The Grouch and T.O.O.T.S.: Dealing with Irritability
(Graphic by Dr. C)
Years ago when I was first diagnosed, my partner asked the neurologist, “Is there something we can do about his irritability?” The doctor responded, “I wish I had a dollar for every time a partner made this request.”
It seems this is a prevalent issue. In past columns I have addressed scenario looping breakdowns, exaggerated emotions, deep fatigue, bad days, and ugly days. All of these contribute to the occurrence of irritability. Add to this “off-periods,” which also increase irritability.
The grouch rears its growling snout, and to keep the relationship protected, T.O.O.T.S. is the necessary muzzle. T.O.O.T.S. stands for Time Out On The Spot. It means that you “time yourself out” — zip the lip and take a trip. Walk away and return when calmer moods prevail.
As a therapist and professor, I have lots of practice monitoring my internal emotive state and taking actions to prevent it from affecting my ability to help others. But with Parkinson’s, it became more difficult. The first time the grouch barked back to a student in class and “put her in her place,” it happened on one of those bad days that overlapped with high irritability. But it was a shock to me that it happened, and I went to the department chair to explain it. He shrugged it off.
I told my neurologist that it was as if the normal filters I use to screen my emotions were not working properly. The emotions just spilled out and this grouch took over. Now further along with the disease, not a day goes by when I don’t have to muzzle the grouch.
PD irritability can bring other exaggerated emotions. Every little thing becomes blown out of proportion. Example: I’ve asked my partner not to smoke in the house and even hung a no-smoking sign. (Yes, inside the house!) Yet, a cigarette still gets lit indoors prior to my partner walking outside. The smoke makes me nauseous and triggers the grouch.
How many little things occur in a relationship that are annoying? With the grouch, it is not like a-fly-in-the-room annoying, but more like someone stole-your-lunch-money annoying. Smelling smoke in the house after numerous reminders is sickening and close to infuriating. I put T.O.O.T.S. into action, calmed down, and later planted a gentle reminder — again. Doing it this way prevents an argument or fight and saves the quality of the relationship. Zip the lip — save the relationship.
Dealing with the irritable grouch not only requires T.O.O.T.S., but also the following
– The 1-to-10 rating system of how bad the day is, which can be a grouch warning.
– Exercise, which can decrease grouch problems.
– Realizing that deep fatigue, if not attended to, will increase grouch problems.
– Understanding that ruminating on something annoying makes it worse; the key is to find a way to move past it.
– Telling people what you want from them. If you wait for them to read your mind, you will be disappointed — and annoyed.
Stress, lack of sleep, not eating or hydrating properly, and disruptions in the daily routine all can act as triggers for the grouch. Self-monitoring all of this as a way of keeping the grouch muzzled is not something that happens with perfection. The grouch still barks at family and partner, but the rehab plan decreases the frequency.
Even more than that, the plan gives reassurance to those who love you that you are doing all you can. Zip the lip — save the relationship.
Does the grouch arrive at your home?
***
Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, Bionews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.
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Comments
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Derek Marshall
Sounds like good advice no matter what adversities bring on the grouch...
SB
I found the grouch was much worse when I was on dopamine agonists e.g Sifrol/Pramipexol, which really kept me on edge - coupled with severe insomnia - a sure recipe for disaster.
Am on Stalevo for almost a year now - and have found it much easier to control my moods. In general am far less stressed out. HTH. YMMV.
Sidney
Hey, I think your blog might be having browser compatibility
issues. When I look at your blog site in Chrome, it looks fine but when opening
in Internet Explorer, it has some overlapping. I just wanted to give you
a quick heads up! Other then that, amazing blog!
Dr. C
Sidney: Are you talking about the column "The Grouch and T.O.O.T.S.? If that column is having compatibility issues then please contact Bionewsservices.com and tell them. If you are referring to the blog at www.DrC.life then please tell me in this post. Thanks.
Damon
Quality articles or reviews is the key to attract the viewers to visit the web page, that's what this web page is providing.
Dr. C
Thanks for your support and kind words.
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Dr. C
Thanks for the supportive comment. It's comments like these which help me stay inspired to continue writing, despite the body inflictions.
