Davis Phinney Foundation, Must Read, Palliative Care, Parkinson's exercise

“Counter Punch” Chapter 10

 

Chapter 10:

Exercise Is Medicine

 

My research convinced me exercise was essential to spar effectively with PD. But what kind and where to find it?

 

My first neurologist referred me to Big and Loud training at Florida Hospital -Tampa. That’s physical therapy for stretching tense muscles and voice modulation. I benefited but needed Capital Eexercise.

 

I asked the Big and Loud PTs about that. They pointed me to Tai Chi exercise training.

 

I found Tai Chi a bit mannered and slow. Nice companions, but I was still searching for The Capital E.

 

Next tip was that two Tampa YMCAs were starting high-speed, spinning classes for Parkies. I began one-hour sessions twice a week on the spinning bikes. Felt good. Still do it.

 

But I needed still more.

 

The more came in a newspaper article. Something called Rock Steady Boxing (RSB) was opening in a West Tampa Bay gym 45 miles from my home. Intriguing name. Worth checking out for my blog.

 

To see first what RSB was like, I went to thewebsite
https://www.rocksteadyboxing.org/videos/ and opened the YouTube video “We are Rock Steady Boxing.”

 

Intriguing. I needed to see it for myself.

 

Gym owner Tara Schwartz pitched program benefits this way: “The studies have shown that forced intense exercise has slowed the progression of Parkinson’s. Parkinson’s slows the conduction of the nerve to the muscles, so everything slows down. Boxing does the absolute opposite of that. And it’s a non-contact form of boxing.”

 

Good elevator speech, Tara. I watched one day. Signed up and worked out the next.

 

Ninety intense minutes to pulsating music and demanding, disciplined but supportive instructors: “Elbows up…jab, jab, hook…chest out, stomach in…just 10 more seconds.”

 

Tara’s class typically has 12 to 15 participants who work out ideally at least three days a week.

 

Said Tara: “While focusing on overall fitness, strength training, reaction time and balance, workouts include ring work, focus mitts, heavy bags, speed bags, double ended bags, jump rope, core work, calisthenics and circuit weight training. No boxing experience is necessary, and people of all ages are invited to participate.”

 

Sessions run 90 minutes and typically have 30 minutes of stretching exercises, 30 minutes of weight training and 30 minutes of working on the punching bags.

 

Until the Lightning Strike (Chapter 4) put me down, I made the 90-mile round trip to the Largo gym three times a week.

 

Rock Steady was a tonic. It returned my energy, concentration, focus and stamina to pre-PD levels.

 

I also glimpsed the power that comes with the camaraderie of working a common task with close friends. I will write more about that in Chapter 9.

 

A growing body of research affirms how exercise improves PD symptoms, bends the disease direction in the right way and helps the brain build new neural pathways to replace functions destroyed by PD.

 

NPF gets it right about exercise with this summary of the literature as of 2017 (14):

There is a growing consensus amongst researchers about the short- and long-term benefits of exercise for people with PD.

 

Exercise can benefit in two ways:

 

Symptom management.  Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination.  Exercise such as treadmill training and biking have all been shown to benefit, as has tai chi and yoga (although more studies are needed).

 

Possibly slowing disease progression.  There is a strong consensus among physicians and physical therapists that improved mobility decreases the risk of falls and some other complications of Parkinson’s.

 

They agree that practicing movement – physical therapy, occupational therapy, and participating in an exercise program – improves mobility. By avoiding complications, you can avoid some of the things that can make PD worse.

 

Beyond this, we know that people who exercise vigorously, for example by doing things like running or riding a bicycle, have fewer changes in their brains caused by aging. Studies in animals suggest that Parkinson’s disease is also improved by exercise. Many neurologists in the NPF Center of Excellence network recommend intense exercise to their patients and also to people who are worried about getting PD because of a family connection. One Parkinson’s Outcomes Projectstudy has proven that people with PD who vigorously exercise for 2.5 hours per week show a slowed decline in quality of life, and the sooner they begin vigorous workouts after diagnosis, the better.

