(68) dESTINATION dOPAMINE

BLOG STATS, JULY 2026

It's good to reconnect with you again, dear reader, after a three-month break. In order to get my mental and physical functions up to speed, and in keeping with Post 67, I've decided to sort of "review" myself. But first, a Blog post update.

In the roughly three-month period between end-April 2026 (the publishing date of Post 67)  and 01 August 2026, a total of 2,310 viewders visited my Blog. I assume the April-July 2026 viewders read my review of Miller Caldwell's compilation of Parkinson's Stories. 

And in the 6 years of publishing, I've had a grand total of 29,642 visitors! I am really pleased with this interest, and bearing in mind that I don't know whether the visitor has just viewed it or read it, I'll use the term "viewders". 

The top six countries that visited my book review comprising 2,310 visitors over a three month period, are as follows:

1. USA;
2. Vietnam;
3. Germany; 
4. Singapore;
5. Hong Kong; and
6. South Africa.

Now, back to this "review" of myself.

MY HEALTH ISSUES

Managing to publish Post 68 (the one that you're reading now) in July 2026 is a significant accomplishment for me. Let me explain.

Firstly, my Parkinson's Disease (PD) ran rampant during the first half of 2026, resulting in my wife having to assist me a few times every night for a few months. Secondly, I've been dealing with prostate cancer (PC) and have had therapy in 2025 and I'm currently undergoing further treatment. I've had to clear the PC and the PD hurdles, concurrently. Therefore, in this post, by way of a catchup, I am going to "review" the state of my health from 2005. 

PD CHALLENGES & ADAPTATION: 2013 ➙

This is a brief history of my PD. 

I was diagnosed with Parkinson's in 2013 by a neurologist DrK in Pretoria, Gauteng Province. I decided, then, not to use his recommended prescription but to seek out as many alternative approaches as I could find, be it physical, mental or chemical. 

My thought was: Could I bypass use of a pharmaceutical drug (with published, accompanying side-effects) and replace it with something else? In my teaching and research throughout my career (1977-2017), I had always sought out and found alternative solutions to most problems confronting me. I described this swashbuckling approach in Post 50, Part 1 (<-click to access that Post), where I wondered if I could find ways to challenge PD through a deep dive into literature, anecdotes and research:

"...I was a "practitioner researcher", generating personal theory from my actual practice (my PhD has this evidence). Could I challenge PD with a PhD? Could I, as a practitioner researcher, eventually generate personal theories based on my own observations of PD?"

      

For instance, Parkinson's started with "asymmetric onset" (i.e. only one side of my body was initially affected). As it had affected my right side, I was not swinging my right arm or moving my right leg smoothly resulting in colleagues asking if I had gout or had had a stroke 😖. Gradually, I noticed other debilitating issues and these forcibly channelled my creative thinking into finding solutions and/or adaptations that worked for me, and some of these are below.

• My right leg was dragging so, at work, I regularly wore a wrist weight on my right ankle (conveniently concealed under my long pants) to remind me to lift my right leg when walking;
• I was unable to slip on sandals/slippers onto my right foot but if I shut my eyes then my foot would slide in (was I bypassing the "old" muscle memory?);
• I was born right-handed but my left hand became the new dominant hand: for brushing teeth, for washing dishes, for washing the car and for holding the steering wheel while driving, etc.; 
• My right arm stopped swinging so, at work, I started wearing my watch on my right wrist (not the left) to remind me, consciously, to swing that arm when walking; and
• My right hand was unable to move my computer mouse so, gradually, I learnt to move it skilfully with my left hand.

What is fascinating is the notion of "neuroplasticity" (and "guided plasticity") (Rosén, Wijk & Björkman, 2026) to explain my shifting dexterity as a result of the Parkinson's: 

"Normal hand function relies on a finely tuned interaction between the sensory and motor systems within the central and peripheral nervous systems. The central nervous system continuously adapts to changed activity, environmental changes, learning, and injury — a phenomenon known as neuroplasticity. The neuroplasticity is a life-long ability and presents opportunities for therapeutic intervention; by directing it, lost or impaired functions can be improved through a process called "guided plasticity"."

