Primer on Diagnoses and Treatment of Symptomatic ...

8
This publication is not intended to provide diagnosis or treatment. Always seek the advice of your physician or pharmacist with questions regarding medical conditions or drug interactions. To request permission to reprint content published in this newsletter, please contact the HAPS office at 713-626-7114 or [email protected]. in this issue HAPS Annual Meeng 3 Partners in Parkinson’s and Other Announcements 3 New Parkinson’s Medicaons 4 Marathon Donors 4-6 HAPS Exercise & Support Group Schedule Insert Upcoming Events and Programs 6 Contribuons and Tributes 7 Pancakes for Parkinson’s 7 MARCH 2015 2700 SW Freeway #296 Houston, TX 77098 ph 713-626-7114 fax 713-521-3964 www.hapsonline.org [email protected] Which HAPS group have you tried this year? Check the insert for all group details! Neurogenic Orthostac Hypotension (NOH) is a set of symptoms that results from the failure of the autonomic nervous system to regulate blood pressure (BP) in response to postural change. Orthostac hypotension (OH) is defined as a drop in systolic BP of at least 20 mm Hg or a drop in diastolic BP of at least 10 mg Hg during the first 3 minutes aſter the change of posion. The risk factors include age, decreased cardiac compliance, anemia, dehydraon and certain medicaons. NOH is aributed to the inadequate release of norepinephrine (NE) and is frequently present in several neurodegenerave diseases including Parkinson’s disease (PD) and Mulple System Atrophy (MSA). By some esmates it affects 40 to 60% of paents with PD over their disease course and more than 80% of paents with MSA. In PD, symptoms of autonomic failure are mainly the result of cardiac and peripheral vasculature denervaon. In MSA, it is more likely to be a result of failure of central NE release. NE deficiency can lead to both orthostac hypotension and supine hypertension, which significantly complicates both clinical diagnoses and treatment. Symptomac NOH is a result of the drop in systemic BP that no longer can be compensated by autoregulaon of the cerebral blood flow. It is present in about 20% of paents with PD at any given moment and increases with disease duraon, severity, and the use of dopaminergic medicaons. Symptoms are the result of the hypoperfusion of the ssue including muscles, rena, heart, and brain. Symptoms can finally emerge as a result of addional stressor on the vascular system, including mild dehydraon due to inadequate fluid intake or concomitant diurecs. Postprandial (occurring aſter a meal) decrease of BP can trigger symptoms in otherwise asymptomac paents. Therefore, it is prudent to avoid large meals and high glycemic index carbohydrates in the diet of paents with PD and NOH. In addion to those factors, many commonly prescribed medicaons can lower BP, including anhypertensives that are oſten given for supine hypertension and vasodilators that are rounely used for the treatment of benign prostac hypertrophy and erecle dysfuncon, among other problems. Clinical evaluaon of NOH should always include daily orthostac vital signs. It is preferable to do it in the morning or aſter meals. BP and heart rate (HR) need to be checked reclining, sing and standing with 3 minutes intervals. Heart rate should normally increase to reverse the influence of gravity, but this response is blunted or completely absent in paents with NOH. In some paents more in-depth evaluaon in specialized autonomic laboratories needs to be done in order to uncover the cause of most asymptomac abnormalies or to confirm the diagnoses. This is usually unnecessary in paents with Parkinsonism. Primer on Diagnoses and Treatment of Symptomatic Neurogenic Orthostatic Hypotension By Stanley Fisher, MD Continued page 2

Transcript of Primer on Diagnoses and Treatment of Symptomatic ...

This publication is not intended to provide

diagnosis or treatment. Always seek the

advice of your physician or pharmacist

with questions regarding medical

conditions or drug interactions.

To request permission to reprint content

published in this newsletter, please

contact the HAPS office at 713-626-7114

or [email protected].

in this issue

HAPS Annual Meeting 3

Partners in Parkinson’s and Other Announcements

3

New Parkinson’s Medications 4

Marathon Donors 4-6

HAPS Exercise & Support Group Schedule

Insert

Upcoming Events and Programs 6

Contributions and Tributes 7

Pancakes for Parkinson’s 7

MARCH 2015

2700 SW Freeway #296 • Houston, TX 77098 • ph 713-626-7114 • fax 713-521-3964 • www.hapsonline.org • [email protected]

Which HAPS group have you tried this

year?