 

The best way to achieve these benefits is to exercise on a consistent basis. People with Parkinson’s enrolled in exercise programs with durations longer than six months, regardless of exercise intensity, have shown significant gains in functional balance and mobility as compared to programs of only two-week or ten-week durations.

 

However, when it comes to exercise and PD, greater intensity equals greater benefits. Experts recommend that people with Parkinson’s, particularly young onset or those in the early stages, exercise with intensity for as long as possible as often as possible.  Your doctor might recommend an hour a day three or four times a week, but most researchers think that the more you do, the more you benefit.

 

Intense exercise is exercise that raises your heart rate and makes you breathe heavily.  Studies have focused on running and bicycle riding, but experts feel that other intense exercise should provide the same benefit.

for you.

 

What happens in the brain to produce these visible benefits? Researchers at the University of Southern California (Fisher et al.) looked at the brains of the mice that had exercised under conditions parallel to a human treadmill study. They found that:

  • Exercising changed neither the amount of dopamine nor the amount of neurons in the animals’ brains.
  • But in the ones that had exercised, the brain cells were using dopamine more efficiently.
  • They also found that exercise improves that efficiency by modifying the areas of the brain where dopamine signals are received – the substantia nigra and basal ganglia.

n

 

Lesson Learned:

Living the “vertical” life means exercise, and plenty of it. Try the many options to find the right fit, then stick with

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Davis Phinney Foundation, Must Read, Parkinson's Disease, Parkinson's Patient Care

“Counter Punch” Epilogue

 

Epilogue

 

I sat with 800 other Parkies and care partners at a Davis Phinney Foundation pep rally on a balmy Florida morning in 2017.

 

I heard a word that electrified me: persevere. “Persevere against the eroding power of PD,” the speaker said.

 

Tim Hague Sr. also challenged me to consider the powerful role “communities” play in a person’s life. He is a PD advocate/educator/motivator living in Winnipeg, Alberta.

 

Hague is best known for winning the first Great Amazing Race Canada with son Tim Jr. Their reward was $250,000 cash, plus automobiles and free air travel. The perseverance required to win the race had everything to do with Tim’s PD-related memory and organizing challenges.

 

To hear Tim tell his story, go to http://www.timsr.ca/watch-tim-speak/.

 

Tim referred to the communities in his life: family, his hometown Winnipeg, fellow Parkies, his health care team.

 

I counted the communities in my life: Immediate and extended family; PD SELFers; Rock Steady Boxing compatriots; Methodist church, The Portico; Rotary International; PD support group members; Florida newspaper editors; Golf group I once belonged to; Duke friends; Milwaukee Country Day School classmates. The list goes on.

 

Each community commands my attention, requires nourishment and provides me support in large and small ways. I count on them to fuel my perseverance against Parkinson’s.

 

My life as a newspaper editor was about building strong, resourceful, resilient newsrooms committed to serving their geographic communities with accurate, timely and compelling stories.

 

My commitment to the Parkie community is service through reporting and advocacy onwww. shufflingeditor.com. “Service Above Self,” the Rotary motto, speaks to my deep investment in bringing PD SELF to the Tampa Bay region.

 

My friend Rich Harwood, president of the civic engagement Harwood Institute, wrote about my community commitments when I retired from the Tampa Tribune in 2006:

 

A good man, Gil Thelen, the publisher of The Tampa Tribune, retired last week, and it’s worth pausing today to think about his work and our own work. In my travels, I have known few people like Thelen who have been able to so authentically combine a sense of integrity, grittiness, innovation, and commitment to his profession and public life….

In a statement he sent around to colleagues and friends last week, Thelen used the word “joy” to describe his work. He said, “There must be joy in making the paper if customers are going to find joy in reading it.” He then called his colleagues “joy makers.”