Even more fascinating is that till today, I am still using my right hand to write and to draw and, yes, there's a body of research to explain that too. Apparently "Handwriting is a complex, overlearned motor program managed by distributed networks in the motor cortex, cerebellum, and parietal lobes, transforming abstract thoughts into fluid physical symbols", so handwriting rules! (HA!!! PARKINSON'S DIDN'T STAND A FLIPPEN CHANCE 😄...)

COMPLEMENTARY SUPPORT FOR PD: 2020 ➙

By 2020 I had started to engage with the following, below, after much reading and thought. Seeing that I was still in alternative survival mode, that included any and every possible supplementary approach to continue the fight against being parkinsed, I cast my net wide.

1. Photobiomodulation: in December 2019 a relative referred me to to a Carte Blanche documentary on television during which they had interviewed people who had had low level laser therapy sessions to alleviate movement disorder issues. Unfortunately neurologist Dr Bhanjan at the Durban Neurolaser Clinic was the only practitioner in South Africa so the earliest appointment I could get was in late in 2020. However, by March 2020 Covid19 (?fate?) had struck South Africa resulting in a travel lockdown so people from outside KwaZulu-Natal had to cancel their travel and their appointments: I was able to see the neurologist almost immediately. I reflected on my positive experience with low level infrared light therapy and PD in Post 10, Post 11 and Post 13 (<-click to read those 2020 posts).
2. Parkinson's ZA workshops started in Durban, KwaZulu-Natal Province, in 2022 as a weekly meeting of People with Parkinson's together with some carers. Their plan was to explore a multidisciplinary model of care for two hours, weekly, consisting of occupational therapy, physiotherapy, speech therapy and exercise, etc. as supplemental to the conventional drug-based treatment of Parkinson's. Attendance is free of charge as it is funded by a large India-based movement disorder support society. I attended their meetings for three years until 2025 when my prostate cancer treatment became an issue. 
3. Walking, Cycling & Cueing. Since 2022, I have been walking around our large apartment complex (including inclines and stairs) and cycling indoors (on a stationary cycle). These activities provide effective, physical stimulation for people in need of an accessible form of exercise. Cueing, on the other hand, is often ignored (click on the term above for an explanatory video) yet is essential especially for us People with Parkinson's. 
4. Biokinetics, "focused on improving physical health...through...human movement and customised exercise programs" has become a welcome, weekly activity since May 2026. My wife and I are fortunate to have a biokinetics practitioner, ZP, visit us at home. 
5. Ayurveda regime for Parkinson's. I started consulting an Ayurvedha specialist in 2022 and was happy with the intervention that included a natural dopamine substitute. (Extract below from Post 63 <-click to read:) 

"There was a lifestyle change involving the following: a diet avoiding certain flour and bread; avoiding stimulants such as coffee and alcohol; avoiding certain milks; avoiding processed food; deep breathing exercises; PD stretches/exercises; and meditation. Eating should be carefully paced and enjoyed rather than rushed.

In addition there were herbal remedies to take daily: two capsules daily to relieve stress (Ashwagandha); two capsules daily for anxiety and to assist the memory (Brahmi); and three capsules daily to assist with dopamine replacement (HP500).    

Unfortunately, the HP500 only worked for me from January 2002 till March/April 2025, when I stopped taking it. (In Post 64 {<-click to read} I will elaborate why I stopped.) However, I am still taking the other two herbal remedies, I meditate, I am doing the breathing exercises and still avoiding certain foods and ingredients." 

CONCURRENT CONDITION: 2024 ➙

In 2005 I had my first prostate wake-up call in the form of minor surgery in a doctor's consulting room when he performed a biopsy to remove tissue from my prostate gland to test if it was cancerous. 

Three more biopsies and medication followed over the years as did  overnight hospital stays until I was asked to also have a PET scan (that included being injected with a mild radioactive substance) in 2025. The outcome: I had prostate cancer (PC)! 

An Oncologist and a Urologist were engaged and saw me regularly both for examinations as well as treatment. This included two treatment regimes.

1. In 2025 I had 5 months of Hormone Therapy comprising 6 injections to lower my testosterone levels as prostate cancer apparently feeds off one's testosterone! An unfortunate side-effect has been permanent hot flushes (I normally perspire profusely) and another is weight gain.
2. In January 2026 I also had a Brachytherapy procedure during which my prostate was injected with tiny radioactive beads to provide internal, direct radiation targeting the prostate gland only. This radiation has a life span of about 10 months from its maximum radiation capacity in January 2026. The complication was during the first few months when I was forced into self-isolation because I posed a "danger" to particularly my/any grandchildren and any young/pregnant women.

