Crista Ellis 00:00:00
Hello and welcome to the Parkinson's Foundation's webinar on resources for veterans with Parkinson's. I'm Crista Ellis, your host for today's webinar. Helping me behind the scenes are my colleagues Jenny Fearday, Danielle Agpalo, and Laura Cameron. We are recording today's presentation. You will receive a follow-up email from us with a link to today's recording and other resources in the coming days.
The mission of the Foundation is to make the lives better for people with Parkinson's, whether you are living with Parkinson's, caring for someone with Parkinson's, or working to end the disease. We are here to support you.
To achieve our mission, we pursue three goals: improve care for everyone with Parkinson's, advance research toward a cure, and empower and educate our global community. Today's program is a great example of one of the things we are doing to help us meet these goals.
The Parkinson's Foundation provides weekly educational and wellness programs virtually through our PD Health at Home series, including Mindfulness Mondays, Wellness Wednesdays, and Fitness Fridays. You can learn more and register for these programs by visiting Parkinson.org/PDHealth. My colleague has put a link in the chat for you all.
Part of the Foundation's commitment is to reach every person living with PD. A critical way we do that is through our partnerships. With more than 110,000 veterans living with Parkinson's disease, the Foundation is proud to have established a formal partnership with the Veterans Administration. This partnership has the overarching goal of improving the quality of life for veterans living with Parkinson's disease and their care partners through greater access to education, resources, and support. I'd like to invite you to visit our webpage and explore the resources offered by the Parkinson's Foundation that can support your navigation of living with Parkinson's as a veteran. That website is Parkinson.org/veterans.
Today's webinar and the entire veterans webinar series is presented with support from the Don and Lorraine Freeberg Foundation. We want to take this moment to thank the Freeberg Foundation for helping to make this program possible.
Today we kick off part one of a four-part webinar series for our veterans living with PD. Today's discussion will focus on the resources and support services that veterans have access to through the VA and the Parkinson's Foundation. We will continue this series on August 31 with a focus on mood changes. On October 26, our webinar will offer tips and support to help us prepare for the future, and to conclude the series on December 14, we will discuss how, for some veterans, environmental exposure and toxins can increase the risk of PD. You can learn more about these events and register to attend at Parkinson.org/veterans.
Crista Ellis 00:02:56
We understand the vastness in navigating Parkinson's disease as a veteran, which is why we have designed this educational opportunity as a series. Today we will focus highly on resources and access to care. If you have questions outside of today's topic, please plan to attend one of our future events or contact our Helpline at 1-800-4PD-INFO.
As we step into the formal webinar, please know that we are recording today's presentation. You will receive a follow-up email from us with a link to today's recording and other resources in the coming days.
To start us off, we welcome Gretchen Glenn, a social worker and associate director of education for the Philadelphia Parkinson's Disease Research, Education and Clinical Center. Gretchen focuses her practice on adjustment to chronic illness, disease education, supportive counseling, resource coordination, case management, and community outreach for veterans and families diagnosed with Parkinson's disease and related movement disorders in their families.
Ms. Glenn also serves as chair of the National VA Parkinson's Disease Consortium Education Subcommittee, which is responsible for providing educational opportunities to national VA healthcare providers on the care of veterans with Parkinson's disease and related movement disorders.
Ms. Glenn is passionate about helping others and has dedicated her career to helping people cope with chronic illness and end-of-life issues. Gretchen, thanks for sharing your time and knowledge with us today.
Gretchen Glenn 00:04:23
Thank you, Crista, and good afternoon, everyone. I'm going to go ahead and bring up my slides.
Okay. Again, thank you for the introduction, and thank you for having me present today.
Today I'm going to review who the PADRECCs are, our consortium center network and the care we provide, as well as a general overview of some of the resources available to veterans receiving care through the VA healthcare system.
The Parkinson's Disease Research, Education and Clinical Centers, also known as the PADRECCs, were formed in 2001 to revolutionize services for then-approximately 80,000 veterans afflicted with Parkinson's disease. This number has since grown to approximately 110,000, and data collection is underway to get a more updated number.
Each PADRECC is designed to deliver state-of-the-art clinical care, pioneering research and educational programs to an expansive geographic region. These centers are staffed by internationally recognized movement disorder specialists and researchers. The six centers of excellence are located in Philadelphia; Richmond, Virginia; Houston, Texas; West Los Angeles; San Francisco; and a split center in Portland/Seattle VA Medical Centers.
As you can see by looking at this map, the PADRECC centers create a necklace around the United States, which makes it difficult for veterans living in the middle of the country to access Parkinson's care. You can see that the PADRECCs are all represented as the red dots. As a result, the PADRECCs developed the National VA Parkinson's Disease Consortium Network.
In 2003, the PADRECCs introduced the National VA Parkinson's Disease Consortium in an effort to promote awareness across the VA healthcare system by providing professional networking, mentorship and training opportunities. It is comprised of VA physicians, nurses, pharmacists, social workers, physical and occupational therapists, and other allied health professionals with an interest in Parkinson's and movement disorders.
Gretchen Glenn 00:06:36
The consortium center network was then launched in 2006 to broaden the impact of the PADRECC mission. These designated centers offer veterans convenient access to specialized movement disorder services within all of our Veterans Integrated Service Networks. These centers are staffed by movement disorder specialists or clinicians with vast experience and interest in the field of movement disorders. Together, the six PADRECCs and 57 consortium centers provide convenient and state-of-the-art care to veterans throughout the country.
As Crista mentioned, in 2020, the PADRECCs were fortunate to form a partnership with the Parkinson's Foundation. As you can see from this map, many of the Parkinson's Foundation Centers of Excellence are close to VA PADRECCs and our consortium centers. The PADRECC centers are represented by the green dots. The blue dots are the PF Centers of Excellence, and the red dots are the consortium centers. You can see that we all work closely together.
Now I just want to go over our PADRECC missions of clinical care, education and research.
Clinical services include a multidisciplinary team approach, and teams can include an attending neurologist, fellows, nurses, geriatric psychiatrists, neuropsychologists, social workers, pharmacists, and physical, occupational and speech therapists. We all work together to provide care for our veterans.
Care can include comprehensive movement disorder neurological evaluations, diagnosis and treatment of movement disorders, DBS for Parkinson's disease and essential tremor, neurostimulation for DBS, Botox injections, neuropsychological assessments and disease education.
