I'm Not Dead Yet!

EP-135 Stress, Anxiety, And Parkinson’s

• Judy Yaras & Travis Robinson • Season 5 • Episode 1

Share episode

Stress isn’t just a feeling—it’s your body mobilizing resources to meet a moment. We sit down with a neuropsychologist to map what stress actually is, how it differs from anxiety, and why chronic activation can make the “on” switch hypersensitive and the “off” switch hard to hit. From there, we wade into depression and apathy in Parkinson’s—two experiences that look similar from the outside but feel very different inside—and why apathy in particular is tough on families and tricky to treat.

We compare roles on the care team—psychiatry for medications, psychology and neuropsychology for therapy and assessment—and talk about why a blended plan often works best. For those navigating young-onset Parkinson’s, we get real about career pressure, parenting, and socially demanding hobbies, and we offer scripts for advocating needs without withdrawing. Hiding symptoms hands the disease more than it took; a single text that asks “What would you like to do with us?” can change the week.

You’ll leave with practical tools you can use today: exposure therapy to unlearn avoidance, mindfulness that’s grounded in sensory cues, and progressive muscle relaxation to pull the only two voluntary levers you have in the stress response—breath and muscles. We round it out with the habits that build resilience—sleep, movement within your limits, honest conversations, and small daily acts of joy—and with the bigger question that shapes recovery: who am I now, and who can I become with this diagnosis?

If this conversation landed with you, follow the show, share it with a friend who needs it, and leave a rating or review so more people can find it. Your voice helps this community grow.

  • Co-hosts: Judy Yaras & Travis Robinson
  • www.INDYpodcast.net


Speaker:

Welcome to I'm Not Dead Yet with Judy and Travis, a podcast about living an extraordinary life with extraordinary circumstances.

Travis Robinson:

Welcome to the I'm Not Dead Yet Podcast. I'm your co-host, Travis Robinson. I was diagnosed with Parkinson's disease at age 35 in 2014.

Judy Yaras:

And I'm Judy Yaras, your other co-host. My husband Sandy had Parkinson's disease for 18 years, and I was his care partner.

Travis Robinson:

Today's episode will be finding out. Probably so.

Judy Yaras:

Well, Travis, I think this is a great topic, and we are really fortunate today to have a wonderful guest with us, Dr. Dov Gold. And I'm going to give you a little background on him. So Dr. Gold earned his doctoral degree in clinical psychology from William James College and completed a specialized concentration in neuropsychology. He completed his pre-doctoral residency at the Warren Alpert Medical School of Brown University's neuropsychology program, followed by a postdoctoral fellowship in neuropsychology at Cedar Sinai Medical Center in Los Angeles. Dr. Gold's training has included various settings, including school-based mental health programs, outpatient clinics, the veterans' health care system, academic medical centers, and psychiatric hospital programs. Dr. Gold works with adults across the lifespan with specialties in geriatric neuropsychology, psychiatric neuropsychology, neurodevelopment neuropsychology, medical neuropsychology, and rehabilitation psychology. I can't believe I did that all. Very good. Who knows to me? Blending a developmental framework and expertise in neuropsychology. Dr. Gold strives to understand the larger whole of his patients and partner with them to identify areas for meaningful growth. And I also just want to say he's a really interesting person. I've had the pleasure of hearing him speak in person. And I'm very excited about this. It's an amazing topic for us to cover because we always hear about stress. And obviously, with PD, you assume if you have PD, there's going to be stress. But I think that it applies to just about everyone. But there's two things I'd like to do first. One, if you will explain just briefly the role of a neuropsychologist, because a lot of people don't understand the distinction. And then we want to hear a little overview of stress, define what it is, why do we have it? I hear about good stress, bad stress. Maybe you can give us a little background on that.

Dr. Dov Gold.:

Yeah, absolutely. And thank you for having me and the warm introduction and getting through all of that. So a, you know, a neuropsychologist in most cases, and I say most only because there's these couple of exceptions, and I don't want to exclude anybody, is a person who has a degree in psychology, a PsyD or a PhD, and they have additional training in the brain and behavior and how different sort of injuries to the brain or processes affect cognitive functioning and affect our day-to-day life. The training for that, according to the prevailing doctor in the Houston Conference guidelines in neuropsychology, which are currently in the process of being updated, involves a two-year post-doctoral fellowship in clinical neuropsychology. So that's the technical definition. If you're a patient, if you're a family member, and that clinical jargon means nothing to you, what we essentially do is we bring patients into our offices. In my case, sometimes I'll meet patients at their homes and we do testing. We do testing of their cognitive functioning, of their psychological functioning. We use standardized questionnaires, we use paper and pencil tests. We also use spoken word tests. As you can imagine, paper and pencil tests sometimes might get confounded when we're talking about Parkinson's disease. It's not really a fair measure of certain abilities if we know that there is a tremor or there is motor rigidity that would impact that score. So we kind of bring all of that to the fore to develop a battery to test these people based on the referral question. That's probably where a lot of practice differs. Some referral questions are very specific. For example, in the world of Parkinson's disease, is this person a good candidate for deep brain stimulation? There's certain domains you're going to want to cover in that battery. On the flip side, same disease process Parkinson's, I just want to get a cognitive baseline. Okay, my battery is going to look a little bit different. So the battery tends to differ among different utilizers based on referral questions. And the secret sauce, if you will, of neuropsychology, apart from just all of our training and our knowledge of the brain and behavior, is our normative data sets. We take your scores on testing and we compare them to the closest approximation of you, the most appropriate approximation of you that we have. So we are talking about, at minimum, probably a correction for age, because we know that cognitive functioning is not stable throughout the lifespan. It's quite dynamic, and different aspects of cognitive functioning will change at different points in people's lives. And so we want to have a good age cohort to compare you against. But what's really great is when we can actually start accounting for other demographic variables, like people's educational achievement, people's gender, sometimes even racial identity, ethnic identity, because a lot of those factors have really meaningful implications for how we understand and make sense of our data. And so that's where the psychologist, if you will, comes in. What do I know about this person? What's going to help me select the best normative data set that's going to give me the most accurate read on this person's cognitive functioning? We put all that together. We answer the referral questions as best we can, but also recommendations. One of my supervisors, if she is listening to this podcast, and she will certainly get the link for it, would be remiss if I didn't, if I didn't honor her through hammering our recommendations. What can we do with what we now know? Right? How can we improve our life? How can we improve our emotional functioning? How can we compensate in a world where we're talking about cognitive deficits for a lot of what I do with the older adult population? We're talking about last phases of life. And I don't say that in a scary way. I say that in a really optimistic way, where we can prepare and we can plan and we can squeeze every little drop out of it that we can and enjoy and optimize quality. And in my case and in my practice, me and in my practice partners and founders and colleagues, we really like therapy. I started this by saying neuropsychologists, most of them are psychologists by training first. I really like therapy. That same supervisor I just referenced once told me neuropsychology will stimulate your mind, therapy will stimulate your soul.