While there is no recorded interaction between my Parkinson's Disease (PD) and the PC and their respective medications, I did feel poorly for at least 2 weeks after each Hormone Therapy jab. And I guess a lot of the accompanying trauma was in my head! 

MOVEMENT DISORDER SPECIALIST 2025: ➙

By April 2025 my Ayurvedic medicines were not working. I was barely able to move and had become my own worst nightmare: a sedentary seventy-three year old person with Parkinson's. My family physician, Dr RSP shares consulting rooms with a Movement Disorder Specialist, Prof VP. I was encouraged to see him, so an appointment was made in May 2025. 

His examination was thorough and he made fewer glib generalisations than the other specialists I had seen over the years. I was at my wits end. My dopamine was neither flowing nor functioning and neither was I. 

So, after actively avoiding a Parkinson's pharmaceutical drug for 12 years I decided to take the plunge: he gave me a script for medication during the day (3 X Sinemet) and overnight (1 X Pramipexole ER) and I accepted. Naturally I was to start my Hormone Therapy sessions two months later so I was concerned. 

It may be useful to examine, briefly and simply, why the absence and presence of dopamine is significant in Parkinson's. Below is what Kimberly Holland (2026) states in Healthline:

  

"What Role does Dopamine have in  Parkinson's Disease?

 

*Dopamine is a neurotransmitter that supports smooth, controlled movement. In Parkinson’s disease, dopamine drops, causing movement to become shaky, slow, or stiff.

*Symptoms often begin after major dopamine loss, sometimes when 60% to 80% of dopamine-producing cells are gone. Early signs can include poor coordination, trouble concentrating, stooped posture, and loss of smell.

*Parkinson’s treatments aim to raise brain dopamine levels or improve response to dopamine. Treatment options include medications like levodopa and procedures like deep brain stimulation."

According to the website, Sinemet "...is used to treat symptoms of Parkinson's disease, such as muscle stiffness, tremors, spasms, and poor muscle control. Parkinson's disease may be caused by low levels of a chemical called dopamine..."

Regarding the cause of PD, it is stated that the "...exact cause of PD is not known. It may be caused by a problem with how your brain works. A chemical called dopamine helps your brain control your movement, thoughts, and feelings. PD causes brain cells that make dopamine to die, so they cannot make enough dopamine."

Enough said. I believe I've presented a reasonably thorough review of my health from 2005-2026. Sigh!

CONCLUSION: now you see me, now you don't

I have found the impact of Parkinson's Disease (PD) and that of Prostate Cancer (PC) quite different and  quite scary. 

The effect of having PD is physically manifested so I can see and feel my tremors, freezing, light-headedness, heavy legs, weak knees, and so on. However, during that window period after I have taken my medication during the day, the Sinemet magic occurs and I feel "normal". And accordingly, anyone watching will be able to see my PD when my Sinemet dose wears off. That's how a movement disorder works, right? It's often so visible!!!

On the other hand, besides the weight gain and hot flushes, no-one will have any idea that I have PC. It's only when I visit a Cancer Centre to see my Oncologist or sit in a room filled with people having their chemotherapy that I am aware that I too, have cancer. It is dangerous, quiet and deadly. It's invisible!!! 

But I'm still here and dealing with life, courtesy of my wife and my carer. Till next time, dear reader, stay well and safe.

(28) NEUROPLASTICITY & MY PD

RECAP In Post 27, I shared some ideas around my freezing and subsequent use of trigger words to initiate internal cueing to assist faltering movement. Many of us with Parkinson's Disease (PD) are reliant on such a strategy to attempt to kickstart dormant motor learning in order to make our limbs move. One example of re-initiating motor learning is overcoming my difficulty - as a PD person - of moving from a seated to a standing position, as illustrated below.

In Post 27, I also focussed on strategies for the re-execution of movement. What is interesting is that while this cueing strategy is supported by the combined effort of a body's muscular, skeletal and nervous systems, I've ignored the fact that the brain has an unfathomable capacity to adapt under extreme circumstances. Let's briefly explore neuroplasticity and my PD.