It can also include psychosocial assessments, palliative care discussions, which include advance directives and goals-of-care conversations, and referrals to physical therapy, occupational therapy and speech therapy for things like falls, balance issues, home modification needs, and speech and swallowing issues, just to name a few of them.
Gretchen Glenn 00:08:58
The PADRECCs also have a robust telehealth program to provide movement disorder care to veterans who are unable to travel to a PADRECC or a consortium center. We're able to do that in a few ways. Prior to COVID, the most common way was to provide care to veterans who would go to a local VA medical center, a VA outpatient clinic or a veterans state home, and they would have a video visit with one of our movement disorder specialists at the VA.
Since COVID, we have greatly expanded our ability to provide what we call VA Video Connect Care, which is basically bringing the care into the home through video. The veteran can be located at home or anywhere they may be located, and they are able to connect with a movement disorder specialist via video to have their evaluation done. We also have a psychiatric consult service to over 52 VA medical center sites, and that is run by Dr. Daniel Weintraub in collaboration and funded by the National Telemental Health Centers.
He provides initial psychiatric consult service for patients with Parkinson's and psychiatric cognitive symptoms. Psychiatric symptoms in patients with Parkinson's have a large impact on quality of life, and managing these symptoms can be difficult and should be done by a subject matter expert. We're fortunate to have Dr. Weintraub with us and available to do that.
Telehealth programs for veterans with Parkinson's are continuing to expand throughout the VA system, especially to meet the needs of rural veterans. There have even been a lot of programs focused around the rehab needs that can be done via telehealth.
Just to review briefly some of our education programs, we have two arms to that. We have patient education and professional education. For patient education, the PADRECCs do monthly virtual support groups, annual symposiums on specific topics related to Parkinson's disease, distribution and creation of print and media resources, and a lot of community outreach. If you were to go to our website, to our Patients and Families page, you'd be able to see a listing of our support groups, and anybody can join those, whether you're being followed at a VA PADRECC or consortium center or not. You're welcome to join.
Gretchen Glenn 00:11:22
We provide a lot of professional education programs and mentorship. We do have a movement disorders fellowship program where we train medical doctors who have received their MD already and give them further education and experience in working in Parkinson's disease and movement disorders. We also offer two movement disorder webinars a year, and we offer monthly case conferences and journal clubs to our consortium center network.
This is just a snapshot of the PADRECC Veteran and Family page, where you can see some of the resources that are available, such as our YouTube video series, which are short videos featuring veterans and PADRECC staff, highlighting different aspects of Parkinson's disease care. We also have different education brochures. Again, here's a listing of some of our support groups, and we recently added, through the Richmond PADRECC, a young-onset group and a caregiver support group.
Just to touch briefly on research, I wanted to mention some of our research initiatives right now. The PADRECCs really do have a robust research program, and this is not an exhaustive list, but some of the areas they look at are surgical interventions, drug therapies, gait and falling issues, depression and other psychiatric problems, non-motor fluctuations, exercise, basic science, which is more lab studies, looking at drug-induced parkinsonism, which is long-term exposure to antipsychotic medications such as lithium and Haldol, gene mapping and genetic predictors, biomarkers and, of course, toxin exposures.
Now that I've gone over who the PADRECCs and consortium networks are, I wanted to touch on how you can access VA care. The first step is really to see if you're eligible for VA healthcare. A veteran may be eligible for VA healthcare benefits if he or she served in the active military, naval or air service and did not receive a dishonorable discharge. Some eligibility factors are service history, VA disability rating, income, as well as some other factors. The recent PACT Act has also expanded eligibility for veterans. I always tell veterans it's definitely worth applying to see if you're eligible.
Gretchen Glenn 00:13:52
If you're a current or former member of the reserves or National Guard, you must have been called to active duty by a federal order and completed the full period for which you were called or ordered to active duty. If you had or have active duty status for training purposes only, you wouldn't qualify for VA healthcare. But you can learn more by going to the VA eligibility website that I have listed here to learn more about the eligibility criteria, as well as be able to apply.
So eligibility and care at a PADRECC or a consortium center: first off, a veteran must be enrolled in the VA healthcare system to receive care through a PADRECC or a consortium center.
Once you're enrolled, you can go to our Getting Care page and choose the PADRECC or consortium center closest to you that you would like to go to receive care. Then you would ask your VA primary care provider or your VA neurologist, who can make a referral or a consult to a PADRECC or a consortium center. Or you can even self-refer by calling the PADRECC or consortium center directly. On that Getting Care page, if you click on the center of interest, you'll see the contact information there.
If you need any help at all with that process, you can call our PADRECC and Consortium Hotline at 1-800-949-1001, extension 205769. We would be happy to help you.
Before I move on, I want to go over some important VA lingo, and that is: what do service-connected and non-service-connected mean? These terms are important as we move on and talk about the different resources that are available, and they're terms that you'll commonly hear throughout the VA.
Service-connected status refers to veterans who are disabled by an injury or disease that was caused or aggravated by military service or occurred while serving in the military. Parkinson's disease is considered a presumptive condition for some veterans, which means that it's presumed that the disability is caused by your military service if you served during specific wartime and/or were exposed to certain toxins. Veterans who are service-connected will receive disability compensation, which is a tax-free monetary benefit, and the amount of compensation is based on the determined level of disability.
Gretchen Glenn 00:16:16
Non-service-connected status refers to veterans who have a disability or health issue not related to their military service. Veterans diagnosed with Parkinson's who do not meet the criteria for a presumptive service connection may still be eligible for some VA benefits under the non-service-connected status. Typically, there is an income limit.
Veterans who are non-service-connected may be eligible for a VA pension, which is a tax-free monetary benefit payable to low-income wartime veterans. Veterans who are eligible for a pension and are housebound or require the aid and attendance or assistance of another person may be eligible to receive additional monetary amounts.
Now moving on to Agent Orange and other toxin exposures. When the PACT Act was first established, Parkinson's was not considered a service-connected condition. But in 2010, it became what we call a presumptive service-connected condition for veterans who served in the Vietnam era and were exposed to Agent Orange. Recently, they have expanded this to include the Blue Water Navy veterans, and the PACT Act has also added five new locations to the list of presumptive locations, which means if a veteran served on active duty in any of the listed presumptive locations, the VA will automatically assume, or what we call presume, that they have been exposed to Agent Orange. In May 2021, parkinsonism was added to the list of presumptive service-connected conditions associated with Agent Orange.