Check the insert for all group details!

Neurogenic Orthostatic Hypotension (NOH)

is a set of symptoms that results from the

failure of the autonomic nervous system to

regulate blood pressure (BP) in response to

postural change.

Orthostatic hypotension (OH) is defined as a

drop in systolic BP of at least 20 mm Hg or a

drop in diastolic BP of at least 10 mg Hg

during the first 3 minutes after the change

of position. The risk factors include age,

decreased cardiac compliance, anemia,

dehydration and certain medications.

NOH is attributed to the inadequate release

of norepinephrine (NE) and is frequently

present in several neurodegenerative

diseases including Parkinson’s disease (PD)

and Multiple System Atrophy (MSA). By

some estimates it affects 40 to 60% of

patients with PD over their disease course

and more than 80% of patients with MSA. In

PD, symptoms of autonomic failure are

mainly the result of cardiac and peripheral

vasculature denervation. In MSA, it is more

likely to be a result of failure of central NE

release.

NE deficiency can lead to both orthostatic

hypotension and supine hypertension,

which significantly complicates both clinical

diagnoses and treatment.

Symptomatic NOH is a result of the drop in

systemic BP that no longer can be

compensated by autoregulation of the

cerebral blood flow. It is present in about

20% of patients with PD at any given

moment and increases with disease

duration, severity, and the use of

dopaminergic medications. Symptoms are

the result of the hypoperfusion of the tissue

including muscles,

retina, heart, and

brain. Symptoms can

finally emerge as a

result of additional

stressor on the

vascular system, including mild dehydration

due to inadequate fluid intake or

concomitant diuretics. Postprandial

(occurring after a meal) decrease of BP can

trigger symptoms in otherwise

asymptomatic patients. Therefore, it is

prudent to avoid large meals and high

glycemic index carbohydrates in the diet of

patients with PD and NOH.

In addition to those factors, many

commonly prescribed medications can

lower BP, including antihypertensives that

are often given for supine hypertension and

vasodilators that are routinely used for the

treatment of benign prostatic hypertrophy

and erectile dysfunction, among other

problems.

Clinical evaluation of NOH should always

include daily orthostatic vital signs. It is

preferable to do it in the morning or after

meals. BP and heart rate (HR) need to be

checked reclining, sitting and standing with

3 minutes intervals. Heart rate should

normally increase to reverse the influence

of gravity, but this response is blunted or

completely absent in patients with NOH. In

some patients more in-depth evaluation in

specialized autonomic laboratories needs to

be done in order to uncover the cause of

most asymptomatic abnormalities or to

confirm the diagnoses. This is usually

unnecessary in patients with Parkinsonism.

Primer on Diagnoses and Treatment of Symptomatic

Neurogenic Orthostatic Hypotension

By Stanley Fisher, MD

Continued page 2

2 | HOUSTON AREA PARKINSON SOCIETY

The symptoms of NOH can vary dramatically from patient to

patient especially in frequency and severity. The most

dreaded symptom of NOH remains syncope, often preceded

by feelings of lightheadedness, dizziness or the “feeling that

you are about to black out”. Those symptoms are the result of

more severe cerebral hypoperfusion. Less severe cerebral

hypoperfusion can cause difficulty concentrating, fatigue,

mental fog, headache, lethargy and excessive daytime

sleepiness. Retinal hypoperfusion often causes impaired

vision that can progress from blurring to loss of color vision to

complete blackness just before syncope. Muscle

hypoperfusion often presents as “coat hanger syndrome,”

which is described by patients as a dull ache in the back of the

neck and a headache after prolonged standing. It can also

cause progressive knee buckling and weakness with walking.

Patients with coronary artery disease can experience chest

pain with standing or walking without significant exertion.