 

Thelen is 67 years old. I don’t know very many people – of any age – who think of their work as making joy. Indeed, think about the words we usually ascribe to the topsy-turvy world of the news media; two that come immediately to mind are “sensationalism” and “hype.”

 

I work in two geographic and Parkie communities. One is the Northern Tampa Bay region (Hillsborough, Pinellas and Pasco counties) where Struby and I lived happily for almost 20 years.

 

The second is Macon, GA, where Struby and I moved in November 2017. Our new home is the splendid continuing care community, Carlyle Place.

 

We moved to be closer to family.

 

Struby is from Macon. Her brother Neil Struby and sister-in-law Hazel Struby live there, as does Niece Hazel Caldwell in nearby Forsyth, GA.

 

My brother Neil Thelen and family live two hours away in Atlanta.

 

Struby has potential help should my Parkinson’s progression go badly, such as severe dementia. I preach preparedness. I need to live it.

 

My Tampa Parkinson’s community revolves around eight Parkies and their care partners in an unusual support group, the Parkinson’s Disease Action Group (PDAG). I describe it this way in the Mission Statement:

 

“No accountability organization or system exists for strongly aspirational and persevering Parkies. We have created one, the Parkinson’s Disease Action Group (PDAG). The group comprises eight Parkies and their care partners.

 

“Our goal is to help one another out-wit, out-flank and counter-punch this unwelcome tenant in our brains.

 

“We will share and learn from one another’s action steps, such as second-and-more opinions, off-label medications, busting through bureaucratic barriers, and workarounds for diminished skills and loss of control.

 

“We will persevere. Promise made. Promise to be delivered.”

 

PDAG’s action program is development of a groundbreaking program Me-Over-PD (MOPD) to reach newly diagnosed people with Parkinson’s. Those newly diagnosed individuals will receive — for the first time anywhere — real-time, verified, actionable, local information to assist them in navigating this mysterious malady.

 

The consortium comprises Tampa graduates of the PD Self Actualization Program of the Parkinson’s Foundation and faculty of the University of South Florida’s Zimmerman School of Advertising & Mass Communications.

 

The unique purpose of MOPD to deliver locally actionable information and resources to newly diagnosed Parkinson’s patients and their care partners. Both are often overwhelmed with complex information about treatment alternatives.

 

The heart of MOPD is a live database of crucial resourcesthat include neurologists specializing in mobility diseases, physical therapists, speech therapists, occupational therapists, dietitians, and personal trainers.

 

No such database exists anywhere for the newly diagnosed Parkinson’s person and his/her general practitioner or treating neurologist.  Existing “help lines” have limited highly local information and lack resources for constant verification and updating.

 

The database will be used to prepare a brochure (“Road Map”) distributed through hospitals, neurology clinics, drug stores, YMCAs, agencies for the aging and doctors’ offices, to name but a few.

 

The target audience, for starters, is Parkinson’s sufferers in the northern Tampa Bay region.  Based upon lessons learned from the Tampa Bay rollout, MOPD intends to extend its reach by partnering with local and regional community support agencies.

 

We believethat newly diagnosed Parkinson’s sufferers can substantially increase the suitability of their treatments along with the quality of their lives if they are fully informed of what resources are needed, where these resources are available and how to access them.

 

MOPD is a Florida non-profit corporation. It received 501 C. 3 approval in April, 2018. MOPD has received a start-up contribution of $5,000 from a Detroit donor.

 

MOPD plans to be operational by the end of 2018. Janelle Applequist, assistant professor at the Zimmerman School is leading operations. I am president.

 

In Macon, Struby and I host meetings in which Parkies and care partners discuss the nuances of PD and design action steps to improve care for all patients in Middle Georgia. Those have included a lite version of MOPD resources and pursuit of additional exercise programs.