In January 2017, VA announced Parkinson's as a presumptive service-connected condition for veterans who were stationed at Camp Lejeune for no less than 30 days between August 1, 1953, and December 31, 1987. It's important to note that parkinsonism was not included on the list of presumptive conditions. It's just Parkinson's disease currently, and this is related to the water contamination at Camp Lejeune.
In December 2013, Parkinson's disease and parkinsonism became recognized as secondary conditions to service-connected moderate or severe traumatic brain injury.
Applying for VA service connection, my advice to veterans is always: if you think you may have been exposed to Agent Orange or if you spent any time at Camp Lejeune, you should apply just to see. Let Veterans Benefits determine if you're eligible or not.
Gretchen Glenn 00:18:55
Veterans Health Administration and Veterans Benefits both fall under the same umbrella of the Department of Veterans Affairs, but we function quite separately. Just to give you some background, VHA is the healthcare system, and VBA, or Veterans Benefits, is the financial benefits side that also includes vocational assistance to veterans. This is just a side note: our systems don't really talk to each other. VHA can provide medical support for benefit claims, but determinations of the claims are done by Veterans Benefits only, and we do not have access to each other's systems.
It's strongly encouraged for veterans to work with a VSO to help in the disability claim process, which can often be complex. We have Mr. Welma James Jackson Jr. with us today, who is from VBA, and he'll be speaking more about the role of the veteran service officer.
To just touch on some of the VA benefits, the more common ones that veterans would find beneficial, VA offers a variety of medical and support services for veterans, with several of them being of particular interest to veterans with Parkinson's. Some of these benefits are based on level or percent of disability. Depending on service connection or income, there may be a copay for some of these programs.
I just want to note, too, that each VA medical center offers similar programs to some extent, but how they are run and eligibility criteria may differ from each VA.
Veterans would be eligible for primary care services, which includes a pharmacy benefit.
We have a very robust mental healthcare system where we provide care for veterans. There are rehab services such as PT, OT and speech, and recreational therapy; adult day healthcare programs; many VAs have contracts with adult day programs in the community for veterans who need increased socialization or supervision during the day; and a home health aide program, which can provide assistance with hands-on personal care, such as bathing, dressing and grooming tasks. Most VAs do not have their own home health aide agencies, but we make referrals to agencies within the community.
Gretchen Glenn 00:21:13
There are respite care services, which include in-home and inpatient respite to allow a caregiver a break; a home-based primary care program for veterans who have difficulty leaving their home to come to their primary care appointments; they may be eligible to have a VA primary care team come out to them, which consists of a doctor, nurse, nurse practitioners, rehab specialists, psychologists, social workers, etc.
There is hospice and palliative care for veterans who are nearing end of life; prosthetics equipment, which is another word for durable medical equipment, and this could range from anything from dressing aids to walking aids like wheelchairs, walkers, canes and stair glides, just to name a few; VA nursing homes and contracted community nursing homes for veterans who are no longer able to be cared for at home.
One of the programs you may be hearing a lot more about is our Caregiver Support Program. There are two levels to that program. There's the Program of General Caregiver Support Services. This is their core program that provides peer support mentoring, skills training, coaching, telephone support, online programs and referrals to available resources to caregivers of veterans.
The second part of the program is the Program of Comprehensive Assistance for Family Caregivers, and this offers enhanced clinical support and services for caregivers of eligible veterans who have serious injury or illness and require in-person personal care services, among many other requirements, including service connection status. Eligible caregivers can receive a monthly stipend to be their veteran's paid caregiver.
I just want to go over a little bit about the PADRECCs and the Parkinson's Foundation Centers of Excellence and how we work together.
Veterans who are eligible for movement disorder care at a VA, this is just really important to note, do not need to give up their community neurologist. We often refer to this as co-practice. PADRECCs and the Parkinson's Foundation Centers of Excellence work together to ensure veterans are receiving the best possible care with access to eligible benefits. Veterans who already have a community neurologist can choose to have that neurologist manage his or her Parkinson's disease and come to the VA at least one time a year to receive VA benefits such as the medication benefit, durable medical equipment, in-home support programs and all of those programs that I had mentioned before. To be able to access those programs, you just need to be seen in the VA at least one time a year.
Gretchen Glenn 00:23:57
It's important that the veteran must choose one neurologist to be the director of care. If they choose to have the community neurologist be the director of care, the VA neurologist will send recommendations to the community neurologist to consider, but it's ultimately up to the community neurologist to make the treatment decisions. This is really just so that you don't have two different people making medication changes, which can often cause problems for a veteran with Parkinson's.
A veteran can change the director of care over time if they choose. You can start out with your community neurologist, and if you become really happy and satisfied with the care that you're receiving through the VA PADRECC or consortium center, you can decide at any time if you want to switch to having the VA be your director of care. For example, here in Philadelphia, we co-practice with several patients with our local movement disorder centers at the University of Penn, Jefferson and Cooper, as well as many other local community neurologists. Several PADRECCs also partner with the Centers of Excellence to provide fellowship opportunities, so that's training opportunities. We often collaborate with patient education programs. Several of the PADRECC and consortium attendings have appointments at the university Centers of Excellence, and we do a lot of research collaboration as well.
I know that was all a lot of information. Some of it can be a little confusing. Who can help you with sorting through it all? We have the VA social workers, which is what my main role is. We can assess your needs and make you aware of the availability and eligibility of services and help to advocate for you. I often put myself out there as a resource person for you. If I don't know the answer, I can try to find it for you or at least point you in the right direction. I would really encourage you that if you are receiving care at a VA, to just make a connection with a VA social worker. They're all located within the primary care teams, so you can ask your primary care provider at the VA if they can refer you to a VA social worker.
Gretchen Glenn 00:26:08
Just even initially, if you don't even have any needs, just to meet with them to build that relationship and to get some education on what might be available to help you.
VA veteran service officers, otherwise known as VSOs, can help with applying for or increasing VA disability benefits. They can help with the process, which can be complicated and sometimes overwhelming, and they can monitor your claim and also be an advocate for you. We strongly recommend and advise our veterans to connect with veteran service officers to help in the process. They can also help you with getting connected to VA healthcare initially.
I also encourage you to check out the Parkinson's Foundation frequently asked questions, which the Parkinson's Foundation and the VA developed together. It goes over a lot of what I talked about today in more detail, as well as a way to connect with a VA social worker or a veteran service officer.