Judy Yaras:

That's good. I like that.

Dr. Dov Gold.:

I know, right? That's why it stuck with me, you know, eight years later. I really believe that. I've worked coast to coast at a lot of different places. And some of my favorites and where I have some of my fondest memories are the institutions or practices where I have been able to do the neuropsych with someone, generate this incredible fingerprint of them, but then actually work with them on it, see them for the follow-ups afterwards and actually put that into practice. And that's something that we really pride ourselves in in our practice. And different people have different skill sets, but that is something that we really try to emphasize because it's one thing for me to give you a report, say goodbye, and send you out the door next. Right. That for me at least, that's that's not how I prefer to practice.

Judy Yaras:

Right. I mean, that's where the whole person comes in. And I think that's amazing. That's wonderful that you do that. Okay, I love that definition. It was it was very clear for me. And I'm sure for our listeners who have never heard the term neuropsychologist, it's gonna give them a nice idea of why, especially with Parkinson's, why you should have a neuropsychologist on your medical team that is going to be doing treatment. Great. Okay, so now let's go to the big question of what is stress?

Dr. Dov Gold.:

I think a better question or a shorter question would be what isn't stress?

Judy Yaras:

Yeah, you're right. What isn't stress? There we go.

Dr. Dov Gold.:

You know, I stress, I was I was really thinking about the definition in preparation for this conversation. And what I found myself thinking about is stress in the most broad definition is anything that takes our homeostasis out of balance. Right? Our body prides itself and thrives at keeping things at balance. It really likes to keep things at balance. When things go out of balance, things start to go a little bit wonky. And so stress broadly is anything that sways that balance. And it could, you could define stress in a number of ways. You could describe it as the psychosocial stress, which I know we're gonna talk a lot about. You could also define it as just physical stress, right? For those of us who are exercising, that is a form of stress, is a desired form of stress, but it is eliciting a stress response. The body is responding to the pressure that you are putting on it. In fact, there is recruitment of the stress response, even when we're waking up in the morning. That requires the mobilization of a lot of the same chemicals that we talk about in the stress response. So to me, the broadest and I think most encompassing definition would be anything that exerts pressure on the homeostatic system that then elicits a response from that same system, good or bad.

Judy Yaras:

Good or bad. That makes sense. I understand that. This it's part of that. What is it, flight or fight?

Dr. Dov Gold.:

Uh-huh. Fight or flight. And in fight or flight. In the trauma world, in the PTSD world, there's fight, flight, or freeze. That's kind of been it's kind of been addended. I've I've seen that come up a bit as well.

Judy Yaras:

Oh, I've never heard that with freeze. That's interesting.

Dr. Dov Gold.:

Yeah, I mean, you could perhaps liken it to a static but internalized flight. That is to say, right, freeze in in the sense of a traumatic experience or a traumatic event. Sometimes people will describe feeling frozen by the fear. And there are tendencies that people will kind of quote unquote leave their bodies, right? You hear that, or you hear people say that they were looking down on themselves. So that makes sense to honor that experience and the very real potential for dissociation among trauma, but it may also just be an internalized quote unquote flight response, right? This is so overwhelming, I must detach from what's happening. That's interesting.

Travis Robinson:

Get away from the situation, regardless of how. That's right.

Dr. Dov Gold.:

You can't physically run away, mentally.

Judy Yaras:

Mentally, you turn off. I never thought of it that way, but that's a really good way to look at it. You know, and it's interesting when you say freeze in the Parkinson's world, obviously, it has a whole different meaning. But I'm thinking about that word, and maybe there is something to that freezing that happens with Parkinson's as well, that is like a disconnect, it turns off. And we have to go back. We're gonna explore that a little bit down the road. I have to really think about that. I've got to spend some time working on that. So, you know, we look at the world today and it is everywhere.

Dr. Dov Gold.:

I try so hard not to.

Judy Yaras:

I do too. I do too. My house does not have news on at any time. But, you know, the world is so stressful. COVID was so stressful. We came out of COVID feeling, oh, we can take a breath now. Everything's gonna go back to being pretty and sweet and nice. But we're in turmoil at all times. And that brings and it creates different sensations for people. And the question I think Travis and I had kind of talked about this at different times is what is the difference between, let's say, stress and anxiety? Are they the same? Are they different? Does anxiety bring stress, which I think it does? And does stress bring anxiety, which it does? But what what how does that work? What's that relationship like?

Travis Robinson:

Which one's chicken, which wants egg?

Judy Yaras:

Right, exactly, Travis.