 

PD: I'm the dope with depleted dopamine

I have PD. I have been told this condition exists because of dwindling levels of dopamine, a complex chemical in my brain. This 'dwindling' has probably occurred over an extended period of time. If that's so, then it could have been triggered by a traumatic brain injury when I was a child (1956) and other specific traumas I can pinpoint during my adult life (1999, 2007, 2012).

From what I've read, dopamine is manufactured in my brain and functions as a neurotransmitter to send messages across my nervous system to deal mostly with movement. For a brief, scientific explanation of dopamine, see the 2 minute video. Besides being a chemical messenger, dopamine is a hormone: it plays a role in mediating rewards in my brain, both as the "excitatory" hormone responsible for my feel-good times, as well as the "inhibitory" type. But it also plays a role in regulating chronic pain, amongst a host of other functions. So, dopamine is no dope!    

What I've learnt about my PD since I retired end-2017 is that, firstly, I have a movement disorder that plays havoc with my muscle confidence. This disorder, coupled with my tremors, instills the constant belief that I need to rest. As a result, I rest more than is required leaving my muscles over-rested and underused. So, I am unable to do simple tasks, although my muscular, skeletal and nervous systems are functional. 

Secondly, being over-rested means my muscle memory converts to muscle-forgetory (see Posts 6, 15 & 16)  making me believe I am incapable of moving "normally". This appears to be a powerful function of my brain, namely, to adjust the body's functions to suit what is the strongest. When my right side started weakening due to the impact of PD my left-hand automatically took over (see Post 8 regarding dexterity) and dominated certain right-hand functions. 

And thirdly, because my nervous system controls my sense of temperature, as a parkinsed person, I am now more sensitive to temperature shifts, both hot and cold. In Post 9 I referred to "trevers" i.e., tremors + shivers, when it gets cold. 

So if my muscular, skeletal and nervous systems are okay, then what is the problem? Probably the decreasing amount of dopamine in my Substantia Nigra (see 2 minute video). Some of this is speculation on my part, so in keeping with my speculative stance I will look at the positives such as my shifting dexterity and cueing to re-initiate my motor learning. Besides the three systems just mentioned, dear reader, let's not forget the brain and its plasticity. 

What is neuroplasticity?

There was a time when scientists believed that the creation of new neurons (i.e. neurogenesis) stopped shortly after birth but that has been proved to be incorrect. The notion of neuroplasticity - also called brain plasticity - is based on evidence first recorded by a Polish neurophysiologist, Jerzy Konorsky, in 1948. He wondered if it was possible to alter existing neural connections in the brain through conditioning (naturally, Skinner and Pavlov were also in this think tank). Later it emerged that new experiences linked to change could influence the brain to reorganise most neural pathways and even generate new ones throughout one's life. Neuroplasticity is a combination of the essence of the nervous system (i.e. neurons) and the brain's capacity to be remoulded (i.e. plasticity) in the face of an individual's challenges. 

One example of 'remoulding' is the ability of a musician such as Ray Charles to excel at tasks generally achievable by a sighted person. He was not born blind and his musical ability as a singer and pianist was superior to that of many of his sighted contemporaries. It could be said that he was able "to perform non-visual tasks better than those with sight". I had the privilege of attending one of his live performances in the nineties and his musical performance together with his piano stool antics made it unforgettable! 

Another example is the phenomenon of phantom limbs where an amputated limb still appears to exist in the mind of the amputee. This supports speculation that every person's brain contains the equivalent of a detailed diagram of all bodily functions and accompanying support systems to sustain the idea of neuroplasticity. Below is an illustration of brain plasticity. 

How experience changes brain plasticity

Regarding the principle of plasticity, it is possible that my advanced internal cueing leans towards functional plasticity. According to Psychology Today plasticity makes it "possible to change dysfunctional patterns of thinking and behaving and to develop new mindsets, new memories, new skills, and new abilities". 

A brief deviation: my advanced cueing for dressing, walking and climbing stairs would be similar to creating a learning strategy called a mnemonic. This allows one to remember a series of words or names in a specific order. For instance, when trying to remember the colours of the rainbow in order, I remember this mnemonic: Richard Of York Goes Battling In Vain. Each first letter is the first letter of word representing a colour, namely red, orange, yellow, green, blue, indigo, violet. The silly sentence about Richard is a primary trigger that takes me to the source, the actual colours. 