These are just some of the materials through the Parkinson's Foundation and the VA partnership that we have developed, which, again, as Crista had mentioned, you can find on the PF website at Parkinson.org/veterans. And now I can open it up for questions.
Crista Ellis 00:27:29
Great. Thanks, Gretchen. I know that one, this is a lot of information for our veterans, for the community even. So we do have several questions, mostly clarifying questions on what these organizations' affiliations and partnerships mean. But to start, one of our viewers is asking, in order to get VA care and to have access to Veterans Administration benefits, do we need to receive care from a primary doctor who's associated with the VA, or can we have a primary doctor outside of the VA network?
Gretchen Glenn 00:28:09
First, you would have to apply for VA healthcare to see if you're eligible. You do have to connect with a primary care provider within the VA system. Again, you can be seen one time a year within the VA. You can continue to have your doctor outside in the community. We understand that you could have had that doctor for, like, 20 years. You don't want to give that person up.
We're okay with that. But just to maintain your benefits within the VA, you should be seen at least one time a year in order to do that. For VA, the financial benefits for service-connected disability, you don't have to be seen in the VA healthcare system if you don't want to. You won't be able to access all of the healthcare benefits that I had mentioned and gone over, but you would be able to receive the compensation financial benefit. You don't have to apply to the healthcare system if you don't want to, but we highly encourage you to do so.
Crista Ellis 00:29:05
Thank you.
Gretchen Glenn 00:29:06
And if you're service-connected, you would automatically be eligible for VA healthcare.
Crista Ellis 00:29:10
Okay, great. Thank you for clarifying that. How does the Veterans Administration work with private medical insurance? Is it one or the other?
Gretchen Glenn 00:29:21
That's complicated. We can't bill Medicare because you're billing the government. There are copays. If you are a non-service-connected veteran, you may have a copay for your doctor visits. It could be, I believe, $20 or $25 for a primary care appointment and $50 for a specialty clinic appointment. If you have insurance other than Medicare, the VA can bill your insurance. Say your private insurance would pay half of the specialty care visit; that way, you would only have to pay a $25 copay for that visit. So it can work. They can work together.
Crista Ellis 00:30:04
Great. Thank you for clarifying that. This next one might be a little bit more general as a response, but can you talk more about what a veteran diagnosed with PD should do to ensure that they're taking advantage of all the benefits offered through VA healthcare?
Gretchen Glenn 00:30:23
If you're not connected with a PADRECC or consortium center yet, that would be a good first step. They are the specialists with movement disorders, to make sure that you're getting the right treatment, and they can also make sure that you're connecting with the other services that might be available. They would be more apt to know if being evaluated by physical, occupational or speech therapy might be in order and connect you in that way. Also, connect with a social worker, a VA social worker at the VA.
They're really your connector for the different resources and services there and can tell you what's available, how you can apply for them, help you apply for them, and just sort of help you navigate through the system.
Crista Ellis 00:31:10
My follow-up question was, what is the role of a VA social worker?
Gretchen Glenn 00:31:15
Right. Like as I mentioned, I always introduce myself as a resource person to the patients that I see. If I don't know the answer, I can at least try to find it for you or connect you to the right person because our system is very large, and it can be very complicated to navigate through. We also do resource coordination within the VA and within the community. So if we don't have the service to provide through the VA, we can help connect you with resources within the community. We do a lot of disease education and support — support for the veterans, support for the family, the care partners, throughout the whole disease journey together.
And we're your advocate.
Crista Ellis 00:31:57
Yes, absolutely. We did get a question specific about support for the caregiver of a spouse with Parkinson's disease, and I saw that you did answer that during your presentation. So thank you for including our care partners out there.
Let's see. What else do we have here? What is the income limit, if I could be so bold to ask, for non-service-connected care?
Gretchen Glenn 00:32:21
I cannot honestly answer that. It changes every year. You could go on the VA eligibility website and you would be able to find it there, and also by contacting your local VA and asking to speak with somebody through eligibility.
Crista Ellis 00:32:38
Yeah. Does it change per state?
Gretchen Glenn 00:32:40
It may, yeah. I mean, I concentrate more in the Philadelphia area, so I haven't really reached out to the VA in other states to see, but it could.
Crista Ellis 00:32:51
Okay, great. So some clarification. We have these words: PADRECC, consortium center, COE, Center of Excellence. One of our viewers is asking, can you clarify if the Center of Excellence network is part of the VA or an affiliate that works with the VA?
Gretchen Glenn 00:33:08
They're not part of the VA. Oftentimes they're in the community, and we're at the VA, but we partner together. So we have a partnership with the Parkinson's Foundation, who oversees the Centers of Excellence as part of the network. But we're separate from each other. The VA is not in the business of trying to take care away from the community. We want to make sure that veterans are getting access to all the care that's available to them.
We're happy to work together with the community neurologists and the Centers of Excellence to just ensure that the veterans are getting the care that they need and they're eligible for.
Crista Ellis 00:33:54
Thank you for bringing light to that, Gretchen. All right, so let's see what else. Can you explain more on caregiver benefits, the second tier where you get paid to be a family member caregiver?
Gretchen Glenn 00:34:08
Right. That's the Program of Comprehensive Assistance for Family Caregivers. There's a stipend that a veteran's care can identify a care partner that might be able to receive a stipend from the VA. There are different categories and two different levels of what that stipend may look like. For specific questions, I would refer you back to caregiver.va.gov, and it gives you the breakdown right on there of what the different programs are and what the criteria is. Basically, you would have to be a 70% service-connected veteran or more and have a certain level of dependencies in your activities of daily living or require constant supervision to be eligible.
Crista Ellis 00:34:54
Thanks, Gretchen. Any final words or gems that you'd like to offer our community before we move into the next portion of our webinar?
Gretchen Glenn 00:35:01
I just encourage our veterans to consider applying for VA healthcare. If you may not need the services now, you might need some of the services later. So it would be worthwhile again, even if it's just come one time a year, so that way you're in the system. And then if you need care later on or need access to some of these resources, you're already in the system and hooked in and know how to get them. It could help your family members and friends and people who care for you later on, too, in your disease journey.
Crista Ellis 00:35:32
Gretchen, thank you for offering an overview of the resources available through the VA for our veterans living with Parkinson's and, of course, our care partners living with them.
Gretchen Glenn 00:35:41
Thanks for having me today.
