Parkinson’s Explained: Symptoms, Treatment, and Living a Normal Life

Parkinson’s disease is one of the most misunderstood neurological conditions—but what does it really look like?

In this episode of Baptist HealthTalk, neurologist Dr. Samer Tabbal breaks down the early signs of Parkinson’s, what happens after diagnosis, and how treatment has evolved. From tremors and stiffness to lifestyle changes that actually make a difference, this conversation answers the most searched questions about Parkinson’s.

You’ll learn:

•  The first symptoms people often ignore
•  What to do right after diagnosis
•  How Parkinson’s progresses over time 
•  Why exercise may slow the disease
•  Treatment options including medication and surgery 
•  Whether you can still live a normal, active life

One of the biggest takeaways? Parkinson’s does NOT shorten your life—and many people continue to work, travel, and stay active for years. 

▶️ Subscribe for more expert-backed health insights from Baptist Health South Florida.

Host:
Anthony Gonzalez, M.D.
Chief of Surgery, Baptist Health Baptist Hospital
Medical Director of Bariatric Surgery, Baptist Health

Guest:
Samer D. Tabbal, M.D.
Neurologist
Baptist Health Miami Neuroscience Institute

If you found this episode helpful, you may also enjoy:

How Deep Brain Stimulation is Changing Parkinson's Care

Life After a Parkinson's Diagnosis

Transcript

SPEAKER_01 0:00

When you exercise, your brain generates molecules that promote the health of brain cells. And that's we're starting to believe that it really slows down the progression of the illness, and we can tell in the clinic people who exercise do better than the people who don't.

SPEAKER_00 0:13

Welcome to Baptist Health Talk, a podcast on all things healthcare powered by Baptist Health South Florida, your trusted source for health care prevention and wellness.

SPEAKER_02 0:23

I'm your host, Dr. Anthony Gonzales. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today we're diving into Parkinson's disease, one of the most searched and often misunderstood neurological conditions out there. From the earliest symptoms to what life really looks like after a diagnosis, we're tackling the internet's most searched questions. Today we are joined by Dr. Samur Tabal, neurologist and director of movement disorders at Baptist Health, Miami Neuroscience Institute. Thank you for being with us here today. Thank you for inviting me. All right, so let's dive in. Let's start with the very beginning. What are some of the earliest signs of Parkinson's, especially symptoms patients just brush off as maybe stress, or maybe I'm getting a little older, or maybe it's just something minor.

SPEAKER_01 1:28

So we have three main Parkinson has three main symptoms. Uh one of them is slowness of movement, the other one is muscle stiffness, and the third one is tremor at rest. That's when someone is relaxed, they may shake. And for the slowness of movement, sometimes we said, well, as we grow older, we all slow down a little bit. So they may overlook, like it takes a little longer for them to get dressed, to shower, what have you. That can be easily um uh mistaken as just a sign of uh getting older. Uh for the rest tremor, you it's a tremor that happens when you relax. So when you're actually doing things, it goes away. So it's usually not a big deal, and patients may overlook that. I have patients who sit on their hands to try to not show it that it's shaking, and everyone blames it on uh maybe I drank a little bit too much coffee or what have you, and just try to ignore it. Even eventually it becomes much more obvious. For the muscle stiffness, it's uh usually it starts in the hand or maybe in the leg. So you may notice that your finger's dexterity is not as good as it used to be, and you may drag a leg uh or a foot, or you may even have a little bit of a facial masking, we call it, or decrease facial expression. That's because of the slowness of the movement of the face.

SPEAKER_02 2:43

So if someone was just diagnosed with Parkinson's, they're sitting in their car afterwards and thinking, okay, now what? What are the first practical steps you tell them to take?