Dr. Dov Gold.:

That's such a good way of putting it, Travis. It's a razor's edge distinction, but there is one. There is one, okay. Stress is the recruitment of resources metabolically in the body to meet a situation, a stressor. Whereas anxiety is best captured by worry about a future event. We are worried about something that perhaps is not right in front of us, but it's a far-off worry. But to your point, does stress cause anxiety? Does anxiety cause stress? I think it's very easy to see how anxiety causes stress. If you get enough worry going, you can elicit the stress response. Right. Does stress cause anxiety? I think certainly at the indirect level, because they play on a similar pathway in the brain. They touch on a lot of the same nodes in the brain. And in a chronic activation of the stress response, the ability to turn that mechanism on or off can actually be impacted. Where the on button is a little bit more sensitive, and the off button, it's almost like sticky, like you can't hit the off button as quickly. So I would argue there's a bi-directionality where if you're under chronic stress, you're probably more vulnerable to anxiety. And if you're chronically anxious, you are probably more vulnerable to stress. But I think that piece of the future-oriented worry is how I would separate stress from anxiety.

Judy Yaras:

And it's it's funny with this because the anxiety that people experience with PD oftentimes, it's, you know, I'll hear people say this in support groups, and you've heard this a million times too, Travis, where people are going, I don't know why I was fixated on this one thing, on something so ridiculous. Was my care partner gonna eat lunch? You know, this was an example that came up this week. Like, what difference did it make if he was gonna eat lunch or not? But this person woke up in the middle of the night stressing about this and having anxiety over it. What could he do to support his care partner, carever eating lunch? And it's such an odd thing that seems so unimportant. Yet for him, it kept him up half the night.

unknown:

Wow. Yeah.

Judy Yaras:

And I found that very telling, you know, in terms of where he is in his interaction with the people that are close to him.

Dr. Dov Gold.:

Yeah, and how and where where Parkinson's is playing with those dynamics, right? Right. It it certainly exerts its influence.

Judy Yaras:

Because he's someone that is supposed to be taking care of him. And yet now he wants to get into that role of being the caretaker a little bit. And I I thought that was an interesting dynamic. Did you hear that, Travis? I think we were in the same group for that one. Yeah.

Travis Robinson:

Yes.

Judy Yaras:

It was kind of interesting. You know, when we look at stress, anxiety, we look at Parkinson's, there's this third big syndrome or symptom that comes along and it's depression. And I'm really curious how depression ties in with stress and anxiety. Like, is it a trifecta of the three of them together, or is can it be really separate? Can you have depression without stress and anxiety?

Dr. Dov Gold.:

To the latter, yes. I've met patients who really are purely depressed. They don't strike much elevations in the way of anxiety, but part of it is they're too depressed to be anxious. Oh, okay. Anxiety is an activation. Your arousal curve, if you will, is pushing upward, whereas in depression, it may be pushing downward. The two are very, very comorbid. I sometimes describe them to patients as cousins because they tend to run together a lot. I don't think there is necessarily one thing that will guarantee someone's going to respond in a depressed way versus respond in an anxious way. Some of it is temperament, some of it is your experience, your own just unique psychology. You know, the person who responds to stress in a, well, what can I do way, right? That kind of frantic problem-solved way. That person may lean more into the anxious axis of their emotional response. The person who receives a stressor and just feels absolutely overwhelmed and can't really move because they feel almost like they're wearing a lead jacket now. That person might lean into the depressive axis more so. It is, I think, rarer to just get one, but I think this is where this is where the diagnostic system comes in when we're talking about normal depression, normal anxiety versus clinical disordered anxiety and depression.

Judy Yaras:

Oh, okay. So the distinction there, clearly. Okay.

Dr. Dov Gold.:

Right, right. When we're talking about anxiety disorders or depressive disorders, you know, we have criteria. We know what they both look like. Still a lot of comorbidity. But when we're talking about a non-disordered individual, by that I just mean someone who does not have either of those syndromes.

Judy Yaras:

I've never met anyone that is never that, yeah, a little bit, maybe.

Dr. Dov Gold.:

I, you know, I I hope this joke, this joke doesn't get me in trouble. Uh, if you don't have any depression, any stress or anxiety, you must not be paying attention.

Judy Yaras:

That's my feel too. Yeah, that's probably true. All right, I'm gonna throw another word in here because this is another symptom with PD that I feel is sort of in this world. It's maybe on the same hemisphere, and that is apathy. So with apathy, where does that fit into the picture? You know, you were saying someone feels frozen, they just can't move, they can't do anything. I always think, oh, that's the apathy that's coming into place. But is it really the apathy or is It really is a part of the depression?

Dr. Dov Gold.:

So every psychologist or neuropsychologist listening to this will laugh at me saying it depends. Um the answer depends on the internal experience of the person because there's a lot of cross-contamination between the behaviors you would see in apathy and the behaviors you might see in depression. But really, what is distinct between them is the person's emotional experience. In apathy, there is almost an inertia, right? If we think about physics for a moment, it takes more energy to take an object at rest and put it in motion than it does to keep an object in motion. It's an initiation issue. Um apathy is very much that. It is a problem with the initiation or selection or activation of a behavior, but in the absence of the emotional or affective component of it. Whereas in depression, you might have that inertia, but it coincides with this low mood, these depressogenic cognitions or beliefs, perhaps thoughts of death, suicidality, changes in appetite, changes in motor functioning, restlessness or agitation or even slowing. Whereas in apathy, it really is more of this disinterest. Nothing's really rousing the person, but they're not necessarily depressed. They're not necessarily sad. They're not necessarily anxious. There is really just this kind of show fucks given.

Judy Yaras:

Yeah. There we go, Travis. Thank you.

Travis Robinson:

Yes.

Dr. Dov Gold.:

That is uh I like your virgin better, Travis. We'll get that into the next iteration.

Judy Yaras:

This is a non-clinical. I love that.

Dr. Dov Gold.:

We should get that into the next iteration of the diagnostic criteria.

Judy Yaras:

We should definitely go in there. Travis will have a few good ones on this. But I do think it's something that again, we hear this in support groups. We hear people talking about it very openly. And they know what they need to do. They know what is best for them in terms of their mental well-being. But then that apathy sneaks in. And I'm always wondering, is this person, is it just apathy? Is are they really deeply depressed? What's causing that? And I think with that person, I never think of anxiety as much with apathy. I feel like there's more depression with the apathy than anxiety with that.