Crista Ellis 00:35:43
The Parkinson's Foundation also offers resources for veterans with Parkinson's disease and their families, including our website at Parkinson.org/veterans, our toll-free Helpline, staffed by information specialists who can address PD-specific questions, a library of educational resources, webinars, podcasts and books. We also have targeted resources for those who have been newly diagnosed with Parkinson's, including information and our online community, PD Conversations, where you can connect online with others living with PD and their care partners.
And now we welcome a special guest to share her story as a veteran living with Parkinson's.
And now we'll hear from Melissa Joanne Martin, who is an LPN Army veteran sharing her experience. Joanne, if you would, please introduce yourself to our community today.
Joanne Martin 00:36:42
Hi, I'm Joanne Martin. I'm a nurse. I'm a veteran. I'm a mom, I'm a daughter, I'm a grandmother, I'm all the things rolled into one.
Crista Ellis 00:36:56
And where do you live?
Joanne Martin 00:36:58
I live in Kingstree, South Carolina.
Crista Ellis 00:37:00
Beautiful.
Joanne Martin 00:37:02
Seventy miles north of Charleston.
Crista Ellis 00:37:05
Wonderful. Well, thanks for sharing that. Joanne, it's really been a pleasure talking with you these last few days and getting to hear your story multiple times, and I'm so glad that you're able to share your story today with our community. I'm wondering if you would be able to share, years ago when you started noticing some changes in your body, like the sleep issues, before you received your diagnosis of Parkinson's.
Joanne Martin 00:37:35
As I look back over time and try to figure this out, I've noticed that my symptoms were nondescript in the beginning, and they probably started in my late 30s, early 40s.
Things like sleep disturbance, constipation, muscle stiffness and aches. I just didn't feel good at all. I'd go to the doctor, and of course the doctor would say, you know, you're just getting a little bit older, Joanne. You're just getting a little bit older, which nobody wants to hear, but it is true. Then I guess probably in my mid to early to mid 40s, I started having more symptoms that were a little more pronounced.
I started having things like twitches in my thumb on my left hand. I'm left-hand dominant, and it was really obvious to me, not very obvious to anybody else, but to me it was. I started having the constipation started getting worse. I started having extreme fatigue and brain fog and just all kinds of issues to where I just broke out in a rash. I had horrible itching episodes. This went on for months and months and months, and I'd go back to the doctor, and the doctor would say, 'Well, you know, Joanne, you are a little older again, and now you're reaching the age of perimenopause,' which any of these other ladies that may be listening dread to hear them say, but it's a fact of life. I don't know. I just never felt well.
Then I guess I was about 45. I had frozen shoulders. It just came up from nowhere. It was horrible. There was no excuse, no reasons that we could come up with. I'm a seeker of answers. I am a problem solver by nature, part of me being a nurse, I guess. And I just couldn't come up with a reason why my shoulder was hurting, why I was having all these strange things that people my age weren't having the same symptoms.
I just pushed issues and pushed issues and just was my own patient advocate and said, 'Hey, Joanne, you really need to see somebody about this.' I had some thyroid issues that kind of muddied the water a little bit as well, and some of the symptoms got blamed on my thyroid. But long story short, I was persistent and got in to see a neurologist maybe in 2015.
They were quick to write me a prescription for Sinemet. They agreed there was a small tremor in my hand and wrote me a prescription for Sinemet, but it was done on a quick exam of hand coordination, handwriting, memory, and being the nurse that I am, a little stubborn. I really didn't just want to take Sinemet just for a little shake in my hand without a concrete reason why it was being diagnosed or dispensed.
Long story short, it took me another year or so, and I went back. I saw a movement disorder specialist who made the statement, she said, 'I don't think you have Parkinson's.' And I persisted on a DaTscan and just insisted that I get it done, and she reluctantly wrote the order to have the DaTscan done, and sure enough, I had Parkinson's.
She treated me for a little while, and then she left the VA, and then I was introduced to Dr. Ketron and Dr. Hinson, and they have taken very good care of me since.
Crista Ellis 00:41:23
It took years for you to get this answer. How did it feel? How did it feel for you to finally get that answer of, you have Parkinson's disease?
Joanne Martin 00:41:35
Well, I won't say I was happy about the diagnosis. I wasn't shocked, but this comes from years of taking care of Parkinson's patients, and I just knew in my heart that I had Parkinson's. It wasn't one of those things, 'Oh, you're just a nurse. You're trying to diagnose yourself,' so forth and so on. Diligence and persistence is the key. You are your own patient advocate. The best advice I can give to anybody that would be listening is you are your own patient advocate. You know your body better than someone who sees you for 15 minutes maybe three times a year or twice a year. And if you're even younger, maybe not even yearly. If you feel something's wrong, you have to just push, push, push until you get the answers that you need.
Unfortunately, mine were, you've got Parkinson's. But Dr. Hinson and Dr. Ketron have tried to make lemonades with the lemon that we've been given, and they've kept my life going. I'm still able to work and enjoy my grandkids and enjoy life. I mean, it's a little slower pace than it used to be, but I'm okay with that. I'm still going.
Crista Ellis 00:42:44
How would you describe your experience in receiving care at the Ralph H. Johnson VA Medical Center with Dr. Ketron?
Joanne Martin 00:42:54
Really good. Years ago, I had dealt with the VA with my father 25, 30 years ago, and it was not a pleasurable experience. Over the years, it has improved drastically. Especially in the period of time that I've been there, they have such advanced technology, and collaboration, I think, with MUSC of Charleston, and women's care has really taken leaps and bounds.
You just have the best technology, I think, in the world, and you have some of the best doctors in the country, if not in the world. They're taking care of you. So I am 100% pleased with my care at the VA. I wouldn't trade it for anything in the world.
Crista Ellis 00:43:41
Joanne, I wanted to ask, I know in our previous conversation, you mentioned a very important person who encouraged you to apply for VA benefits. Would you speak to that?
Joanne Martin 00:43:53
I would. His name was Gusta Gaines. He was the Veteran Resource Officer in Williamsburg County. I initially had joined the National Guard and was deployed to Saudi Arabia during Desert Storm. When our unit came back in 1991, Gusta was really on top of things, and he encouraged every individual that was in that unit and other units, other veterans, not necessarily in the unit that I was in, to explore the VA benefits because we deserved them.
I mean, basically it was, we qualified, we deserved them, don't let it slip by because we live in such a rural area. He was the news for us. He was the reason we knew what to do. In the larger cities, you have more options, you have resources. In the rural communities, you don't. And Gusta was our way in to everyone being able to access the benefits that we deserved. I guess that's the best way I could put it.