SPEAKER_01 2:54

Okay. So the first thing to do is not to give up. It's not the end of your life. Parkinson will not shorten your life. You're gonna live as long as you would have if you didn't have Parkinson disease. Uh that's the first thing to think about. Think about improving symptoms. Learn more about treatments. That's very important because the longer you take the medication and start feeling that you're doing better, the more you're gonna think, oh, I can do this, I can live with that. And it's very important to start treatment early. This way, you start feeling better and not give up early in the disease. The other most important thing that I always tell my patients is exercise. Now, this cannot be over-emphasized. It's like everyone, when you ask him, when they ask you about a medication that slows down the progression of the illness or stop the disease, they think, oh, are you gonna give me a pill or a potion or whatever or an herb from some uh from Mount Everest? That that's not the way it works. When you exercise, your brain generates molecules that promote the health of brain cells, and that's we're starting to believe that it really slows down the progression of the illness. And we can tell in the clinic people who exercise do better than the people who don't. So never give up, exercise, get your treatment, and learn about the illness. Now, this is where it becomes very murky. I often tell my patients half of what's on the internet is wrong, and of the other half, half of it probably doesn't apply to you. Wow. So if you read about something on the internet before you freak out, you give me a call and I'll let you know what's in it for you. Uh, you're gonna go online and they're gonna sell you all kinds of different supplements, you know, these like little vitamins and brain health potions and stuff like that. I wish they worked, but they don't. So make sure you filter that out.

SPEAKER_02 4:51

Wow. Oh, it's it seems scary. It feels scary.

SPEAKER_01 4:56

It is scary. So we're all afraid of what we don't know about, and that's why whenever the patient shows up and adoxin for the first time, of course, they're in shock first. And then we go through this is what's gonna happen for the next many years. So you need to know about it this way. You plan accordingly. So the first thing I tell my patients is I'm gonna put you on this medication, you take it three times a day, it's well-tolerated medication, and it works great. When you first take the medication, you're gonna do very well for at least five to seven years. And when I say that, I mean you're gonna be practically practically normal. Your trauma will get better, your stiffness is gonna get better, you're gonna move much faster. And after five, uh five to seven years, the medication will still work, but it may not work for as long. So instead of, let's say you take the pill and it lasts you for six hours, it'll last for five hours. And after a few years, it lasts for four hours, and after a few years, it lasts for three hours. And when that happens, we have the option of bringing the doses closer together to cover your whole day, or we can add a medication that makes the medication work longer. With the medication that we have currently, you should do very well for 10 to 15 years. At 10 to 15 years, you'll have a lot of ups and downs. The ups is when you take too much medication, you may have a little bit of an extra dancing-like movements. And when the medication wears off, the Parkinson symptoms come back, you shake, you stiff, you don't walk as well, and what have you. And that would be a good time to think about the next step, which is the deep brain stimulation surgery or something called hyfu, high intensity focused ultrasound, that's for tremor only. But the deep brain stimulation um therapy actually helps with everything. And that'll take give you another five to ten years. So if we do the math, we pretty much have you covered for the last next 25 years. Now, Parkinson is mostly a disease of the elderly. So if you're 60 plus 25, that makes you 85. I can't promise you anything after that. However, we have a lot of research going on by then, hopefully.

SPEAKER_02 6:58

By the time you get through, yeah. So let's focus a little bit on the tremor. You said um there's a tremor and the patients have a tremor. Is it really just a tremor? Is there more going on behind the scenes than just a tremor?

SPEAKER_01 7:09

So Parkinson's disease is certainly not only tremor. Okay. Actually, 40% of Parkinson patients do not have a tremor. They only have the stiffness and the slowness of the movements. Also, Parkinson's disease is not only a movement disorder. Okay. There's many other symptoms that sometimes come with it. Not on every for everyone, but many patients have that too. They can have mood changes like depression, anxiety, hallucinations, and what have you. Uh, they can have um what we call autonomic symptoms, meaning uh symptoms, uh the functions that the body handles without you thinking about it. There's a part of the brain that handles that. It's called autonomic nervous system, and that handles digestion, drooling, um bladder control, sweating. These can be also affected in Parkinson. Um, pain. Some people have pain syndromes where they have fatigue is another one, and another big one. Now we uh we have treatment for all of these. It's just that you should make sure you let your doctor know that this is what you have, and there's practically treatment for almost all of them.

