Dr. David Blatt: The Balance Doctor

The easiest way to introduce you to M.D. David Blatt is to show you this video.

That’s him, at age 61, balancing on basketballs over twenty years after he was diagnosed with Parkinson’s Disease. If you explore his YouTube channel, you’ll find dozens of other impressive videos. You’ll see him boxing, skiing, running, juggling, and more—all with a level of activity many people would deem impossible for someone with PD. David had such success with these physical challenges that he began to teach others with Parkinson’s how to push beyond their own limits.

But David was not always so active. In the first several years after diagnosis, he experienced a progressive physical decline. By year eight, he had trouble getting up from a chair. So what happened? How did he manage to turn his situation so strikingly around?

I sat down with David to learn the secrets behind his remarkable turnaround, and to gather info on how other PwPs can use his methods to improve their quality of life. Our conversation covered the importance of embracing carbidopa-levadopa, how to exercise in a manner that stimulates your nervous system, and why you need to get your ego out of the way.

David is keenly concerned that he does not represent what he has been able to achieve as showing that he has mastered all of his PD symptoms. “Every day has been a challenge for me since diagnosis,” he says, adding he still struggles with depression. And he points out that he had the advantage of being young and healthy and physically active at the time of diagnosis. “It is much harder for people who are older at diagnosis,” he says.

But as my interview with him shows, he is thoughtful and modest in discussing what he has accomplished, stating accurately what he has done, but making no unwarranted claims about what his achievements demonstrate. His efforts, however, are another illustration of how limited the expectations of what Parkinson’s patients’ can do are. I agree wholeheartedly with him when he says that his improved function shows that the disease is different than what it is conventionally believed to be.

 

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Pam: So let’s get right to the point, have you always had such good balance?

David: I’ve always had reasonably good balance. Before I was diagnosed I did a lot of hiking, and as a kid I was an avid skier. So those things helped me develop a sense of balance. But I’m no natural athlete.

Honestly, I’m kind of short and slow. Medicine was an appropriate career for me.

[Laughter]

Pam: But you’ve always been able to do pushups on basketballs?...

David: : No. That came in 2013… 16 years after I was diagnosed with Parkinson’s.

Pam: 16 years after you were diagnosed?!

David: : Yes.

And over the past decade I’ve accomplished a number of other things as well, despite my Parkinson’s. I’ve learned the art of striking a boxing speed bag; I’ve learned how to race on skis; and I’ve learned how to juggle while balancing on a Bosu ball (a balance-training device that looks like a beach ball cut in half, a dome with a flat base).

If you had told me 20 years ago that I would be able to do any of those things today, I would have thought you were crazy!

I'm fortunate in that I have a somewhat milder case of PD, so the accomplishments I've enjoyed may not be attainable for everyone with the disease. Since I began teaching an exercise class for other people with PD, I've seen some able to accomplish similar feats to me, but others experience more limited improvements.  Most people I teach though see some improvement in their mobility and quality of life. That tells me the principles I have followed to combat my PD are essential for anyone who wants to improve their function to know.

Pam: What are these principles?

David: Well the first and most important thing is to be properly medicated. Having appropriate levels of chemical support allows you to exercise enough to boost your mobility.

All of the improvements I just listed have come exclusively in my medicine “on” state. If you look at me in the medicine “off” state, my function is actually worse than it was in previous years.

But by taking a sufficient dosage of medication, I’ve been able to maintain and in some cases improve my quality of life in my “on” state over the last decade. I’m happy with that. People forget that the medicine “on” state is what determines the largest part of your well-being.

Pam: Can you talk a little bit about what medication you use?

David: I take a variety of medications, but the one that has improved my life the most is carbidopa-levadopa.

For years I avoided this drug out of the fear of getting dyskenisia. In hindsight, I put it off a great deal longer than I should have. I let myself decline to the point where I was having trouble getting up from a chair. I would push myself up about halfway and fall back down in defeat.

I knew I had to do something, so I agreed to go on the drug. That was in 2005, eight years after my diagnosis.

The transformation was profound. Within a few days my mood lifted and my body began to come back to life.

Pam: The first time I took Sinemet I had a similar experience.  For the same reasons I had put it off 13 years, and like you I wish I had gone on it sooner. I still remember the first day I took it. I felt reunited with my former self. It was magic. 

David: Yes. The turn around was instant.

Within 48 hours I had no trouble standing up.

After a few more days I was able to resume hiking in my neighborhood forest. I hiked often after that. Within two years I was able to climb almost 5000 feet up to the top of South Sister (one of three volcanic peaks in Oregon’s Cascade Mountains). The whole trip was around 12 miles.

A few months after I started levadopa, I also started to work on my skiing again. One of my kids joined the high school ski racing team, and I decided to help out. In exchange the coaches taught me basic ski racing techniques, which I had never learned before.

From 2005 to 2012, I skied 20-25 days a year. My peak came in the 2012-2013 ski-season, when I trained 10 half-days with a masters racing team. Later that spring I participated in my first master’s slalom and giant slalom. I finished in last place out of about 50 men – but I was thrilled.

In all of these situations I kept waiting, expecting to hit a wall in my functioning, but to my surprise I kept improving! So I just kept going. 

But it all began with my decision to start taking carbidopa-levadopa. If I could do it over again today, I would go on the drug sooner.

Pam: I would too.

David: At the same time—for those reading this—you shouldn’t automatically go on carbidopa-levadopa. If you can exercise with a fair amount of intensity without the drug, you don’t need it right now.