A veteran resource officer, to this day — I mean, there are others that have come and gone. He's no longer there. But every county should have a veterans resource officer. Everyone should investigate what can be done if you are a veteran.
Mood and an attitude are your best friends with Parkinson's. Stay positive, even on the rough days. Stay positive. Make sure you have a good doctor who's got your back and weather the storm.
Crista Ellis 00:45:53
Thank you so much, Joanne, for sharing your story with all of us here today. And now I'd like to introduce our next panelist joining us, Dr. Christina Ketron. She is a doctorally prepared nurse practitioner specializing in mental health. She is a nurse practitioner at the Ralph H. Johnson VA Medical Center in Charleston, South Carolina, where she sees patients both with movement and memory disorders. She is a faculty scholar with the Edmond J. Safra Visiting Nurse Faculty Program through the Parkinson's Foundation. She holds a master's degree in nursing education and is an affiliate instructor at MUSC's College of Nursing in Charleston.
Christina, welcome to our webinar, and thank you for sharing your time and knowledge with us today.
Dr. Christina Ketron 00:46:35
Oh, thank you so much for having me. Do you hear me okay?
Crista Ellis 00:46:39
Yes, you sound great.
Dr. Christina Ketron 00:46:41
Perfect. I decided not to have a PowerPoint behind me today. I just wanted to talk with each of you, even though I can't see you. I wanted to talk to you as if I were sitting with you in my office. One of the things that I think is important that we talk about when it comes to veteran resources is, one, what resources are available to you. You've already had a couple of speakers talk to you about that, and you're going to have more throughout this program and in the next three sessions. But today, I specifically wanted to talk to you about what it looks like when you come into an appointment.
I hear often that patients, you know, they come in and you've been waiting for your appointment for six months, maybe even a year. Maybe it's been three months, but still, you have these things that you want to tell your provider, that these things have been going on. You're not sure about some of the symptoms. Joanne did a really nice job of describing her symptoms and what she was experiencing, and then what she does experience even now after diagnosis. So I want to just give you a little tidbit of some information and how you prepare for an appointment.
And this is whether or not you have come to the VA or whether you're in the civilian sector with a neurologist and you want to start in the VA, or whether you're already a patient. All of these things that I'm going to mention are going to apply to each appointment that you come to. There might be a slight difference in the initial appointment, and so I just want to speak briefly about the initial appointment with either a general neurologist or a movement disorder specialist.
Some of the things that we want to know is when did your symptoms start? Did it start in the right hand or the left hand? What did that look like? Did you experience anything else? Maybe you started falling and that was kind of your first symptom. Maybe it was the thumb and the tremor in your thumb that was the first thing. But we want to know when your symptoms started. Do you have a family history of Parkinson's disease? Does anyone else in your family have any other neurological disorders?
And as you have heard already, did you serve in the Vietnam era or were you exposed to any other toxins that we know have had presumptive conditions attached to them? We will talk about that information. Now, in your appointment, often I have people who come in and they want to go ahead and talk about the service connection attached to that diagnosis. And as providers, we don't have the opportunity to, or we don't even have, the resources available to us.
Dr. Christina Ketron 00:49:42
But you will hear from the veteran service officer today and how you navigate that. Of course, your social worker is also available and how you get service-connected, as you've heard already. If you're a returning patient, what are some things that we want to talk about? I would say, first of all, that what you want to do is come with a list, a list of questions. But the one thing that I want you to think about is: what is the one thing that we could do for you during that appointment? If we can do nothing else and we don't have time to do anything but that one thing, what is that? That's always a nice way to start out our appointment time, and it kind of helps us to focus that appointment on what is really concerning you the most.
Some other things that would be helpful for you to write down, and even keep a journal during the time between your appointments, are some things like: if you're on carbidopa-levodopa, how is that working for you? Does it last the full four hours or three hours, whatever your regimen is set up with your provider? Are there any times where you feel any off symptoms? Off symptoms are, you know, we describe that as feeling like the medication just didn't last the full time and then I started getting my tremor back. Those are things that can be helpful.
Are there other medications that you've had in the past that may present with Parkinson's-type symptoms? We want to know if you've had any of those before. Do you have any falls or balance issues? Are you feeling like your gait is not quite the same as what it used to be? Starting out with that, we talk about motor symptoms. Knowing what your tremor looks like and how it's been. Are you experiencing any kind of stiffness or any kind of trouble, as I said already, with gait or falls? Are you having trouble with constipation? We can discuss dietary issues.
Are there any issues with urination? Because that can be a symptom of Parkinson's disease, or it could be something else going on, and we want to help you with that as well. We can coordinate with our interdisciplinary team. Are you having trouble with speech or swallow issues? Do people ask you to speak up frequently? Do they say that your voice is softer than what it used to be? Are you having any episodes where you get choked on your food? Or are you having any drooling, which can be really embarrassing whenever you have to admit that? But these are things that we want to know because we have resources available to help you with these things.
Dr. Christina Ketron 00:52:24
Then we can break it down into what's called non-motor symptoms. Typically, whenever I write a note, this is often how I will separate it out between motor and non-motor. Non-motor is just as important as the motor symptoms that you experience. Non-motor can be things like your mood. Are you more irritable than what you used to be? Are you experiencing some agitation that's really not part of your personality at baseline?
Are you apathetic? You wish you want to do things, but you just don't want to get out and do the things that you used to do. Maybe you feel sad or hopeless or very anxious, and that's not something that you've ever been before. In the veteran population, we're working with patients that also may have post-traumatic stress disorder. Teasing out those symptoms with symptoms that may come along with Parkinson's disease in itself is something that we need to focus on. It's important to you, and if it's something that is the most important thing to you, we want you to bring it out early on in the appointment.
You want to talk about how you're sleeping. Are you having any kind of active movements, or are you having more vivid dreams or nightmares? Again, in the veteran population, we're trying to figure out: are these things associated with your post-traumatic stress, or is this something called a REM behavior disorder that is common in Parkinson's disease? Are you having any hallucinations? Often, whenever I ask these questions, sometimes I'll get a grin from people, or sometimes they'll look down at the floor and they don't want to make eye contact, or sometimes they'll say, yeah, I am. Often that's a hard thing to admit because it's a struggle to say that you're having hallucinations, but it's nothing to be ashamed of, and we also want to know because we have resources available to help you with that.