Dr. Dov Gold.:

The the overlap with depression is far greater. In fact, I don't know. Again, if if you hold on to my simplification of anxiety being a sort of activation or your arousal curve is creeping up, that is antithetical to the apathetic response where it's kind of just flat. Nothing's moving it up, nothing's moving it down. Um, and again, that's where the person's internal experience, their internal emotional experience becomes so critical in distinguishing it. And I will say, apathy, whether it be Parkinson's, brain injury, Alzheimer's, frontal temporal dementia, any other neurodegenerative disease or brain injury, apathy is really hard. Apathy is so hard to manage, to treat, to get our arms around. The research around treatment for it pharmacologically is just not giving a lot in the way of intervention sometimes. There is some modest benefit with certain agents, but it is very tricky. I think for care partners and family members, it's quite distressing because they'll do everything, right? They'll do anything and everything if mom or dad or brother or sister would just come along with us. Any loved one, if they would just come along with us, right? But they don't they don't want to do anything. They're telling us they don't want to do anything, they don't feel interested. I feel bad pushing and I just don't know what to do. And it feels like they've given up. And then you, as the care partner, are throwing up your hands because you know, I I can't try harder than this patient's trying. And I think sometimes neuropsychologists can almost give permission structure for care partners to just exhale, like this is part of it. It's not insurmountable, but you can't let their apathy feed your own.

Judy Yaras:

Right. Because what happens, I think, for the care partner is the care partner starts to go into depression over their lack of ability to be able to help the person that they love. And that could be a friend. It's it's not, we have care partners that are friends. They may not even be partners that live in the same household. And it's it's very challenging when you hear that. I've heard people with PD say, oh, I think I'm just a lazy person. I've I've been lazy. And I keep going, like, yeah, I don't think it's lazy. I think you have apathy. You know, like that's that that's something you can't avoid. So, okay, so we have these things. We have anxiety, we have depression, we have stress. Obviously, we have stress, anxiety, depression, we have apathy. So now, you know, what is the coping philosophy? Like, what do we do with this? Do we just, is there a pill for every little thing? You know, I you we live in Los Angeles, and probably I think this is true all over the world, maybe not so much all over the world, but all over the US. You hear people taking their antidepressants, their happy pills. And certainly in PD, you know, we say to people, are you on an antidepressant? You know, I've heard people in groups say, have you tried an antidepressant? So what is the general idea of how to help someone that is going through all of this? Is it strictly pharmacological or are there other things? What does that approach look like?

Dr. Dov Gold.:

Well, since you did bring a neuropsychologist on the podcast, you're definitely not going to hear me say it's strictly pharmacological.

Judy Yaras:

Great. Good. Good. Okay, good.

Dr. Dov Gold.:

But if you have a psychiatrist on in a few weeks, maybe they'd have a, they'd take a different take.

Judy Yaras:

Oh, and let's let's touch on that because I want people to understand that. This is really good that you said that. Because a lot of people say, Oh, I have to see a psychiatrist. And I said, Well, do you understand the difference between that today? It's my understanding that psychiatrists are more pharmacical based. Does that make sense? Am I saying that correct or is that incorrect? Okay. So that they are more to figure out medications for you, where the neuropsychologist is looking more at the therapeutic side of it. Right.

Dr. Dov Gold.:

Yes. There's, with the exception of a few, a few states that are looking at prescribing privileges for some for some mental health professionals, California not being one of those. Right. That distinction holds true. And it it kind of follows the tracks of their of their education and training. Right. If you're a psychiatrist, you went to med school, right? You studied medicine, that's what your degree is, and then you specialized in psychopharmacology. And you may have had some experience around therapy and provision of therapy around that, but that is not what you spent years and years and years and years doing. Whereas, granted, some people are MD PhDs and they do. And in that case, you're a double threat. God bless you. Um, and you have you have a stomach for school far greater than mine. Right. Whereas whereas the psychologist, you're doing years of work. Whether if you're a PhD, you're doing a lot of research in practicum. If you're a Psy D, which I am, instead of spending the majority of my time in research, every single year of my graduate school training was practicum, right? I was in a different setting. I was working with a different population. It was the clinical laboratory instead of the research laboratory.

Judy Yaras:

Right. That's what I loved about reading your bio was you you really span from children to geriatric treatment, which I thought was great.

Dr. Dov Gold.:

Full credit to my program for their structure where your first year, you have to be with a kid or adult, and your second year is going to be the other. And then all the years after that, you can you can apply wherever you'd like. But they really force us to have the lifespan, at least in the beginning, so we can figure out what we like and also importantly, what we don't like. But every year, that was where the specialization was. We took a lot of the same courses, but I spent a lot of time relative to, say, a PhD cohort, paralleling me a lot more time in the clinical trenches, if you will, applying these therapeutic techniques, refining my therapeutic craft and all the way through, even into fellowship, especially. So can psychiatrists provide therapy and provide good therapy? I'm sure, absolutely. It's just a matter of where our relative specializations are. Whereas that is all of what I studied. That is all of what my focus was on in concert with the neuropsychology and neuropsychological assessment. So it's just a matter of what it is, you know, what it is that the person needs, truthfully, in the best case scenario, you'd have both working hand in glove.

Judy Yaras:

And I that's what I was thinking, that for your team, as we're building this medical team, you have a neuropsychologist, you have a psychiatrist. Yeah. In the same way that you have a movement disorder specialist, and you might have a urologist, a gastroenterologist, or a neurogastroenterologist? We have all these specialties that we're kind of bringing to the table now to build your team of doctors to support you with your PD.

Dr. Dov Gold.:

Yes, absolutely.

Judy Yaras:

So, what are some of the best practices then that you look at when you see people that are going through this? Is it do they do months, years, weeks, weeks, months, years? I mean, what does it look like?

Dr. Dov Gold.:

Here it comes again. Depends.

Judy Yaras:

Okay.