This seemingly long process is, in my experience, how successful remembering can occur. So, my shift from saying "toe-toe" to counting from 1-6 when climbing six stairs is my way of creating a sense of continuity (from a green light to amber - see Post 27) in my stilted movement. Maybe, the fact that it works is my brain telling me it has accepted an amended cue and indicating that a form of learning has taken place. Hmm...evidence of plasticity?   

This perspective of neuroplasticity is an enlightening one for me as a parkinsed person. I have scratched the surface of this phenomenon to provide food for thought, dear reader. There is also recent research on exercising and neuroplasticity that I have included below to further whet your appetite. 

Neuroplasticity and exercise: more food for thought...

Research published in 2019 found that the impact of aerobic exercise resulted in positive change in the brain plasticity of subjects with PD (see EXPANd trial article no. 2 in Resources below). The article focuses on two groups, (1) a HiBalance and (2) a HiCommunication group. Their broad focus area was on exercise as a form of non-medical intervention for those with PD, particularly in the light of the unpredictable nature of current pharmaceutical "remedies". 

Another strand of research also published in 2019 is on healthy subjects without PD and the impact of extreme aerobic exercise on their brain plasticity (see "Exercise-Induced Neuroplasticity..." article no. 1 below). It focuses on exercising among healthy individuals and indicates that "fit individuals show greater neuroplasticity induction than unfit individuals". 

Happy Holidays, dear reader, and thank you for visiting this blog. Till we connect in 2022.

Resources

Neuroscience: click on desired link & when site opens scroll down for short video.

1. Know your brain: Substantia Nigra
2. 2 minute video: Dopamine
3. 2 minute video: Parkinson's Disease
4. 2 minute video: Huntington's Disease
5. 2 minute video: Caffeine (vs adenosine)  
6. 2 minute video: Reward system

 Articles

1. This journal article focuses on the effect of exercise on healthy individuals without PD. If you're bored, then only read the Abstract (at the beginning) and the Limitations and Conclusion paragraphs (at the end). "Exercise-induced neuroplasticity: a Mechanistic Model and Prospects for Promoting Plasticity." by El-Sayes et.al. (2019). Available as a PDF.
2. This journal article focuses on individuals with PD: "The EXPANd trial: effects of exercise and exploring neuroplastic changes in people with Parkinson's disease: a study protocol for a double- blinded randomized controlled trial. By Franzén, et.al." (2019). Available as a PDF. 
3. How our brain adapts to impairment: "Loss of Sight and Enhanced Hearing: a Neural Picture." 
4. A blog site for PD people like me: "Fighting Parkinson's Drug Free."
5. A useful easy read on brain plasticity in a South African publication "Psychology Today."  
6. What is neuroplasticity? Positive Psychology
7. This chapter: Neuroplasticity after traumatic Brain Injury by Su, Veeravagu & Grant, focuses on traumatic brain injury and neuroplasticity. If you're bored then just read the introductory paragraphs, the section on Neuroplasticity and the Conclusion.

(27) PD robot: GREEN (go); RED (find AMBER)...WTF!

NB (27) above indicates the numerical order

Lights, action...freeze frame!

During the past two months four water valves in my residential area burst resulting in our being without water for up to three days at a time. This might continue as we are in an old part of Durban with crumbling infrastructure (hmm...like that of my body). I had a number of freezing incidents during these periods. For instance, once, I was unable to get out of a recliner, something that had never happened before. Also, in bed I have been struggling to turn onto my side. I assumed it was the PD but maybe my para-olympic mind-games had begun again!  

My immobility may have been because missing a daily shower resulted in missing my daily stretching routines in the shower. We know the aged should be active for as long as possible, daily, otherwise, their muscles will stop responding to requests to move and become sluggish. It is likely that my muscles were unable to respond (A) because of my inactivity and (B) because of my PD. Or maybe (C) I need to have regular physiotherapy or biokinetics.

Further analysis of my freezing problem, led to my developing an amended set of previously reported Parkinson's Disease (PD) strategies called cueing that I will share later.