Telling us about those things will be really helpful. Are you having any trouble with memory? Often, we find that within Parkinson's, you can have difficulty with word finding, thought blocking where you know what you want to say, but it just doesn't come out very well. Also executive function things like, you know, I used to be able to multitask and now I can't do that very well anymore.
We want to know about those things because memory can be impacted by Parkinson's as well. Another thing I just want to throw in here really quickly that I think we should talk about a little bit more with our patients is: do you have advance directives? This is something that's helpful for us to know, and we can navigate those resources for you. Also, we want to know if you have caregiver strain. We've talked about the Caregiver Support Program, and that is such a strong resource within the veteran population.
We rely very heavily on our social workers, our palliative care providers, and our rehabilitative resource, which is often speech therapy, physical therapy, occupational therapy. In order to address those concerns and resources within the VA and within Parkinson's, I want to turn it to Shawn, who is a staff member with me and an excellent OT who is also LSVT trained with the BIG program, which is very beneficial for our patients.
Shawn Katalinas 00:55:51
Well, thank you.
I'm going to talk about ways that a veteran could access supportive care or rehab therapies through the VA. This has been said earlier, but basically a consult can be placed to occupational therapy, physical therapy, or speech therapy through primary care or neurology. Then that veteran would be evaluated at their nearest rehab clinic. Oftentimes, that could be at a main hospital or that could be at a community-based outpatient clinic.
Some cost-effective ways that a veteran could do home modifications to ensure more safety in their home — a couple things I just want to discuss. Throughout the house, we do want to talk about reducing fall risk. Sometimes that would include removing or securing throw rugs, getting rid of unnecessary obstacles or transitions in the house. Oftentimes, a person with Parkinson's may have difficulty transitioning from one room to another, especially if the flooring is different. We want to try to minimize that if we can.
If a veteran is home alone at times and possibly a fall risk, we would be able to issue a Life Alert if appropriate. That is just a device that would enable a veteran to access emergency services if they needed help and they were alone. In the bedroom, we could issue a bed rail to help get in and out of bed. At night, if necessary, use a urinal or a bedside commode to decrease fall risk at night if needing to get up to use the bathroom.
A couple other things in the bathroom: we would be able to issue grab bars, other durable medical equipment such as a raised toilet seat, shower chair, tub bench, long shower hose, long sponge.
Shawn Katalinas 00:58:18
Additional things that we could do through the VA is what's called a HISA grant. That's a Home Improvement and Structural Alteration grant. If approved, this could include a barrier-free shower modification, which would be taking a tub shower and converting that to a barrier-free shower. The patient would need to be assessed for this and also try durable medical equipment beforehand. But if they are approved, that's something that the VA could help assist with. Also, other modifications could include doorway modifications as well as vertical platform lifts.
Other adaptive equipment that an OT could issue to a veteran with Parkinson's could include different sorts of utensils. Sometimes these are weighted utensils or self-stabilizing utensils. These could help reduce the effect of a hand tremor, which is common in Parkinson's. Additional adaptive equipment for self-feeding would include suction cup bowls, other adaptive bowls or plates. Sometimes these have higher ridges on one side. In addition to that, we could issue plate guards, which is almost like a bumper for a plate that could help just make self-feeding a little more successful.
In addition to that, other ADLs a veteran with Parkinson's might have difficulty with would include self-dressing, and an OT would be well-equipped to evaluate a veteran and see what kind of dressing equipment they may benefit from. That could include a dressing stick, reacher, sock aid, shoehorn, long sponge.
Along with occupational therapy, we do work very closely with physical therapy. Physical therapy helps a patient keep moving for as long as possible, as well as possible. When should someone with Parkinson's see occupational therapy or speech therapy? We always say as soon as possible. The sooner a veteran could get in for therapy, the sooner we could identify: is this patient a fall risk? What kind of equipment might they need? Or what kind of therapy can we provide to help them be independent as long as possible?
A lot of times this could include issuing a walking aid such as a rolling walker, rollator, U-Step. A U-Step is a specific device designed for people with Parkinson's that actually helps a patient ambulate safer by kind of preventing a forward motion that is very typical with Parkinson's, and that could help prevent a fall from that forward momentum.
In addition to that, we offer physical therapy here in our main hospital as well as community-based clinics. If a veteran is not near to those, we could offer physical or occupational therapy throughout the community as well.
Shawn Katalinas 01:01:42
To touch on specific therapies available for people with Parkinson's, a popular therapy is LSVT BIG. This is the amplitude-based movement therapy. This is designed to help people improve the quality and size of their movements. This is often structured four times a week for four weeks, and it is run by a PT or an OT. We offer this at our main hospital here in Charleston, but also throughout the community if a veteran would qualify.
Oftentimes, a high percentage of people with Parkinson's experience speech and voice disorders. For this, a referral to speech therapy is often made. A speech therapist could evaluate for speech and voice disorders and instruct a patient in exercises for strengthening their voice quality. A speech-language pathologist can also assess swallowing ability and make recommendations for diets and also recommendations for safer eating to reduce aspiration risk.
A speech therapist could also provide LSVT LOUD, which is similar to LSVT BIG, but rather focuses on the quality and amplitude of a patient's voice. This is also offered here in Charleston and throughout the community through Community Care.
I'm happy to answer any questions related to our rehab services here.
Crista Ellis 01:03:19
Sweet. Thanks, Shawn, and welcome back, Dr. Ketron. We have tons of questions and we're already behind on our timeline, but I'm going to try. I'm just going to fire them off at you guys, so if you would indulge me. Tons of questions from our community today.
Dr. Ketron, what would you suggest to someone who lives alone in a rural area without any support or Parkinson's resources? Do I need to move?
Dr. Christina Ketron 01:03:46
Right. No, you don't need to move. But I do think it will be helpful for you to, when you come to your appointment, tell your provider. Because in that situation, we can reach out to the social worker, who then knows so many different resources in the area where you may live. It may be that we have to go outside of the VA and into the community to see if there are other organizations that can check on you if we don't have something that's available close by. But no, you don't have to move.
Crista Ellis 01:04:18
Thank you. Shawn, you mentioned a few adaptive equipment. Does the VA offer any financial support for these items?
Shawn Katalinas 01:04:28
Yeah, for sure. If a veteran was evaluated by OT, PT, or speech, and there was DME or adaptive equipment identified that would be appropriate or helpful for that veteran, we would get those items for them.
Crista Ellis 01:04:45
Great, thank you. Dr. Ketron, what strategies do you recommend for veterans to effectively navigate the VA healthcare system?