These symptoms can significantly reduce mobility and quality

of life due to fear of falling and constant fatigue. Syncopal

episodes can often result in fractures, head injuries,

lacerations and other problems related to unprotected falls.

This can lead to general deconditioning, social isolation,

anxiety and depression.

It is important to know that NOH is very treatable condition.

The first step is a nonpharmacological intervention. The

management strategy should involve diet, exercise and

change in sleeping habits.

It includes:

Elevating the head of the bed 20-30 degrees;

Avoiding large meals, high glycemic index carbohydrates,

caffeine and alcohol;

Gradual transition from supine to standing position to

avoid falls;

Increased salt and fluid intake;

Frequent aerobic and resistance exercise in a safe

environment;

Avoiding Valsalva maneuvers by treating constipation and

urinary retention;

Discontinuation of antihypertensives, especially beta

blockers except when used specifically for nocturnal

hypertension;

And of course, if those strategies do not alleviate

symptoms, use of thigh level tight compression stockings

and abdominal binders.

However, despite those measures, certain patients continue

to experiences NOH and require medical treatment. As a first

step, we try to adjust dopaminergic medications; if possible

without compromising motor control.

The next step would be to raise BP with medications. For

many years the most commonly used medications were

Fludrocortisone (Florinef) and Midodrine (ProAmatine).

Fludrocortisone is a synthetic adrenocortical steroid that

enhances the reabsorption of sodium from the plasma,

causing fluid retention and corresponding elevation of BP.

Most side effects are related to that and include resting

hypertension, peripheral edema (swelling in the legs),

congestive heart failure and low potassium. Midodrine is an

alpha1 agonist which acts on alpha-adrenergic receptors in

the peripheral vasculature, producing an increase in vascular

tone and elevation of BP. It’s no surprise that potentially the

most dreaded side effect is marked elevation of supine BP

with all the associated long term risks.

Recently, after years of clinical research, FDA has approved

first drug specific for the treatment of NOH. Droxidopa

(Northera) is a precursor of NE, which is extensively

distributed through the body. NE increases BP by inducing

peripheral arterial and venous vasoconstriction. Even though

it is likely to transiently elevate supine BP, in the long run it is

unlikely to cause persistent resting hypertension according to

the studies and Japanese experience. Because it is not simply

elevating BP, but attempting to normalize the response to the

sudden positional change, it attempts to go after the root of

the problem of NOH in patients with Parkinsonian syndromes.

In summary, today we have many viable options for the

treatment of NOH and prevention of the related disability and

injuries.

It is important therefore to relate your symptoms to the

treating neurologist or cardiologist. I recommend that all

patients with Parkinsonian syndromes, even those who are

currently do not experience symptoms of NOH, elevate the

head of the bed by at least 20 degrees and measure

orthostatic vital signs early in the morning at least couple

times a week to be aware of potentially asymptomatic drop in

BP. Appropriate diet, hydration and exercise may help you to

prevent more disabling symptoms of NOH and avoid

potentially serious injuries associated with falls related to

syncope.

Dr. Stanley Fisher, MD has taken a new position as the Co-

Director, Saint-Luke’s Marion Bloch Neuroscience Institute in

Kansas City, MO. A former member of the HAPS Medical Advisory

Board, his primary interests include medical and surgical

treatment of Parkinson’s disease, tremor, dystonias, and

Tourette’s syndrome, as well as Neurological Rehabilitation

utilizing intrathecal baclofen and botulinum toxin. An

internationally recognized expert in the field of Neuromodulation,

Dr. Fisher has collaborated extensively with the researchers and

engineers at the Center for Neuromotor and Biomechanics

Research.

HAPS thanks Dr. Fisher for his many years of dedicated service to

our organization and the local Parkinson’s community. During his

time as a Medical Advisory Board member, he provided countless

hours assisting HAPS in educational endeavors. We wish him the

best of luck in his new role at St. Luke’s Marion Bloch

Neuroscience Institute in Kansas City.