Dr. Dov Gold.:

And I say that because there are certain conditions that lend themselves better to one or the other. On base, if I take all conditions all being equal and just kind of mesh them together and give you an aggregate, the answer is going to be probably both. The best outcomes are gonna yield from a combination of psychopharmacology and a combination of psychotherapy. The duration and the target of the psychotherapy, which I'll that's we're all focusing on, that's going to depend on the person. Because there are people that I have seen who have Parkinson's, and we are just talking about a very targeted issue, right? They want to come and see me. It's a really targeted stressor, and we're working through it. And we're coming up with strategies with what I know about this person, what works for them. Their stress management plan might differ from the patient who's coming in the door right after them, even if they have the exact same problem. Because it depends on certainly what's available to you, what you like, what you've tried and haven't tried. And even as we're talking about Parkinson's physicality. Because it would be really messed up of me to tell a patient with ambulatory limitations, oh, you just need to run three miles a day. You'll feel great, right? I can't just give.

Judy Yaras:

Yeah, yeah. Yeah. It's not something you can do. And I think, you know, for me, I really have a lot of friends in the YOPD group in this young onset population. And for me, I see that their challenges are really different than someone who is, let's say, 75 plus, or even 70 plus. They are at the peak of their careers, or they may have young children or children going off to college, or, you know, they how the things that they are facing creates a different stress level than for someone perhaps that is older, that has had their time in working and living out a lot of their dreams of their life. So how does that play in with all of this, the therapy? What are some of the things we can say, or can we, or do we not say something specific to someone who is a a young onset Parkinson's patient?

Speaker 4:

Yeah. And I I mean, Travis, I don't know if you if you have a take on this, just given, you know.

Judy Yaras:

He's gonna add, but trust me.

Dr. Dov Gold.:

Fair enough.

Judy Yaras:

He has it, he has an ad.

Dr. Dov Gold.:

I it's it is so, I mean, symptomatically, but also I think psychologically different than your older onset group. Um because if you imagine your 30s and 40s and just the developmental milestones, the life milestones that are happening in those 30s and 40 years, a lot of them require a lot of physicality, right? If we are talking about someone really rising through the ranks of their career, right? That's a kind of 30, 40-year-old, I think. Right. Well, we would hope. We'll see what the economy looks like.

Judy Yaras:

You never know, not today, but that's the change.

Dr. Dov Gold.:

Right. That's the model we all we all uh aspire to. That's a lot of energy. It takes a lot of energy to put in those allies. It takes a lot of energy. And and if we're talking about Parkinson's disease, energy is not at the peer level in many cases. We might feel more tired, we might not have the energy, the stamina, or or if we're talking about even just recreation, right? If we, you know, we live in California. Everyone in California seems to love hiking. And if you don't believe me, go take a look at just the parking lot outside Runion Canyon on a Saturday morning, right? Saturday morning. It's right. It's crazy. Um it's right. But okay, you, you and your early, your early young adult onset Parkinson's disease, you've got a group of friends, 16 of them arranged to go do a 10-mile hike uphill. Okay, like if you have the ability to go do that, go do that. But at the same time, that does present on its face a very obvious challenge. Um, and I would say to my patient in that particular situation, what is the most important thing for you to get out of this? Do you do you want so badly to participate with them? Okay, let's let's figure this out. Let's figure out a mid-ground, right? It doesn't have to be all or nothing. Maybe you just do the first five miles and then you, you know, tell them you'll meet them for drinks or for brunch after, go to Mel's Diner or something, right? Um But maybe they say, you know, that's just physically, that's not where I am. I can't really do more than the mile and say, okay, so maybe we have to talk about being our own best self-advocate. Maybe we have to talk about being the squeaky wheel. And what are you, what are you afraid of with being that squeaky wheel? Are you, you know, are you afraid of the pushback? Are you afraid of being the wet, the wet blanket? I think we all sometimes assume the worst of ourselves. We are our harshest critics. Um and I think sometimes that lends itself to us being quiet when we when we feel like there's a need that is not being met.

Judy Yaras:

Right. And you you pick the perfect thing too, because Travis is a mountaineer. I don't know if you know this about him, but you may not know this, but he is a true mountaineer and has climbed, I I forget how many mountains, but well over 10,000, 13,000 feet. And is hung from the side that my my most pronounced visual that I always have is Travis in a cot hanging off the side of a mountain when they could not complete the the climb for the day, which gives me anxiety. Okay. That's as his friend, it gives me anxiety. But Travis, for you as a young onset person, we all know your motto for the most part, that you have a fuck this motto. But in reality, there have been times that you've had to change direction or change change plans, pivot a little bit. Am I right?

Travis Robinson:

Yes. And what often makes that decision for me is who else is involved? You know, yes, I do not live my life in a vacuum and everything that I do or don't do the facts other people in my life. So I try to be cognizant of the facts of my action.

Judy Yaras:

That's why he never tells me when he's going on a planet, because he knows I'm gonna worry all weekend.

Travis Robinson:

Right. Exactly.

Dr. Dov Gold.:

You know, but I mean with that though, even our absence in among from our from our social groups, that has an effect. Right? People, people who who just withdraw from the world, I think do so on the assumption that no one notices. But the reality is Oh, that's interesting.

Judy Yaras:

That's a very interesting point.

Dr. Dov Gold.:

I never Yeah, just like, oh, it's better off for me to just fade into the background. But I don't think that is true. And I think for the the person who does not have Parkinson's who is missing you, they don't necessarily know how to break in there because right, we don't wanna, we're all so self-conscious. Oh, I don't wanna, I don't want to overstep and and say something and upset them, you know, maybe they don't want me to mention the disease, right? And and everyone kind of just shuts down because we don't want to talk about the the uncomfortable thing. But the reality is if your friends are doing an activity that is physically not accommodating to where you are, and you just decide to disappear from that social group. Well, for one thing, you're just promoting your own loneliness and you're you're inviting the depression that is so easily already, so easily arriving in some of these cases. Yeah, it's on your shoulder. It's on your shoulder. You're just bringing it on faster. But imagine, imagine that same that same person who's withdrawing getting a phone call or getting a text message from someone of that group saying, you know, hey, like we've done a lot of hiking this month, and I haven't seen you at any of them. And what can we do to spend time with you? What you know, what what do you want to do? How do you want to spend time with us? I think most people would react really positively to receiving to receiving a message that is that empathetic and Consider it, even if it requires addressing the elephant in the room of Parkinson's.

