash flow and did not have to liquidate any funds.  Now, as this new claim is about to expire, it appears that I will receive a 3-month emergency extension, which covers us to the end of June.  Hopefully the SSDI claim will be approved shortly after this and our financial future will be much more secure.

A case could be made that I did not deserve to be blessed like this based on my lack of faith when things really got tough.  Fortunately, God does not work that way.  In fact, as I look back on my life and consider the “dark hours”, I consistently see God’s hand at work in leading me through to the “other side”.  An ongoing component of my prayers for many years has been that God will “show me the path that He would have me follow”.  That prayer continues to be answered even when I struggle to find the courage to follow that path.

August 17, 2009

Friday night was cloudy when we went to bed.  When we got up about 4 am to go to the bathroom (pee outside the tent), the stars were out and a sliver of moon-it was beautiful.  When we went back to bed, I was awake for a while thinking about my book project.  I thought about the working title quite a bit and what would capture the essence of what I wanted to convey.  The title I had been using was wordy and negative (though witty in a depressing way).  I was thinking that what I wanted to write about was the confluence of my personal experience with PD & cognition issues with my faith in the context of my important relationships with Linda, family, friends (including other patients), and my doctors.  I have been clear about what I wanted to accomplish and who the target audience will be.  Anyway, it occurred to me that I (and others like me) are at an important crossroads.  Life is going to be different in the future.  There are choices that need to made in terms of how to react, level of proactive engagement (exercise, mental activity, nutrition, etc.), choice of doctor, plans for the future.  These are things that we can control.  Other things will not be in our control to a large extent.  One of the choices I have made is to depend on God and submit to His will.  I will try to do my part, but in the end is a wonderful relief to know that He will take care of me and my family.

September 29, 2009

Another God thing.  I had contacted Cleveland Clinic and St. Joseph’s Hospital in Phoenix (both top 10 neurology hospitals) after my last Kluger appt to pursue idea of more testing related to cognition and “second opinion”.  Both responded positively and invited me to make an appt.  The doctor at St. Joes was a Dr. Lieberman at their Barrow Neurological Institute.  I wasn’t sure what to do.  Kluger said he would recommend Cleveland Clinic but wasn’t familiar with St. Joe’s.  He also said I could speak with Dr. Hoyt for an opinion.  Dr. Hoyt said he could do another neuropsych for a new baseline in November and I said OK.  Subsequently, I was talking with my PD neighbor Lloyd and his wife at length and he loaned me a PD book he recommended I read.  Turns out it was written by Dr. Abraham Lieberman.  I went directly to his chapter on dementia.  It was very enlightening and convinced me that he really understood this issue in PD situations.  Then I read that he was at Barrow’s and checked the referral I had been given and, of course, it was him.  Once again, this felt like God was telling me something, so I contacted St. Joe’s once again and confirmed that they take our insurance.  I talked it over with Linda and we decided to go for it.  


November 3, 2008

It occurred to me during the night (Saturday night, I think) that I might consider writing something resembling a book with a focus on my life with Linda.  Feels like a good idea.  Reminds me of when the girl in “I Remember Mama” is given advice to write about what she knows.  Might be more interesting to the boys.  Also ties in nicely with my poem, which seems significant.

November 6, 2008

After we picked up Carson, Dani, & Doug from school we were on our way to pick up Kaya.  I suggested that we take a “short-cut” and go the back way from Quebec to University that goes by the entrance to Gleneagles Village.  While stopped at the stop sign by the entrance to GV, Carson looked over and said (out of the blue) that he would “like to go in there some time”.  We hadn’t said a word about it.  What a coincidence!?  Linda and I looked at each other, smiled, and said “maybe we would do that some time”.
January 29, 2009

I am making good progress on my book now.  I feel a sense of focus as well as urgency.  I hope the first chapter is not too tedious with all the detail.  The second and third chapters balance that out, I think.  The fourth chapter is starting to take shape.  I may approach my former colleague at Cook, Liz Duckworth, who is an editor at Waterbrook Press now, to get her feedback.  My “PD friends” have commented to me that there isn’t much out there about the disease and its’ ramifications written by people who have it.  Two I have read are “Lucky Man” by Michael J. Fox (PD) and “Life in the Balance” by Thomas Graboys, MD (PD/Lewy body disease).  If, by some chance, a publisher feels that my story might be interesting or helpful to people with whatever I have (TBD) or their caregivers that would be great.  In that event, I am sure there would be editing involved and perhaps co-writing (as was the case with Graboys).  I am not approaching this idea with no relevant experience since I was Marketing Director for both Chariot Victor Publishing (a division of Cook Communications) and Navpress (a division of the Navigators)-both Christian publishers.  I will hold off on meeting with Liz until after the 2/5 doctor appointment. 

April 8, 2009

I had a busy day yesterday.  Made a trip into CS to pick up supplements, do some shopping at Sam’s (including Linda’s birthday cheesecake), and check out computers at Best Buy (our computer is seriously outdated and there are some great deals available).  Also picked up some prescription refills at Walgreens, had a meeting in Monument with a lawyer, and picked up a few things at WalMart (including MJ Fox’s new book).

While in town, I also met with my friend from Cook, Lee Hough, who is now a literary agent for Alive Communications.  We talked at length about my interest in exploring the possibility of publishing a version of my memoir.  It would mean a lot to me if my experience might be helpful to others (i.e. PD/dementia patients, caregivers, families, baby boomers, etc.).  I told him that I had already written a letter to the MJ Fox Foundation regarding this idea and the possibility of donating a portion of proceeds to the foundation.  Also shared an email response from Dr. Thomas Graboys (who I quoted in Chapter 1 from his book “Life in the Balance”).  He is an advanced stage of both PD and lewy body disease.  Here is what he wrote:

From: Graboys, Thomas Barr,M.D. [TGRABOYS@PARTNERS.ORG]
Sent: Monday, April 06, 2009 11:02 AM
To: Kirk Hall
Subject: RE: thank you

Bravo tto you mr hall and congrates on comoleting 8 chapters..writing  as your
can onlyimprove your will be a legacy to your famiry.keepit up  so
important to keep your mind and body stimultated...keep it up!
My bestTom

Thomas B. Graboys, MD
Professor of Medicine
Harvard Medical School
617-731-6811 - direct line
44 Old England Road
Chestnut Hill, MA 02467

I was deeply touched (and motivated) by this response.  Lee and I talked about my writing and agreed that, if my situation unfolds as it appears, the longer I can continue to provide information for the book, the more interesting it will be.  This would likely require, as with Dr. Graboys, a co-writer (which I am open to).  Lee made no promises, but thought the project had merit (that sounds kind of heartless, which he wasn’t at all, but we were talking business at that point) and that he would like to see a manuscript when I was ready.