MARCH 2015 HAPS HAPPENINGS | 3

Many thanks to Erin Furr-Stimming, MD, Assistant Professor of Neurology, UT Health, Co-

Director UT MOVE, Chief of Neurology, LBJGH and HAPS Medical Advisory Board member who

led the presentation of the Newly Diagnosed Education Program on February 21st. We

appreciate your time and expertise.

Thank

You!

On January 28th Houston Area Parkinson Society kicked off its 41st year of serving the Parkinson’s community at the 2015 Annual Meeting of the HAPS Boards at the home of Drs. Ellin and Robert Grossman. The evening marked the end of long tenures of a number of members of the Board of Directors who were celebrated for their many contributions as we welcomed new Board members who begin their terms this year.

Pictured are Erick Sandlin, Daphne Haskin, Philip Francis, Denise Bishop and Joe Ahmad. We look to our new leadership with great excitement as they guide the organization and further the HAPS mission to improve the quality of life for those affected by Parkinson’s disease.

HAPS WELCOMES NEW BOARD MEMBERS

MARCH 16-22, 2015

The Brain Awareness Campaign is a worldwide celebration of the brain that brings

together scientists, families, schools and communities. This global celebration,

launched by The Dana Alliance for Brain Initiatives in 1996, presents an opportunity

to bring attention to brain science advances and advocate for science funding.

Brain Awareness Week serves as a launching point for year-round brain awareness

activities.

The Michael J. Fox Foundation and AbbVie have partnered to create Partners in Parkinson’s, a national strategic health initiative which aims to fill in knowledge gaps, and provide new

educational tools and resources for the Parkinson’s community to help patients optimize their

care from point of diagnosis through advanced disease.

Combining virtual and face-to-face opportunities, Partners in Parkinson’s empowers patients and families to “discover the benefits of team” by connecting them with information and resources

that can be crucial in developing a plan of care specific to their Parkinson’s.

Together HAPS and MJFF are bringing Partners in Parkinson’s to Houston in September 2015.

Stay tuned for more details about this exciting, upcoming event!

CO

MIN

G S

OO

N MJFF’s Partners in Parkinson’s Coming to Houston!

HAPS social workers are going to Washington! Check out HAPS at Parkinson’s Action

Network’s 2015 PAN Forum on March 23rd - 25th through social media. Follow HAPS on

Twitter and “like” the HAPS Facebook page to see pictures of the event! #PANForum15

4 | HOUSTON AREA PARKINSON SOCIETY

Donald Abrams

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In this year’s Chevron Houston Marathon, HAPS Superhero Squad has outdone

the record-breaking numbers of 2014 and raised an exceptional $119,756! Our

heroes also increased Parkinson’s awareness with a massive group of 250

participants running and walking in complete hero attire. From our top

fundraiser, Jim Thorp, who raised $15,251 to our youngest fundraiser, Madeleine

Skaufel, who raised an impressive $1,151 at the age of 8, HAPS heroes combined

to make this a widely successful event.

HAPS Marathon Co-Chairs, Diana Rutherford and Dotti Visosky, attribute these

achievements to attitude and awareness. Dotti stated, “The enthusiasm and the

number of people who came out to raise money and participate was better than

ever. I was extremely impressed.” Diana added, “I think people are now more

aware of Parkinson’s disease. More people know what the disease is, understand

it and are willing to contribute to the cause.”

HAPS would like to thank the walkers, runners, fundraisers, volunteers,

spectators and the nearly 850 donors (listed below) who participated in the

Marathon and helped in the quest that Dotti describes as, “showing the

community that life is not over for people with Parkinson’s.”

1. Jim Thorp $15,251

2. Fred Stephens $14,200

3. Diana Rutherford $8,700

4. Debby Hurlbert $7,126

5. Mike Hendryx $4,975

6. Pamela Skaufel $4,151

7. Leon Keeble $4,090

8. Kathleen Crist $3,727

9. Cathi Hernandez $2,465

10. Steve Bingham $2,241

11. Lauren Diliberto $2,185

12. Steve Atchison $1,900

13. Albert Frank $1,785

14. MVP Proud $1,520

15. Justin Folloder $1,390

HAPS’ Top 15

2015 Fundraisers

HAPS Superhero Squad Does It Again!