Dr. Christina Ketron 01:04:55
I do think that it kind of goes back to my brief talk about preparing for your appointment. If that is the one thing that is most important to you, to help to navigate the resources, then we want to know about that. Because whenever you feel like you can navigate all the different things that we've talked about even today, which is a long list of what Gretchen provided, we have resources that we can kind of farm out and bring all of it together. It's not something that you have to stress or worry about, although I do understand that it can be very overwhelming. But it's something that you want to talk to your provider about.
Our social workers in the VA system are amazing, and they do a really great job. So you're not alone in feeling overwhelmed.
Crista Ellis 01:05:44
We've been getting a lot of questions about advocacy. Would you highlight the social worker as kind of the charge individual in the VA system to be the advocate for veterans?
Dr. Christina Ketron 01:05:56
Yeah, I'm happy to do that. I think first I want to go back to what Ms. Joanne Martin said, that the patient has to be the advocate for themselves to begin with. I think sometimes the role of that sometimes goes to the caregiver. They're the ones that come in and say, you know, this is what's going on. So we rely on our patients and their family members and friends to tell us what's going on. The social workers just have resources that we often don't have time to talk about within our 30-minute or 60-minute appointment. They are someone where we can put in a consult for them if it's more than just a random question.
We can put a consult in and we can lay out what it is that the patient has questions about. Then that individual, a social worker that's attached usually to the primary care, will contact that veteran or spouse, family member, and help them to navigate the resources.
Crista Ellis 01:06:56
Thanks for highlighting that, Dr. Ketron.
Shawn, a question that has been a pattern that's been asked by several of our audience: when is it recommended for individuals with Parkinson's disease to see an occupational or physical or speech therapist? Part one. And part two, how can they access BIG therapy and Rock Steady Boxing through the VA?
Shawn Katalinas 01:07:21
Great question. I would say again, as soon as possible. As soon as you have a diagnosis, or even honestly, if you don't have a diagnosis and you're having difficulties with any of your self-care or mobility, ambulation would be a great time to seek out a referral to occupational therapy or physical therapy. But if you are newly diagnosed with Parkinson's, I would say mention to your primary care or neurology that you would like to be seen by rehab services because there's almost always something we could offer.
Crista Ellis 01:07:54
Yeah, sort of setting a baseline. This is when we just got diagnosed with Parkinson's. This is where I am at today, and we can watch that progression through the years.
Dr. Christina Ketron 01:08:06
I will say, too, Shawn, I'm going to give you a little props here. Shawn has actually probably caught a couple of different people with Parkinson's disease that he was working with individually and messaged me and said, hey, I think this person might have Parkinson's. Can we get them in?
Shawn Katalinas 01:08:24
We work very closely together, so it's nice that we have that kind of relationship. As far as you asked about LSVT and Rock Steady, definitely, we have those services here, and we're also working to expand those services, especially for LSVT BIG. If we don't have the services by that veteran's home, we could refer them to community care and have them get LSVT BIG in the community. For Rock Steady, we're working on expanding offerings through the VA, and then we could refer them to the community as well.
They're two great programs.
Crista Ellis 01:09:05
Yeah, they really are. Accessible through the VA, so that's wonderful, Shawn. Thank you for highlighting that. Ending this session on a note of what we can do. What can we do for our Parkinson's disease or our loved one affected by it, even for ourselves? Can you please share what would be an ideal kind of exercise routine for a person with Parkinson's?
Shawn Katalinas 01:09:30
Definitely. Exercise is the one thing that we could really promote as helping everyone that does have Parkinson's. It could help slow down progression. So we encourage, even if it's just as simple as going out for a walk in the neighborhood safely, and if you're using a rollator, I'd recommend taking that, but just getting up, moving around.
Again, I'll go back to LSVT BIG. We will show you a series of exercises. They're simple, you don't need any equipment, and those are things that we would recommend you to continue to do lifelong. Just getting up, moving around. If there's something you're interested in that you're participating in outside, I would recommend getting up and getting out as often as you can because laying down in bed, on the couch all day, that's not helping us out. We got to get up and moving around as best as we can.
Crista Ellis 01:10:27
Thanks, Shawn. Dr. Ketron, any final words or gems or pearls that you'd like to offer our community before we move on?
Dr. Christina Ketron 01:10:35
Yeah, I think it's true about the exercise. I was just having this conversation yesterday with a veteran who exercises five to six times a week. But what we spent the majority of our time doing is talking about how to time his medication based upon when he's going to go work out, so he can get the most effective workout that he can with the highest level of medication in his system, but also not get hurt in the process. Definitely would encourage that, and if we all could have a prescription pad for that, I think we would give it out every day.
Crista Ellis 01:11:14
Thank you so much, Dr. Ketron and Shawn. Appreciate you both.
Dr. Christina Ketron 01:11:19
Thank you.
Shawn Katalinas 01:11:19
Thank you.
Crista Ellis 01:11:21
The Parkinson's Foundation not only offers information and resources about these therapies and the benefits to people with PD, but we also provide professional education and training programs for allied healthcare professionals through our online courses, Physical Therapy Faculty Program, team trainings, and more, which Dr. Ketron and Shawn have both been engaged in. Our goals are to educate the people living with PD and to ensure healthcare professionals across the country are up to date on the latest Parkinson's information and best practices when it comes to treatment and care.
In closing, I just want to make sure that I give a shout-out to each panelist who was present today: Gretchen Glenn, Ms. Joanne Martin, Dr. Christina Ketron, Mr. Shawn Katalinas, and Mr. Welma Jackson. Thanks to all of you who joined us today. A follow-up email will be sent with a survey. Please tell us what you thought about today's program. You'll also receive a link to today's presentation and additional resources.
Join us for part two of our veterans webinar series, Veterans and Parkinson's: Managing Anxiety, Depression, and Apathy, on August 31. For veterans living with Parkinson's disease, non-motor challenges are not always easy to discuss. With a focus on mood changes including anxiety, depression, and apathy, this program will provide strategies for coping and talking about it with healthcare providers or your loved ones. For more information and to register, find the program on our webpage at Parkinson.org/veterans.
If you had a question today that was not answered, please reach out to our Helpline by calling 1-800-4PD-INFO or emailing Helpline@Parkinson.org. You can use that same contact info to order our free resources, educational book series, and our Hospital Safety Kit. We thank you for joining us today and hope to see you again soon. Bye-bye for now.