Judy Yaras:

Yes. What do you think, Travis? Would that work for you?

Travis Robinson:

Absolutely. Yes, that consideration of my situation would be worth a lot.

Judy Yaras:

I think that's such a great point. And I hope for people that are care partners or friends of care partners that are listening, this is a great takeaway from today. And that's Travis's medication alarm. That's okay, folks. I think it's wonderful that we can touch on this to let people know that it's okay, it's uncomfortable to talk about it and it may make you feel uneasy. But sometimes it's just good to say to the person with Parkinson's, what would you like to do? What are you able to do? And I'll do it with you. I'm your friend. And I know Travis has those friends. And I know that he has climbing friends that have adapted to his style and needs in his climbs at different points as his as his PD has progressed. Am I right, Travis? I've met a few of them.

Travis Robinson:

Right.

Judy Yaras:

Yeah. And this is, I think, very admirable of them. I mean, they want to be with him. They're not looking at the experience just for themselves. And maybe that's the clarification that that can help people understand that you're not just a fly on the wall looking in. You're part of that whole process, right? You're part of the group. It's it's community. It's community.

Dr. Dov Gold.:

It's community, right? Like that's, I think fundamentally that's that's something we all we all look for and we all sometimes struggle to find. I mean, especially I feel like in LA, it can be really like a lot of people. I mean, I'm I'm not a native, I'm a transplant. Um so for me, I mean, I establish my community through my through my profession, through my professional relationships, through family relationships, right? That's that's mine. But you know, for someone who just moved here and doesn't have the sort of the the community, the the professional community as an outlet, it can be really hard to make friends in LA. Yes, and it can be build that community, and that's a stress. That's a stress itself.

Judy Yaras:

That is a stress right there, yeah, absolutely. And I think even if you've had community, but you have pulled away from them, I think getting back to it can be really, really hard to do.

Travis Robinson:

Particularly if you pulled away before you had PDR before your symptoms were very pronounced.

Judy Yaras:

Oh, that's a good point, Travis.

Travis Robinson:

Introducing yourself to folks. It's like I'm the fucked up cripple down the street.

Judy Yaras:

Right. How are you? Right. Obviously, that's not the introduction most people would use, but it's but I think but that's what's in your head, right? Right. So that's the introduction that sits in your head, but it's not what comes out of your mouth, obviously, you know. But I I think being able to even just take that first little step to contact someone, that is the hardest part that I see for people. And I hate it when I hear that people are isolated, that they don't have a support system around them. It's it breaks my heart.

Dr. Dov Gold.:

Because such a difference.

Judy Yaras:

It makes such a difference. And you know, that's what COVID took away from so many, and people couldn't wait to get back together. Now people are sort of back together, but it's in a different way. I think people, and I see a younger, and a younger generation now that likes to, they work from home, they stay home, they don't go places, everything's delivered to them, their clothes are delivered, their shoes are delivered, their food is delivered, they don't step out. And so what's happening now with society? How are we managing this? That everyone is so isolated. So that's a whole other story.

Dr. Dov Gold.:

No, it is, but I mean, I I remember some of my first social encounters after the lockdowns. And right again, like I have a degree in psychology, for God's sakes. I felt so out of place. It's like, it's like I had forgotten some of my just like basic. And I think, I think many people who knew me before the lockdowns kind of would describe me as a pretty extroverted, extroverted, outgoing conversational guy. And I certainly have a lot of that. But my my consumption of out-of-the-home activity dropped precipitously. And it, I wouldn't, I don't even think it's near that baseline at this point. And you know, some of that might be just increases in professional obligations, sure, maybe, but I certainly still feel it, right? I think we all we were all so excited to be done with the pandemic. And what what I think we missed was, you know, the COVID pandemic, now endemic, may have may have sort of may have sort of fallen in the rear view, but we traded it for a different type of pandemic, a sort of social isolation, a sort of loneliness pandemic, which I know the the surgeon general last year. Yes. Oh yeah, last year he yeah, yeah, raised the alarm bells about it. Um and that I think is still is still going on. And I think when you have when you have a disease like Parkinson's, or really any of the non, shall we say, the non-invisible diseases, um I feel like there is a inadvertently a subtext to that we have to sort of hide it or that we sort of, you know, we we can't make other people uncomfortable with with our symptoms. And I'm gonna I'm gonna borrow from Travis's dictionary. That's bullshit. That is just absurd to me. I think that when you when you feel like you need to hide your symptoms, you have just given the disease more than it took. Right? The disease will take. It will. Right. You don't need to cede ground to it prematurely. And if you do, you might invite, apart from depression, disease progression through stagnation, through right, right, right.

Judy Yaras:

Travis, you you wanna I know you want to comment on this too.

Travis Robinson:

Yes, absolutely. And it is awkward. I myself have found sharing my disease symptoms with folks that I don't know as well uncomfortable because they see it and I can see their awkwardness.

Judy Yaras:

Like they don't know what to say to you, right?

Travis Robinson:

Right.

Dr. Dov Gold.:

Yeah.

Judy Yaras:

Yeah. But but in a way, the fact that you are still willing to share what's going on with you, I think is is pretty positive. And we know that there's many people that don't share that. And and in the young onset population, the fear of losing a job, you know, because you share that information or wanting to go on a date, you know, and you can't date if you're if you have Parkinson's, but there are people that definitely date with Parkinsons and have relationships. So yeah, it's I mean, I I've watched you, Travis, over the years, and I I have always felt you are pretty open. I've I've even traveled with you, you know. We went we went to Barcelona for a conference together, and and I watched you in different settings the way you present yourself. And you've always been very open to let people know what's going on with you. But we both know people that do not do that and are trying to keep it a secret.