MARCH 2015 HAPS HAPPENINGS | 5

Carol & Tom Helms

Barbara & Jimmy Hemphill

Ruthann & Carlos Hendricks

Mike Hendryx

Gavin Hepburn

Robin Hermans

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Liz & Rob Herrada's

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Jake's Inc.

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Maryanna & Eugene Rhemann

Lee Richardson

Bob Richter

Yolanda Rico-Pyron

Carole Riekert

Lucy & Hayden Rieveschl

Keith Ritchey

Valerie & Tom Rizzoli

Linda Robertson

Lori Robertson

Jessica Rocca

Carol Roche

Elisa Rochford

Celida & Leandro Rodriguez

Sara Rodriguez

Gabriel Rodriguez

Patricia Rodriguez

Molly & Chuck Roe

Karen Rogers

Uncle Ronnie

David Rose

Sheila & Marvin Rosenberg

Joanne & Jerry Ross

John Rudisill

Marie & Pete Rupp

Joan Rush

Rebecca & Arlis Russell

Diana & Jim Rutherford

Wendy Rutherford

Diane Ryan

Janet & John Ryan

Deirdre Rysn

Jeremy Sabio

Frank Salazar

Ashley Salazar

Juan Diego Salinas

McClain, Lainy & Nathan Sampson

Meridith Sanders

Marianne & Tom Sanders

Emily Sandvig

Janis & Bruce Savatsky

Kathleen Sayers

Edward Saylor

Laura Schafer

Karla & Allen Schapansky

Cristy & Mike Schmidt

Lisa Schmitz

Bill Schoenfield

John Schoepf

Mary Jane Schott

Norm Schuett

Paul Schulz

Robert Schwartz

Muriel Selber Folloder

Eric Self

Mary Seymour

Amy Shearon

Shell Oil Company Foundation

Shelley Shelton

Nancy & Jack Shelton

Bonnie Sherk

Todd Sherrill

Nirav Sheth

Christie & Michael Shopoff

Courtney Shopoff

Yulia Shuvalova

Shelly Shwartz

William Sibley

Adrienne Sicinski

Robert Sime

Pam & Ernie Simien

Rod Skaufel

Linda Skaufel

Madeleine Skaufel

Pamela Skaufel

Sylvia & Charlie Slaughter-

Cunningham

Slay Industries

Paul Smith

Michele & Mitchell Smith

Lynn & Mike Smith

Rand Smith

Jeanine Smith

Meryl Smith

Holly Smith

Dylan Smith

Tracy & Ken Snodgrass

Yinka Solola

Heather Sommer

Patricia & Kurt Sommer

Pat & Gordon Sorrells

Laura & Scott Southall

Katie & Billy Spaur

Brenda & Chuck Spaur

Cindy & Lance Speck

Kathy & Paul Spicer

Marcus Spillson

Lavonda Spinnato

Richard Spinnato

Oliver Wendell Sprott, Jr.