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js
When my husband becomes irritated these days, I ask him "What do you like today?" It also helps to write down one thing you like every day outside of yourself. I learned this years ago when I was studying Aesthetic Realism and I am very grateful. https://aestheticrealism.org/
Dr. C
Thank you for the post. It's perfectly matched to what this column is addressing. My partner and I both practice an "attitude of gratitude" nearly every day.It does help change the Grouch. Dr. C.
Michele
Thank you for this article. My husband has Parkinson’s and he has recently been a lot grouchier. I’m trying to find ways to help and deal with it. By nature, I’m usually the grouchy one in the relationship, so this is good advice for me, too.
Dr. C
Hi Michelle ~ Thanks for your comment. See my reply to "Dan" who identified from a Parkinson's patient perspective a validation that emotional outbursts, surges of exaggerated emotion, and oftentimes beyond "being grouchy" are experiences that affect the patient and his relationships. I have written additional columns on "threshold management" and the "surges" of exaggerated emotion (SEM) -- I hope you get a moment to read those as well. It is an important aspect of Parkinson's that patients and loved ones experience but oftentimes don't discuss. Keep the lines of communication open and remember there are many others who are going through the same challenges.
Thank you for reading my columns and I hope you continue to check in at BioNews Services Parkinson's News Today for insight and information.
Dr. C.
dm
I've had Parkinson's for over 5 years and this well-written article is spot-on. Having never read this article, after numerous similar anger outbreaks I found that I have had to do the same thing... stop, retreat (and like right now) and cool off by myself. Unfortunately my anger episodes have upset and even frightened some... this is unlike me. While I have never had PMS, I strongly suspect it's similar in many respects. I hope others will extend grace. We really can't help it (at the time).
Dr. C
Hi Dan ~ Thank you for your comment. I'm glad that you read this article and felt that it addressed what we and our loved ones often face in the course of this disease. It can be an overwhelming feeling of loss of control or changes to what we knew we once were. I encourage you to read additional articles in my column that address what I call "threshold management" -- events and circumstances that occur that lead us down the slippery slope of managing stress, emotions, reactions and our relationships. I have identified ideas of "surges" of exaggerated emotions and the "broken conductor" in our brains. I share what I experience and am still exploring these topics. Thank you for reading my columns and for checking in to BioNews Today and the Parkinson's News Today postings. Stay tuned for more information...
Dr. C.
N klein
OMG. YES. THNX FR YOUR ARTICLE. I END UPCRYING & NOT SPEAKING AT ALL. MOST TIMES ALL DAY. IF HE SPEAKS TO ME I DO TRY TO ANSWER. JUST THANX. I FEEL SO BAD FOR HIM.
Dr. C
This is Mrs. Dr. C. and I can certainly understand your frustration and concerns. It is hard to watch someone go through all that PD patients have to manage. The "Grouch" as we refer to it in our house still pops up. We've been working on it for years yet still occasionally things get tough. I find the hardest thing is to have family or friends understand. If you can find a support group in your area, reaching out to people with loved ones who have PD can be a tremendous help. It requires a lot of strength to keep supporting someone through all of this. Hope it helps to know you are not alone. I will keep you in my thoughts -- and Dr. C. thanks you as well for sharing.
Mrs. Dr. C. & Dr. C.
Holl Garbutt
Yes I am glad I read this article .. i am the daughter and caregiver (58 years old) of my father (81 years old) who has had parkisons for 6 years... i find its getting harder for me because my dad lays into me...... He is Al there there is no dementia... he jates me asking questions. I feel he is a valid human bean he has a right to make choices.... in the meantime... i am getting more depressed.... i will show him this article....thankyou,
Holly
Dr. C
Hi Holly ~ The roots of irritability and the "Grouch" may lie within an understanding of "SEM attacks". I have a number of columns addressing this and am exploring it further. Mrs. Dr.C. knows what it is like to be on the receiving end of these exaggerated emotional responses. But we are trying to work our way through understanding what they are, what causes them and how best -- for both of us -- to handle them. Thank you for taking the time to make a comment. Your time as a caregiver is very valuable and I appreciate you sharing some of that time with me and the BioNews website.
Dr. C.