Travis Robinson:

And I'm saying, even for me, it's uncomfortable and awkward. So for other folks, it must be magnified.

Judy Yaras:

Yes. Are there tools that people can use to help them get to a place where they can feel more comfortable sharing? Is there a recommendation you would have for something like that?

Dr. Dov Gold.:

Yeah, you know, and I think this comes up a lot with a lot of my patients, again, whether it be Parkinson's or stroke or injury, or even just physical injury or spinal cord injury. I think it's the at the talk therapy level, I like to understand what's the root of this fear, right? And and it's sort of a a sort of Socratic dialogue of so you are worried about people seeing your symptoms. Because if people see your symptoms, then fill in the blank for me. And if that happens, then fill in the bright. And we just drill down. We drill down to what you're really what the real fear is.

Judy Yaras:

Okay.

Dr. Dov Gold.:

Right, right. And for some people, it might be as simple as, oh, it's embarrassing. Okay, well, now we know. And we can we can develop some really targeted therapies around that embarrassment, right? That may be more of a an exposure paradigm where you kind of run at the fear instead of running away from the fear. Because when we run away from the fear, it feels really good in the short term. Avoidance feels great. Oh, who doesn't love avoidance? But it just increases the likelihood that you're going to avoid later. And it just makes the fear bigger and bigger and bigger. And so, exposure therapy, the main thrust of it is run at the fear in a really conscious and deliberate way. Expose yourself to the thing you're scared of because one of two things will happen. The thing you're scared of won't happen, and you'll realize that your brain will learn not to be scared of this thing. Or the thing you're scared of will happen and you'll survive it, and you'll realize it wasn't necessarily as life or death as you thought it might be.

Judy Yaras:

As you imagined, right, as you imagined it to be. That's really fascinating to me because I'm thinking when you said that, I thought, oh, like people that are afraid of flying, they just don't take airplanes. They take trains, they take buses, they take cars, but they will not get on an airplane. But people have done work with exposure therapy, right? To get over fear of flying.

Dr. Dov Gold.:

Yes, it is for so many different anxiety disorders, whether it be social anxiety, panic disorder, a specific phobia, obsessive-compulsive disorder, which, you know, technically it's a different category, exposure, exposure, exposure. Exposure, right. Um, and then separate, and sometimes as an adjunct to that, basic, just basic stress management. And it takes so many different forms. It's so And what does that look like?

Judy Yaras:

Class of ideas, basic stress management.

Speaker 4:

You know, I think mindfulness has taken off in America, and that's wonderful, right? It's this the Western the Western world has finally caught up to what the Eastern world has been saying for generations.

Judy Yaras:

Breathe for centuries. Yeah.

Dr. Dov Gold.:

Um, the, you know, and and mindfulness, it doesn't just have to be breathing. Um, I think sometimes people get in their heads like, oh, I'm a bad meditator, I'm a bad breather. And I'm like, what the hell do you mean? Like, what are you talking about? No one, you're breathing. You're doing it. You're breathing. Right. And uh and a different mentor of mine once told me it's about losing your mind and coming to your senses, which I just I love that.

Judy Yaras:

Oh, I like that. I know, I know. I'm writing that one down. That is so good.

Dr. Dov Gold.:

So it's such a great way of describing it where you are, you are coming to your own thought process, non-judgmentally, attempting to connect with just what you're doing right now, right? And so as I'm sitting here, if I were to sort of turn my mindfulness mind on, I like to do it in a sensory way. So I'm coming to, I'm feeling bringing my attention to my body, I'm bringing my attention to the feeling of different fabrics on what I'm wearing, I'm bringing my attention to the vibration of my voice in my chest as we're talking, right? But while I'm doing that, guess what I'm not doing? I'm not worried about what I'm doing after this podcast. I'm not thinking about my agenda. I'm I'm sent to the water.

Judy Yaras:

You're staying in the moment.

Dr. Dov Gold.:

Right. And you could do mindfulness walks, you could do dishes mindfully, you can bake mindfully. I mean, it's so it's so broadly applicable. And all you need is your breath and a little bit of time and practice. You have to flex that muscle just like anything else. So that's, I think most people have some exposure to that just by living in our culture nowadays, at least. You know, there's also progressive muscle relaxation, which is basically going through the different muscle groups, pairing it with breathing to actually force the physiological relaxation response. Because when we talk about the stress response, most of it's automatic, involuntary. There are only two sections of it that we have any voluntary opportunity to control. And that is our breathing, and that is our muscles. That's it. The rest of it is just gonna go one way or another. And there, those are the doors. You don't have those, that's it. Um doors.

Judy Yaras:

There isn't a third.

Dr. Dov Gold.:

Right. That's that is how that's how our openings to regulate the stress response when it is happening. And as we train ourselves to do this when we're not stressed, we train ourselves in these skills when we're not stressed. It's amazing how they just deploy themselves when we are stressed, right? If you want to be able to lift a car from an accident, you need to have been going to the gym for months, probably years, to build the muscle to rise to the occasion. And if you've never done any of these things, yeah, no kidding. Mindfulness is not gonna help you in your panic. But you shouldn't do it the first time there. It might help, but it's not gonna, it might not give you the give that you're looking for. But if you've been practicing it and cultivating it, it's much more likely that that pathway, that groove in your mind will turn on in response to the stressful stimuli, or it'll be more quickly accessible to you in the frantic, what do I do? Maybe the first step is breathe, right? Separate from our first reaction. What's our second reaction? What's our third reaction? And then allow ourselves to problem solve more effectively. Those are, I think, really practical and and easily applicable, and you don't need anything to do them. And then beyond that, it's I think a stress-resilient lifestyle such that we can, you know, and these get these get to the simple things. These are, are we just taking care of ourselves? Are we throughout the day when we're not stressed, are we tending to ourselves? I will tell you right now, my stress response goes from a dimmer switch to a light switch, depending on how much sleep I got. If I get less than four hours, I am punchy.