Ellen Sprovach

Crews Sprovach

Joseph Sreshta

Christine Staudt

Jacqueline Steel

Annette Stegemoeller

Kim Steinmetz

Fred Stephens

Ted Stephens

Susan & Gordon Sterling

Jackie & Julie Stevenson

Richard Stewart

Mindy Stinson

Sebastien Stoffel

Mark Stone

Maureen Sullivan

Zachary Sullivan

Elizabeth Suman

Tina Summers

Barbara Sutherland

David Svedberg

Simone Swamber

Stacy & Tammy Swedenburg

Nelly Tacam

Deborah Taggart

Terri & Benjie Talley

Kiana Taylor

Carol & Mark Taylor

James Taylor

Steve Tefteller

Cindy & Howard Tenney

Eric Thiede

Bill Thomason

Stephanie Thomsen

6 | HOUSTON AREA PARKINSON SOCIETY

Edna Thornton

Patricia Thorp

Carolyn Thorp

Jim Thorp

Tim Thurmond

Patricia Timpanaro

Kenneth Titt

Glenn Tomblin

Jason Tracy

Harper Trammell

Stefni Tredennick

Margie Trevino

Dana Tumpowsky

Sandra Turner

Jeremy Underwood

Tina & Lance Underwood

Drew Underwood

Jaclyn Underwood

Jan Van Dyke

Sarah Vandergriff

Mary K. Vanderslice

Lisa Varghese

Amanda Vasquez

Melissa Verne

Sherry & Drew Verret

Terry Villarreal

Mario Villena

Robert Villeneuve

Rachel Vincent-Finley

Barbara Virany

Mary Jean & David Volpe

Jennifer Volpe

Ngoc Vu

Lam Vu

Annastasia Walker

Deborah Walls

Karin Wang

Ashlee & Matt Ward

Susan Ward

Gayle & Don Warren

Sylvia & Phineas Washer

Shayna Watts

Cindy Weatherall

Leslye Weaver

Linda Weeks

Richard Weirich

Mark Werner

Lisa Westarp

Andrew Wheeler

Lydia Wheeler

Murrell & Brian Whelan

Courtney & Brandon Whigham

Ken White

Lee Whitley

Matt Whitney

Mark Wilburn

Barbara & Larry Wilkins

Bonnie Williams

Julie Williamson

Jan Willis

Culver Wilson

Wanna Wilson

Pat Wininger

Dulcie Wink

Beth Wolf

Helen & Dallas Wolf

Monica Wolf

James Woltz

Tom Woltz, Sr.

Heather Woodcock

Shelby Yllana

Heesook Yoon

Matthew Young

Angelia Yurch

Neda Zafaranian

HAPS is currently enrolling individuals for the upcoming PEP session which will begin

Friday, April 10th. This five-week session is limited to twelve participants with mild to

moderate Parkinson’s disease, so get registered now! The four-hour program is presented

at Memorial Drive Lutheran Church each Friday for five consecutive weeks and has

components of exercise; recreation; socialization; education; peer-led discussion;

professionally facilitated support; ice breakers; and lunchtime conversations. Registration

is required. Contact Celeste Harris, LMSW at 713-313-1706 or [email protected].

Mark your calendars—the second YOPD Breakfast Club

is just around the corner. Join others under the age of 50

who are living with Parkinson’s disease during this fun,

social gathering. The YOPD Breakfast Club will meet

quarterly with the next event scheduled for Saturday,

April 25th. If you are interested in learning more about

this program, you may contact Celeste Harris, LMSW at

713-313-1706 or [email protected].

2015 Saturday Meeting Schedule

April 25th July 25th October 24th

Special Thanks

We are extremely grateful to the following individuals for their generous support of HAPS.

Without the continued support of our donors, none of our programs or services would be possible.

IN MEMORY IN HONOR

GIFTS

Peter Almy

Marian Harrison

Linda and Kent Anderson

Debbie and Frank Jones

Eve Asner

Carol Lee Seliger

Roy H. Cullen

Charlotte Duncan

Phillip W. Edwards

Pat Edwards

The Janisch Family

Mark Messerly's Family

Alan Hackenson

Judy Bruner

The Datta Family

Fannie Messec

Rebecca A. Hackenson

Thomas Byron Horton

Judy and James Stover

Herman Lauhoff

Bettie J. Szatkowski

Judy Bruner

Margaret Mika and son, Jason Mika

William R. Williams

Cindy and David Marquez

While we make every effort to be accurate and thorough, it is possible to accidently omit or misspell a name. Please contact the HAPS office with corrections.

