The Emotional Flicker Effect Has Its Triggers and Precursors
One of the major goals I have for managing Parkinson’s disease is to decrease the frequency and intensity of the “ugly days.” Ugly days are episodic in my life but still require managing symptoms every day. If I can keep the worst of the symptoms at bay, I — and those around me — can avoid the downward spiral of emotional, psychological, and physical dysfunction.
Before I was diagnosed in 2014 and started on the treatment levodopa, the ugly days were crushing, totally disabling, and completely unpredictable. Mrs. Dr. C. often said she felt like she was walking in a minefield.
Emotional lability and the neuropsychological distress associated with it, which manifest in Parkinson’s patients as anxiety or depression, are recognized, but are rarely addressed adequately. Outbursts include fits of both laughing and crying, emotional lability, and emotional dysregulation. Sleep disorders and impulse control are also identified in some Parkinson’s patients. Despite the various terms used to describe these disorders, they are often missed and even sometimes misdiagnosed.
Now, seven years after my Parkinson’s diagnosis, my ugly days have started increasing in intensity and frequency. Granted, I’ve been through a lot in the last couple of years. I’m not alone in dealing with a pandemic and social isolation. We have also relocated to a new environment. Moving is always stressful, but it has already increased our quality of life, as long as I can survive all the transitions and challenges of a progressive illness. I can’t increase the levodopa due to side effects. My choice is to either give up — meaning, live with the results of these threshold-crossing events — or design a new brain rehabilitation program for myself.
I describe the basic elements of this program in my new book, “Possibilities with Parkinson’s: A Fresh Look,” and I continue to expand on these ideas in my columns. I’ve identified my own episodic symptoms as a “flicker effect” and use “threshold management” to monitor and adjust when symptoms start to escalate. I’m changing my actions to decrease the flicker effect and the impact of ugly days. The daily application of both threshold management and mindful movements has made a big difference.
Still, life isn’t easy. I still get a monkey wrench thrown into my healing routine. Recently, extreme emotions roared back because a broken water heater forced cold showers on me for more than a week, but the experience reaffirmed that I could minimize the impact of disruptions. It was possible.
When I first began sitting and observing the ugly days, instead of running away or lashing out, I was overwhelmed. Flicker effect events are tied to the eight regulatory systems monitored by the two dopamine centers, and trying to sense each individual system dysregulation through all the noise was extremely difficult. I needed a strategy to identify what triggered these dysregulation events and what the flicker precursors were for each of the regulatory systems. A trigger (by my definition) is any response — such as feeling fatigued or dealing with stress from an unexpected event — that occurs out of my control and that makes the flicker effect worse.
Trying to keep a certain schedule or meet others’ expectations when I am feeling overwhelmed are triggers. I try to avoid as many triggers as possible.
Some epilepsy patients experience an aura that serves as a precursor to a seizure, and I am able to note something similar at the beginning of a flicker, alerting me that I need to put threshold management in place. These precursors are the subtle hints that something is amiss, and I need to be aware of them before the flicker surges beyond my control. I describe such a precursor in my column on the histamine flicker effect.
Sometimes, it is not just a Parkinson’s patient who can identify precursor events. One reader said she could tell when her husband is about to start thrashing during his nighttime sleep. She was so attuned to his Parkinson’s symptoms that she had become able to calm him with her touch to prevent an escalation.
The flicker effect can also be controlled with lifestyle changes, such as exercise or meditation, that act as buffers to decrease it and improve one’s tolerance and resilience.
I’m continually exploring and implementing new perspectives of self-management in ways that reduce symptoms and create a life with Parkinson’s that is filled with possibilities.
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