But if you can’t, you should consider asking your neurologist about the drug. I have seen a lot of people be so afraid of starting levadopa that they let themselves become severely disabled. They want to exercise, but they can’t because they don’t take the levadopa that allows them to move. I watch these people deteriorate.

I believe today that it is possible that taking optimum doses of levadopa and exercising regularly can decrease a person’s risk of getting dyskenisia.

Pam: Surely your success is not just because of carbidopa-levadopa. I’ve been taking the drug for 15 years and I can’t do push-ups on basketballs.

David: You’re right. Taking an adequate amount of medication is only the first step. The medicine gives you the support you need to take the second step in improving your function: exercising in a way that stimulates your brain and body.

My students and I achieve this by dividing the exercises we do each day into three categories:

1.    Exercises that we can do reasonably well
2.    Exercises that we can do not very well
3.    Exercises that we can barely do or have never done

Which exercises you choose to do is not as quite as important as making sure you are pushing your body and brain to their limits. You have to exit your comfort zone if you want to see improvements.

Pam: When did you decide to focus on improving your balance?

David: I’ve always been aware of the importance of balance. When I was diagnosed in 1997, my doctor told me that the two symptoms of Parkinson’s Disease that caused the greatest decrease in quality of life were a loss of balance and a decreased speed of motion.

It wasn’t until 2008, however, when I had a small fall on an easy ski run that I decided to focus on balance specifically.

Around that time I also decided to focus more acutely on increasing my speed of motion.

Pam: How did you go about doing those two things?

David: To better my balance, I began performing pushups on Bosu balls turned upside down (with the domed side on the ground). Once that became easy, I flipped the Bosu balls right side up (with the flat side on the ground). That evolved into doing pushups with one medicine ball under either hand. With each workout I just pushed myself to make exercise a little more complex.

Now I can do full push-ups balancing on four medicine balls.

To increase my speed of motion, I made sure to continue running. I also resolved to improve my juggling skills. I had the basics down from before I was diagnosed, and I had been experimenting on and off with juggling clubs for the past few years. I think it was in 2013 that I mastered that skill.

And on my YouTube channel you can see that I combine the two: I juggle while balancing on a Bosu ball.

Neither of these things came easy, though. I had to struggle through a lot of failure. You know, that brings me to another very crucial aspect of improving your function: you need to get your ego out of the way.

When I was first diagnosed with Parkinson’s, I didn’t like being seen shaking while I exercised. I stopped going to the gym; I started doing exercises just on my own where other people didn’t see me. In retrospect that was a mistake. I became more isolated, and I didn’t exercise as often. Things got worse; my condition declined. It was a really tough time.

It was only once I embraced the necessity of failing in front of other people that I started to see significant improvements.  Take balancing on basketballs. I can’t tell you how many times I fell flat on my face learning to do that. But by that point, since I had put my ego of the way, it didn't matter to me that people saw me like that. I wanted to fail. In fact, if I wasn't failing multiple times at the end of each balancing session, I took it as a sign I hadn't pushed myself enough.

I continue to apply that principle to anything I am trying to learn today. The famous UCLA basketball coach John Wooden put it best when he said, “If your not making mistakes, you’re not doing anything.”

[Laughter]

Pam: How do you assure safety when you are pushing yourself? I know a lot of people who are prone to failing, or have hurt themselves exercising.

David: One, aim for small failures, not large ones. Two, I encourage every person with PD to exercise one on one with a physical therapist or with an exercise trainer. The physical therapist or trainer can select appropriate exercises and safety precautions.

Or you can join an exercise class with other PwPs.

As a side note, I encourage people to use BOSU balls when they already have exceptional balance. There are less risky exercises you can do to improve your balance, and you should master these first before exercising with a BOSU ball.

Pam: And do you have any advice for PTs and OTs out there with Parkinson’s patients?

David: I would encourage them to push people with Parkinson’s Disease to improve function and not just aim for maintaining function. I would also encourage them to not set limits on what they believe PWPs can do. Patients and their PTs and OTs have to find a healthy balance between acceptance and denial of the disease.

On the one hand, that means being careful. I've read some recent reports about physical therapists pushing PwPs too hard... On the other, there is also increasing research about the benefits of vigorous exercise for people with Parkinson’s. If all you have someone with Parkinson’s do is walk or ride an exercise bike at a leisurely pace, or do exercises sitting in a chair that are not challenging them, they might see some improvements in physical function, but it’s going to be pretty minimal.

I’ve been leading exercise classes for seven years now, and I've tried a variety of approaches to help my students improve function. The change that has helped them the most by far, was changing the class from two days a week to four days a week.

Pam: Final question: if you were diagnosed again what would you do differently?

David: First I would not react with the feeling that my life is doomed. I think there is a lot more reason to be hopeful today than there was when I was diagnosed. I would start exercising the way I have learned to exercise—hitting all those three categories—and I would take the medicine necessary to enable that. I would not isolate myself from my family in the way I did. That was unfair to them, and it only hurt me. Once I opened up we were able to deal with the disease much better as a family. They have given me so much amazing support.

If you had told me the year I was diagnosed, that I would be able to ski 20 years later, I wouldn’t have believed you. If you had told me I would start an exercise class for people with Parkinson’s 13 years later, I wouldn’t have believed you. The fact that I have been able to improve function, and that participants in my class have been able to improve function shows that the disease is different than it was conventionally believed to be.

Obviously there are different strains of Parkinson's and some people may be able to progress further than others. I have been fortunate enough to improve quite a lot, and I view my case as evidence that there are a lot of PwPs out there who are not realizing their full potential. The disease does not have to be as inevitably progressive as people once thought it was.