Hi Mom and Dad,

I feel like I've covered these things many times in email and iMessage/text but they seem to keep getting lost, so I'm putting together this page for you, so you always have an easy reference. So here goes...

Table of Contents

Reminders for repeated questions

Safety, Scams, and Security

1. Treat online interactions the same way you would real-world interactions. For example, if a stranger approached you on the street claiming your bank account had been hacked and asked for your PIN, how would you respond?

2. We can’t help you unless you know your goals or success criteria. If you ask whether you should take a trip, buy something, or handle a situation a certain way, we need to know what you are trying to achieve. For example, if your goal is to take an intercontinental trip and arrive in reasonably good shape and well rested, you will probably need to pay for business-class seats. If your priority is simply to buy the cheapest fare, then given your age and health, you should plan on needing at least a day or two to recover from long flights.

3. We will judge your situation, but we will not be judgmental. You have the right to live your life as you choose. We may not always agree with your decisions, but we respect your right to make them. The only real issue arises when you are not fully honest with yourself or with us, because that creates cognitive dissonance. It becomes difficult to reconcile what you say you want with the outcomes of your actions. Please be open and transparent about your wishes and goals. We will either help you pursue them, even if we disagree, or we will respectfully decline to participate and sincerely wish you the best.

Health

Mom

2026.01.31 Update

You now want to more actively engage in better managing your Parkinson's. To the best of my current knowledge these are the things you should pursue immeidately.

1. You need to learn more about your disease, its prognosis, and its management.

2. You need to see if there is a Parkinson's specialist within your health care group. If so you should transfer care to that specialist. With that specialist you should start discussing what treatments, both chemical/medication and psychological/physical, you can do to slow deterioration.

3. You need to see if you can get your health company to cover occupational therapy to keep yourself stronger longer.

4. I will setup therapy for you (and dad) to deal with the emotional issues related to your disease, your marriage, and your personal challenges.

5. It's likely you and Dad should join a Parkinson's support group.

Previous

• You have Parkinson's disease. You are not medicating presently. You are trying to "stay active" by taking walks.

• You have hearing/processing issues. You've chosen to not address this issue. This has and will affect your cognitive decline.

• Your doctor suggested that you check back in with him in "about a year". 

Our Advice for Mom

Parkinson’s disease is a chronic, degenerative condition. Functionality that is lost cannot be regained. We would strongly advise you to be aggressive in procuring targeted, disease-specific coaching and physical therapy. For example, you’ve mentioned taking walks, but did you know there are optimal ways to walk that can counter the decline in musculoskeletal capabilities? Additionally, there are specific mental exercises that can help slow the decline of memory and cognitive functions.

We understand that you are hesitant to spend money on anything outside what your “normal” insurance covers, but we would argue that the opportunity to use the wealth you’ve created through diligent frugality is best invested in your health now.

It is painful for me to say this, but the median survival rate for an 80-year-old woman diagnosed with Parkinson’s disease is 5–10 years. Being as optimistic as possible, that places you at maintaining a more fully independent life for the next 1–3 years, needing assistance in years 4–6, and likely requiring a specialized memory-care or 24/7 dementia care facility in years 7–10 (assuming in-home care is not affordable or cost-effective under your current long-term care insurance). Please see the current costs for different types of housing; we would expect these costs to rise rapidly over the next five years.

Because of these timelines, and as we also relate to Dad below, we think it is very important that you start prioritizing the things you want to do, the places you want to see, and the people you want to visit.

Dad

• You have heart disease / cardiac issues. Specifically Second-degree AV block Type II (Mobitz II). You've had a pacemaker put in.

• You have high blood pressure which was untreated for many years. You are now taking Losartan an angiotensin II Receptor Blocker.

• You are considering making lifestyle changes.

Our Advice for Dad

You are in control of how you want to live your life. From our perspective, many of the symptoms that began after your cardiac event in Austin have gone unaddressed for the past 3 years and 8 months. We’re not bringing this up to criticize you, but to provide context for how we’re thinking about things.

If ignoring or minimizing symptoms over the last 3 years and 8 months allowed you to enjoy food, life, etc., and you want to continue to do so, we want to support your choice. The likely trade-off is a shorter lifespan and a reduced quality of life as your health changes. If you feel that continuing to enjoy the present is more meaningful to you than pursuing more aggressive lifestyle or medical changes that would likely lead to a longer lifespan and a higher quality of life, we will support you as best we can.

If that’s the path you choose, we would encourage you to prioritize the trips, destinations, and visits that are on your "bucket list" this coming year.