MARCH 2015 HAPS HAPPENINGS | 7

Georgene Brandon

Agatha and Gus Brann

Cathy Brown

Lewis & Partners, LLC

Bob Casey

Agatha and Gus Brann

Shawn Casey

Agatha and Gus Brann

Margaret Romeo

Michael Romeo

Jonathan Shear

Terry Moore

Peggy Jackson

Shirley and Edward Ross

Michael Brown

Esther Crosby

Andrea Friedel

Harry H. Grant

Cynthia Crellen

Dr. Bob E. Stout

Marian Harrison

Eleanor Evans

Elizabeth E. Trahan

Porter Leon Layne

Rose Ann and John Shelton

Shirley Toomim

Linda and Tommy Hathaway

Connie and Bob Bains

Jackie and Jimmy Dan Rollins

Emily Morgan

Charles H. Grube

Irene and Gordon Kellogg

Cheryl, Talma and Mark Turrentine

Busgy and Larry Carter

Lisa and Aaron Stout

The Prince Family Charitable Fund

Lewis & Partners, LLC

Mary Cox

Sherry Foster

Mr. and Mrs. Patrick McCowen

Mr. and Mrs. Casey Hernandez

Mr. and Mrs. H. Scott Galloway

Van and Dick White

Ron Tunnicliff

Beverly and Anthony J. Deptula

Warren Williams

Georgia and Jerry Forbis

Pancakes for Parkinson’s Raises Awareness and Support

On Saturday, February 21st HAPS joined Team Fox for

the 4th annual Pancakes for Parkinson’s at Rice

University to raise money for The Michael J. Fox

Foundation for Parkinson’s Research. Led by student

volunteers, this event featured a wonderful lineup of

speakers on Parkinson’s disease, pancake eating

contests, improv comedy skits and musical routines to

entertain those attending the pancake breakfast.

Professor Robert Flatt, an esteemed photographer

who lives with Parkinson’s, was a key speaker and sold various pieces of his original photography, donating the proceeds

to raise support. At the end of the day, $3,500 was raised to help fund Parkinson’s research. HAPS appreciates the

opportunity to join Rice University and Team Fox each year in their efforts to find a cure and raise Parkinson’s awareness

in our community!

Houston Area Parkinson Society

Anne Thobae - Executive Director

Kathleen Crist, LMSW - Director of Social Services & Program Development

Kelly Nicholls - Coordinator of Marketing & Communications

Chris Bell

Ron Bernell

Nina Brown

Aubrey Calvin

Joiner Cartwright, Jr.

Bob Casey

Rich Clifford

Robert Cruikshank

Meredith Cullen

Frank Donnelly, Jr.

Madhureeta Achari, MD

Leanne Burnett, MD

Steve Croft, MD

Albert Fenoy, MD

Erin Furr-Stimming, MD

Robert G. Grossman, MD

Cindy Ivanhoe, MD

Staff

Board of Advisors

Greg Groogan

Ellin Grossman, EdD

John E. Hankey

Harriet Hart

Kamden Kanaly

Liz Lary

Harriet Latimer

Dan Lauck

Anne Martin

Robert A. Martone

Medical Advisory Board

Richard K. Simpson, Jr., MD, PhD - Chair

Joseph Jankovic, MD

Joohi Jimenez-Shahed, MD

Eugene C. Lai, MD, PhD

Laura Marsh, MD

Greg McLauchlin, MD

Kimberly Monday, MD

William Ondo, MD

Terry K. Satterwhite, MD

Mya Schiess, MD

Desiree B. Thomas, MD

Gage Van Horn III, MD

Ashwin Viswanathan, MD

Michele York, PhD

Marti McWhirter

Quin McWhirter

W.O. Neuhuas III

Malcolm Pettigrew

George Puig

Jeff Rosenberg

Arthur Schechter

Joyce Proler Schechter

Binky Stephenson Strom

John Strom

Board of Directors

Leann Randolph, LMSW - Social Worker & Advocacy Outreach Coordinator

Celeste Harris, LMSW - Social Worker & Special Programs Coordinator

Angelica Rodriguez - Coordinator of Therapeutic Programs

Mike Hendryx - President

Gabriel Zamora - Vice President/Treasurer

Leslye Weaver - Vice President/Secretary

Joe Ahmad

Denise Bishop

Chris Brewster

Randi Carrabba

Joan Cupic

Philip Francis

Jo Furr

Joyce Gilbreath

Tom Ganucheau

Daphne Haskin

Joshua Huss

Rob Kerr

Jim Nicklos

Gerald Rideaux

Erick Sandlin

Terry K. Satterwhite, MD

Pamela Skaufel

Jim Thorp

Michael Young