PD: advanced cueing & triggers 

Let's start with an analogy. Small parts of the USA between the 1920s and 1940s, had two way traffic lights, that were red and green only, as illustrated in the picture below. These were suspended above a few major city intersections to control the flow of pedestrians and traffic. An amber, third light was only introduced in the 1950s. 

In the context of PD, stopping an action should be discouraged. If the equivalent of red lights are our reality, then we should encourage thinking of amber lights to introduce the possibility of further action.

  

Recently, I discovered that what I called 'internal/remedial messaging' (Post 17) is referred to by neurologists as "internal cueing". So, I will adapt. "Internal cueing" is used, for instance, by athletes to talk to and to understand micro-movements of their limbs by making actions transparent and visible in their minds. This is to allow them and their coaches to improve their performance. 

 

Parkinsed people can also use this technique of cueing to address their faltering movement. But this requires us to be able to isolate specific actions involved and then to break them down into micro- movements. Only then can one assign specific words, phrases or even tunes - all regarded as cues - to initiate and to execute these actions. Isolating and identifying specific micro-actions would be like asking you, right now, to find the animal in the picture below: focus and you will find it. (Got it?)   

My own system of cueing was based on using single action words to assist the limbs to move. For example, when pulling on pants I would say "slide" and then "slip" to visually picture my hands sliding my pants up my legs and then slipping my thumbs into the waistband. Or walking up flights of stairs I would say "toe" when putting my first foot down on a stair and "toe" again when moving the other foot up to the next stair. After my recent immobility scare (courtesy of the water outages) I amended my single cue to a series of multiple cues and associated movements. 

My amended cueing strategy is based on the idea that a single cue triggering a single movement is like going from a green to a red light. Saying "toe" only takes me up one stair. However, counting from "one to six" when ascending a single flight of six stairs propels me up one whole flight and then I can start at "one" again for the second flight without saying "toe" six times. So, my counting is a substitute for repeating "toe-toe" and similar to using words that trigger actions. Embedded in such triggers are meanings associated with specific series' of actions. 

Advanced cueing: as easy as 1,2,3,4

Let's unpack specific conditions and my understanding of freezing. In a standard flow chart there are a set of "if-yes-then" and "if-no-then" conditions controlling a process. This is aligned to a definitive red and green robot or traffic light analogy where flow is either on or off. There is no room for the equivalent of an amber light. So, let us consider the idea of a green and amber traffic light.

Green (go) and amber (approach with caution) is more apt to my understanding of PD as it introduces the possibility of movement and flow. So for me as a PD person, initiating movement may be regarded as a set of "when-I-then-I" conditions. The green and red traffic light represents a start-stop implementation of a single action where a blockage in the pathway (dopamine depletion?) results in my freezing. But green (go) and amber (approach with caution) allows me to confront the freezing. 

EXAMPLE When attempting to stand up from a seated position I used to have to repeat the action of getting up many times before being able to stand. It must have looked Chaplinesque. It used to be a single-stage failed action. But, introducing a green and amber traffic light to represent the when-I-then-I system of internal cueing, encourages a sustained multi-stage motion for me as a parkinsed person. 

ACTION So, when-I wish to stand (1) then-I push my legs forward and straighten my knees, (2) then-I push myself away from the seated position and shift my weight forward, (3) simultaneously ensuring my head and neck are as far forward as possible and at right angles to my torso (so that I do not fall back into my seat) and (4) then-I stand up. Breaking the action down into four stages ensures me a 90% success rate of standing and not falling back into my seat. The critical point is that the trigger words are 1,2,3,4 and not a series of words or phrases. 

And what is fascinating, is that 1,2,3,4 also works as my cue for climbing stairs: a revelation! And so far it has been effective!! I should count my blessings...

Next post

Constantly adapting to and creating new habits is central to the brain's ability to reorganise and rebuild synaptic ability, i.e. neuroplasticity! My growing ability to regenerate cues and multi-action movements are based on the brain's ability to relearn. And it needs a whole post, so I promise to pay attention to neuroplasticity in post 28. 

Some Resources

• A strategy for PD balance when standing and turning is spotting (Post 6).
• Article on PD human-computer interaction: High-accuracy detection of early Parkinson's Disease...while typing.
• An early detection site for PD involving your keyboard and mouse is at Key Sense - it is only for those who've not been diagnosed with PD.