SPEAKER_02 8:23

Wow. So can someone live a normal life with Parkinson's? And what does that normal really look like? Okay.

SPEAKER_01 8:31

So in the first few years, definitely. Okay. We have a lot of patients who still go to work, we still drive, I have people who ski, I have people who run marathons. Okay. Now, over time, depending on you how you how you respond to treatment, you may or not live a normal life. Uh, but for the most part, I have so remember the the progress, the progression of the illness the way I describe it, this is on average. Some people do better, some people do worse. But uh, I have a patient who did not need surgery until 23 years of illness. And for the most part, for the first 15-20 years, they were living a normal life. Besides, remember, let's say you get it at 60, but 15 years you're 75, people start having all kinds of other problems by 16 and 75. They have heart attacks, they have strokes, they have neuropathy, they have diabetes, they have all these other things that also will not make your life normal. But for the most part, when you're properly treated, hopefully, if you respond well enough to the treatment, you should practically live a normal life. And again, above all, never give up.

SPEAKER_02 9:41

Yeah. And I think the mind plays a big part of that because people hear the word Parkinson's and right away they think that they're gonna lose their independence and um it they're really it's gonna progress rapidly. Uh, you talked about a patient now that didn't progress for 23 years. So, what does that mean and how long they will live? Uh, you you know, I think you mentioned that earlier on.

SPEAKER_01 10:02

Again, Parkinson disease will not shorten your life. You're gonna live as long as you would have if you didn't have Parkinson disease, but you have to deal with taking medications and have some sometimes uncomfortable symptoms that we can work around. Um there's three things that I tell my patients to do to beat the disease. Three things. Uh the first thing is exercise. We talked about yes, you absolutely have to do it every day. Uh the second thing is a good social support system, family, friends, what have you. These are very important. And the third thing is the right attitude. The right attitude, and I mean by that, you don't just sit there and cry for the rest of your life because you have a disease, you do something about it. You do, you, you take your you take your treatment, you exercise, you learn about it, and you learn to live with it. You know, there's no treatment for diabetes either, but we still live with it. There's no cure for Parkinson's disease. We're working on that. But we live with it, and that's what you need to do. You make the most out of what you have and take it from there. We don't have a cure for aging, right? And still, there are a lot of older individuals who are working we're working on it. We're working on it very hard. Yeah.

SPEAKER_02 11:19

I'll call you when we find something. Um, and you call me, of course, as well. But so you keep mentioning exercise and then and I and I want to focus in and repeat exercise, but talk about other effective therapies. You talked about the high food. So let's go through the progress of what's available right now, what's emerging, and what gives you real optimism that there's going to be great stuff in the future. Very well.

SPEAKER_01 11:41

So uh the best medication that we have is Levodopa. Oh, by the way, I have a little disclaimer: no drug company pays me any money. I'm in it for your knowledge.

SPEAKER_02 11:49

And you're in it for the patient's health.

SPEAKER_01 11:53

Awesome. So um uh Levodopa is by far the best medication that we have. It gives you a lot of benefit and little side effects, as opposed to all the other medications that gives you a little bit of benefit and maybe more side effects. Um, and when the Levodopa is not working well enough, we have several medications to boost it, Russageline, and decapone or picaporone. There's a list of them. And there's something called dopamine agonists. We're shying away from using it, but it it turns out that they have they cause a lot of problems. So frankly, I don't use them anymore. And then uh when the medications don't control your symptoms, then the next step would be to uh consider the de-brain stimulation surgery. Now, with that said, all the treatments that we have, whether the medication or the surgery, now control are there to control symptoms, they don't stop the disease. Okay. Right now we're in a position where we understand enough about the disease to do something to stop the disease or delay it. And this is where all the research is going right now. Uh, there's several studies that's been done in trying to get to remove uh abnormal protein in the brain. It's called alpha-sinuclein. Try to remove it from the brain, and we think that that may actually slow down the progression of the illness or maybe stop it. Um the studies are still early. Uh, we at the uh Miami Neuroscience Institute uh are uh one of the sites for the study. We're gonna start it soon with multiple other centers. Um, so there's a lot of research going on. We're really very close to being a position to know what causes the disease and how to work on it to actually stop it or slow it down, at least.