Roger Myers
My question is as a caregiver to a family member with late stage parkinson's is how come the latest parkinsons medications are so hard have prescribed from a doctor? I am referring to medications such as INBRIJA that can treat the off episodes. Does medicare cover them? Also, we know what causes diabetes, but still after all this time we do not know what causes parkinsons. Could there be more inexpensive existing drugs to treat parkinsons that are not commonly used? Also what about the surgical options that are done such as deep brain stimulation, and dopamine pump implant, how well do those work for parkinsons patients? I just feel that as an advocate for a late stage parkinsons patient, we are not given all of our options when it comes to medications, and the other treatments available. Lastly, what in the world does a late stage parkinsons patient do when then have severe depression, severe insomnia, severe shoulder pain, severe muscle weakness, falls easily in all directions, and can't get out of bed? I need some advise. Please help. Respectfully Submitted.
Dr. C
Hi Roger ~ Dr. C. has asked me to respond to your comment and I am known at BioNews as "Mrs. Dr. C." As a caregiver I can appreciate your frustration and all the challenges that you and your family member are facing. While Dr. C. is in the early stages of Parkinson's, his writings focus on this view. We write together and do a lot of research on the disease. We understand the problems of finding reliable and helpful information. My best suggestion to you, as a patient advocate, is to bring these questions to your family member's provider. If you are comfortable in attending their medical appointments, then be there. If you can establish a communication with the provider outside of the appointment, for instance, emailing, then do that. If you and your family member are not getting the information from your current provider, do not hesitate to look for a different provider who can be supportive of both of you. If your family member is in late stage then perhaps you need to consider specialists from the "movement disorder clinics" rather than the general practitioners. It has been our experience that many providers, even neurologists, have limited understanding of Parkinson's disease. There are so many aspects to the diagnosis and the best thing you can do, in our opinion, is keep asking questions of the medical community. Local support groups are very helpful -- patients and their caregivers who face the same issues can be a wonderful resource for finding answers. Both of us wish you the very best in what you are doing. We hope you continue to read the columns by Dr. C. and check in with BioNews to get more information. Dr. C. and "Mrs. Dr. C."
Michelle G.
I am wondering about how this framing could be applied to other brain chemistry experiences. I see a validity in your descriptions of human reaction to pain in the context of depression or addiction. Not to conflate at all, my partner has not been diagnosed with Parkinson's but we both have learned about meditation, mindfulness, and how to detach from the story and everything you write strikes a bell for me. Thank you for putting these important self-care methods and ideas out there. Your work will help many people! Be well.
Dr. C
Hi Michelle ~ Thanks for your comment and reading my columns. I find that as I explore the ramifications of Parkinson's, and seek to find and describe my experiences with self-management, that these ideas are transcending into other patient lives. It is gratifying that the universality of my writing is finding resonance. I have tried to incorporate my years of professional clinical experience and research development into my personal "patient" world. I look forward to more feedback from you with your well thought-out comments.
Dr. C.
Martha Lynn Doan
My 75-year-old husband was just diagnosed with Parkinson's. It's nice to know that there's a reason for his grouchiness
John Citron
You hit the nail on the head here! I went searching for that irritated feeling and Parkinson Disease and your article came up. Yes, I was diagnosed in 2014 after having signs for years before. It's a long story of misdiagnosis as focal dystonia and an idiot doctor no longer in practice, but that's for another day.
Anyway, I can relate to being a grouch. My young nephews call me "Squidward". Yes, that cartoon character from Sponge Bob! I'm grumpy like him they say, but it's more than being just grumpy as you noted.
I find I have to have patience with the patient, meaning myself. I still expect myself to keep up my normal routine, but that isn't the case any longer. I have to let things go as you noted. That's the tough part for me because I expect from other what I expect of myself, and this also means I have to lower my expectations of myself as well. As a music major, I practiced piano to perfection, but playing the piano at that level is no longer possible. It's these things that get our goat as they say, and they add up some days until we explode.
Angie
My husband has used language towards me I would never repeat, thrown things at me and elsewhere, broken things and recently has slapped me twice. There are no signs at all of dementia, just increased anger. He is 61, I am 57 so we might have many years still to go. Our empty nest has turned out to be a nightmare, and it breaks my heart that occasionally our kids get a glimpse of it.