Judy Yaras:

I'm just I think everyone is punchy with less than four hours.

Dr. Dov Gold.:

Yeah, but you know, but sometimes that's what life demands. But I'm really, I'm I'm almost militant about trying to get closer to seven or eight hours because it just makes such a big difference for how I'm dealing with the dodgeballs that life and my life or my clients' lives or any just is throwing at me day to day. So it's both what you can do in the moment, but also how can we cultivate resiliency before we even get there?

Judy Yaras:

I love that because I think resiliency is you have to be, if you have Parkinson's, you have to be resilient. You have to be. It for I think it forces you to be resilient unless you are going to just stay in your home in a big chair and watch TV all day long and sleep and eat and do everything from that chair and never leave your home. Because to be, am I right, Travis? Like you have to be, you're resilient for sure.

Travis Robinson:

Yes, you have to be, or you will die.

Judy Yaras:

Yes. Yeah, I think that's that's the the key to it all. This has been like fantastic. I mean, I feel like I could go forever talking to you for another hour or so, but I I don't want to take you down here with the time. Travis, do you have any other points or anything that you wanted to talk with Dov about or share anything of your your experiences, what you do when you feel that stress?

Travis Robinson:

No, I feel like we capsured it pretty well. I think that I own personal tricks all in what you were saying about mindfulness or exposure therapy. I'm very much a "run at the fear" sort of person. So that is a lot of what I do.

Judy Yaras:

And maybe it's good to analyze. You know, Travis is definitely running towards it. I tend to I might slowly move a little bit. That's okay.

Dr. Dov Gold.:

That's okay.

Judy Yaras:

But I I don't like heights, so I I love to hike, but not up too high where I have to look over an edge. I like flat roads.

Dr. Dov Gold.:

Yeah.

Judy Yaras:

But but I, you know, I think the takeaway for me too is with all of this, is you need to take some time and reflect about who you are. You know, every time you said it depends, well, it really depends on who you are and maybe being honest with yourself about who you are. And I I've known people that have really changed their lives having Parkinson's doing exactly the opposite of what they did all of their life. People that were very type A, pushing, pushing, never spent a moment doing meditation, and now they're exercising and doing meditation and they're socializing and they're meeting with people that they never thought they would ever meet with before. And they have really radically changed their life. So for me, I think this idea of understanding and taking a moment to reflect on who you are can really be good.

Travis Robinson:

And it's worthwhile that we take time to know ourselves. As the Greeks told us at Delphi. Know thyself.

Judy Yaras:

You're right, Travis.

Dr. Dov Gold.:

Ancient wisdom, yet again. Ancient wisdom.

Judy Yaras:

But you know, also I think for a lot of people, it's okay to not feel like you have to know yourself, know thyself on your own. I mean, this is why I think it's important we have neuropsychologists that we can help guide us to see who we are and help us discover who am I now? Okay, so I've got Parkinson's, and maybe I'm not exactly the same person, but who can I be while I have my Parkinson's? And how can I still feel that joy and love and success in my life, even though I have Parkinson's disease that I didn't ask for?

Dr. Dov Gold.:

Absolutely.

Judy Yaras:

And it really sucks, you know.

Dr. Dov Gold.:

No, I think there's there's a real question of identity that comes up, I think at various points, but I think in the face of disease, most disease, especially chronic disease, now who am I in response to this, right? I don't like what this disease is making me. And let's, okay, can we can we excavate some of that? Can we understand what it is, what it is that the disease is taking? And can we work around to give you back what you feel you've lost or some semblance? And is that semblance, is that sufficient? And some people will say no, right? Some people have this all or nothing. If I can't do it my way, I don't want to do it. Right. Fine. That's not my job to push you beyond that. I might ask some insightful questions about if you know how that strategy is working out for you.

Judy Yaras:

Oh, yeah, how's it working for you?

Dr. Dov Gold.:

You're sitting in my office, how's that working out? But yeah, okay, what well, have we have we explored all the options? Have we explored things you haven't yet thought of? Because it it can be quite simple. And, you know, one other thought on just cultivating um resilience and really protecting ourselves, especially in the the world we live in today. I with some of my my clients who are really struggling with stress and who are really struggling with the anxiety that this disease creates, sometimes the question I ask them is before the session ends, what what have you done for you today or this week? What have you done, patient, to take care of yourself this week? And sometimes I get wonderful answers. And sometimes I get a deer in the headlights moment, and I'm like, now I know what your homework is this week, right?

Judy Yaras:

Whatever that's so good. That's such a great question.

Dr. Dov Gold.:

Yeah.

Judy Yaras:

We ask that all the time in the sport groups. We talk about that. You know, Joe, I I want you to come back another time when you have another hour to uh hang with us because I would love to talk about loss in relation to Parkinson's, not necessarily loss with death, but this other this other idea of loss, and and that's a whole other thing we could talk about. This has been very enlightening for me. I learned a lot. Travis, did you learn anything?

Travis Robinson:

Yes.

Judy Yaras:

Good. I'm glad to hear that. I know you did. And and I, you know, I I love talking with Travis because I always wait for his great pearls of wisdom, know thyself, right? And where it came from, right? You know, most people have know the saying, but they don't know where it really stems from. I think origin.

Dr. Dov Gold.:

Yeah, I've I've used that saying, but no, I didn't know. I didn't know it's Greek origin. So thank you.

Judy Yaras:

Greek origin, Socrates. Okay, now we know who to give the credit to.

Dr. Dov Gold.:

Yeah, no, excellent, excellent. And I I would love to I would love to uh thank you. It's it's a wonderful conversation. They're all wonderful conversations, and yeah, uh, for better or worse, uh, I can talk forever.

Judy Yaras:

Well, that's good. We thank you so much, Dov. This has been wonderful, and uh it's just been a great experience to have you on and to be able to share this time with us. Thank you. We really appreciate it.

Travis Robinson:

Thanks. All right.

Judy Yaras:

Is that a wrap, Travis?

unknown:

That's a wrap.

Head Shot

Travis Robinson

Host