SPEAKER_02 13:38

All right. So, what about diet and eating? You know, diet is a big topic. There are certain foods that people should avoid when they have Parkinson's disease. Why does nutrition matter so much?

SPEAKER_01 13:50

So, diet is an important thing for everything, for everyone, not only for Parkinson's patients, all diseases, you name it. So we know there's two things that prolong the life of a rat in the lab Celagene, a medication that we use for Parkinson's disease, and caloric restriction, eating less. If you eat less, you live longer. That's been proven a long time ago, and we're past that. Now, for Parkinson's specifically, I tell the patients to eat whatever they want. Really. Yeah, there's no restriction to it. You can eat whatever you want. Now, early in disease, it's not a big deal. As the illness progresses and you have more of the motor fluctuations, the ups and downs, you may notice that if you eat a lunch that has a little bit too much protein, the medication does not get absorbed as well, and you may feel a little bit more off and what have you. So when that happens, and that typically happens 10, 8, 10, 12 years into the illness or something like that. Then if you actually feel that, then what you could do is take your medication one hour away from meals, and you probably would do okay on that. But uh, see, uh, it's bad enough that you have to take the medication three or four times a day or what have you. I don't like to have patients constantly stuck at, oh, when am I gonna eat, when am I gonna take the medication? It turns into a full-time job. So just eat whatever you want. If you feel that you know the medication doesn't work as well when you eat a big hamburger because it has a lot of proteins in it, then you may want to space it out a little less. Now, with that said, we know that the bacteria in the gut of Parkinson patient is different from normal patients. And I've had a lot of patients come to me with a little bottle that says this is a probiotic, it says it's good for Parkinson. I wish we knew more about it, but we're not there yet. So we know a we're starting to understand a little bit more how what these bacteria are doing in your stomach. It looks like it affects everything, actually.

SPEAKER_02 15:49

Yes, yeah, the microbiome.

SPEAKER_01 15:51

The microbiome is called, and it affects everything. It affects your behavior, it affects your mood, it affects uh other diseases, rheumatoid arthritis, multiple sclerosis, everything. So, yeah. So the bottom line is we all are supposed to eat a healthy diet. Yep. Okay. All right. And I'm not saying you're not supposed to eat a steak, you're welcome to it. It's just you don't have to have it three times a day. That's all.

SPEAKER_02 16:16

I don't think a cardiologist would love that either. There you go. All right. So sometimes you hear the rule, the five to one rule in Parkinson's care. Can you break that down for us in like simple terms? Yeah.

SPEAKER_01 16:29

Uh to tell you the truth, I don't think it's very useful. Um but let me tell you what it is, and you you'll be the judge, and the audience will be the judge. So the five-to-one rule is a way supposedly of figuring out if someone has advanced disease or not. So if you have um uh if you take medication five times a day, supposedly that implies that you have advanced disease. Uh, if you have two hours of feeling off, meaning the medication not working, that supposedly correlates with advanced disease. And the third one is if you have one hour of dancing involuntary movement due to the medication, so they think that if you have one of these three, then you're more likely to have advanced disease. But what does that mean? It really doesn't mean much to me because if I give you the right medication or if I put a deep brain stimulator in your brain, in your brain, your dyskinesia will be much less, your off states is gonna be much less, and you're gonna take less medication. So I'm telling you that we have treatment to move your how advanced your disease is. So it's really not very useful. And I have patients who come to me, they read about the staging of Parkinson, it's it's called the Hern and Yar staging one, two, three, four, and five. Five being in a wheelchair and one being a little off disease on one side only. That's I don't think that's useful either because when you take your medication, you actually change stages. If you can't walk and you take your pill and now you can walk, you jump two stages back. Yeah, downstairs. So effectively, it's not very useful to do that. Now, if you really want to know where you are in your Parkinson, I divide it really in just three little stages that are very intuitive. Early disease, when you take the medication and you're doing great, that's early disease. Moderate disease, this is when you start to have a lot of uh some motor fluctuation and a little bit of involuntary movement, but you're fine otherwise. I call that moderate. And advanced is when you have a lot of motor fluctuations and a lot of motor um involuntary dancing like movement, and that's around the time when you really need to go to the next step of having the deep brain stimulation surgery. And that's, I think, more than enough.

SPEAKER_02 18:38

Wow. All right, so let's final, I'm gonna finalize on your favorite topic, which is being active and being independent. So, what do patients can really do so they they can stay active, stay independent, and feel like themselves?

SPEAKER_01 18:53

It's all a matter of chronic good behavior. If you exercise all the time, all the time, okay. So the recommendation by the FDA is 6,000 to 7,000 steps per day. Uh, you know, with a smartwatch or with your phone, you can actually measure that these days. And sometimes I bust people in the clinic, like give me your phone up and they're not walking enough. So you can do that. Uh, but again, most importantly, is try to really live a normal life. Now, you don't have to climb Mount Everest tomorrow if you have Parkinson's disease, even though if you want to do that, you can still do it, just do it early in the illness. But you know what? We're not supposed to wait until we retire to do things that we need to do or we would like to do. I think just do whatever you want, knowing your limitations. You're welcome to bungee jump. It's not very safe, but you probably don't want to do it. So, again, it's a matter of exercising regularly. If you do good things for long enough, you see the results. If you if you're a couch potato every day and after two years you complain that your joints are hurting, well, you know what? You brought it on yourself. So you really need to stay active. You try to live as normal of a life. You should have probably an exercise routine. And usually I send my patient to the physical therapist the very first time I see them. They give them the exercises and they get to do them on their own. It takes 20-30 minutes to do them a day. Uh, there's all kinds of different programs for uh exercise. If you like dancing, dancing has been proving to be effective to help Parkinson's symptoms. Walking, tai Chi, uh epilatus, you whatever you want. And on top of that, an hour of walking a day. That'll decrease your chance of um dementia. Uh it decreases your chance of Alzheimer's, even. Um uh it decreases your chance of heart attacks, strokes, improve your mood, improve your sleep, if and improve your Parkinson's symptoms. So in every way you look at it, everywhere, yeah it's there. And I even have a patient who actually uh Parkinson, a young Parkinson patient who runs marathon, and he tells me when he runs his marathon, he feels he doesn't need medication for two or three weeks. Wow. So it's real, and that's also been proven in animals. Like if you take a rat and you have it run on a treadmill for uh eight hours a two uh for two weeks, just two weeks, and you take its brain and look at it under the microscope, and you compare it to the rat that didn't run, you can actually see the difference between the two and you can measure the trophic factors, the good chemicals in the brain. You can tell that the one that ran actually has more of them than a regular rat. So you need to try to live a normal life as much as possible. Go out with your friends, enjoy your life, and as usual, do your exercises, make sure you get your treatment. Any problem you call to you talk to your doctor, and should be fine.

SPEAKER_02 21:40

Incredible. Yeah, well, thank you, Dr. Tabalt. Great, thank you. It's been a great conversation. Thank you for sharing with us uh your insight to our audience. Remember, viewers, be sure to hit that subscribe button on our channel right here to keep up with the latest health and wellness information and tips from our experts. Thanks for watching.

SPEAKER_00 22:01

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