I am working with Mercer University’s medical school to improve Parkinson’s awareness among future physicians.

 

 

As of mid-2018, Georgia lacks a care system for patients to enter for guidance and assistance in making necessary lifestyle improvements. Those include diet, exercise, social engagement and mental discipline.

We are working to pool the university and health-care-organization assets we have in Middle Georgia and create our own ”system” of care.

Doing both would move us to the front rank of states doing well by citizens who are fighting back against their enigmatic malady.

 

Davis Phinney Foundation, Must Read, National Parkinson's Foundation, Palliative Care, Parkinson's Disease, Parkinson's Patient Care, Uncategorized

Heads Up Middle Georgia! Your patient-care problems are revealed.

Listen Up Middle Georgia!

We have important work to do assisting people “Live Well With Their Parkinson’s.”

Thirteen Parkinson’s people — patients and care partners— recounted their journeys to students at the Mercer School of Medicine Tuesday, March 6.

Bottom line: The Thirteen got scarce information at diagnosis about the disease or their future with it. Plus, there was no PD care system for them to enter.

They were left alone, very alone, with their incurable but treatable malady

Parkinson’s is the second most prevalent neurological disease after Alzheimer’s. Incidence is forecast to double in the next 20 years.

Georgia natives and residents are particularly at risk.

Agent Orange is a known causal agent. Georgia has large numbers of veterans who served in Vietnam and were exposed to Agent Orange.

Certain agricultural chemicals are also linked to PD. We are a rural, agricultural state.

A key answer and action step is to strengthen the teamwork between family doctors who diagnose PD and expert neurologists who prescribe a treatment plan.

Equally challenging is the lack of a care system for patients to enter for guidance and assistance in making necessary lifestyle improvements. Those include diet, exercise, social engagement and mental discipline.

We can pool the university and health-care-organization assets we have in Middle Georgia and create our own ”system” of care.

Doing both would move us to the front rank of states doing well by citizens who are fighting back against their enigmatic malady.

An important marker of a state’s vigor in PD treatment is the availability of an acclaimed exercise program named Rock Steady Boxing (RSB).

Florida has 32 RSB franchises; North Carolina 19; Tennessee 9; South Carolina 7; Alabama 6.

Until recently, Georgia had but one, in northwest Atlanta. Savannah and August are recent additions.

That’s unacceptable.

Georgia could vault to the front rank by strengthening the ties between family physicians and expert neurologists and by creating an effective, after-diagnosis care “system.”

Let’s start doing both.

Today.

 

 

 

 

 

 

 

 

 

Davis Phinney Foundation, Must Read, National Parkinson's Foundation, Parkinson Disease Foundation, Parkinson's Disease, Uncategorized

Rock Steady Fighting to Survive in Tampa

Rock Steady Boxing (RSB) is thriving nationwide. Except in Tampa.

This proven, highly effective exercise program for People With Parkinson’s (Parkies, in my vernacular) is short of enrollees in Tampa. The monthly average is 10. The same class in nearby St. Petersburg (Pinellas County, to be exact) averages 34 boxers.

Program director Jordan Brannon can’t explain the difference. “Same metro area. Same people. I am puzzled.”

She told Tampa boxers their program will end December 31 unless 20 steadfast participants are aboard. That’s her breakeven financial number. She is redoubling her recruitment efforts in Tampa.

I am in the Tampa program. See below for the letter I wrote Oct. 18 to University of South Florida Health (Neurology). USF Neurology responded Oct. 24 (below).

The Rock Steady difficulties are the second setback for PD patient-care initiatives in Tampa Bay.

USF Health (Neurology) was chosen as one of nine national 2016-17 test sites for the PD SELF information-and-action training program for Parkies. Seven of the nine sites were renewed for 2017-18. Tampa was not. (I was a “co-facilitator” of the Tampa program for part of its run.)

Diane Cook, PD SELF program director, has written that results of the 2016-17 rollout “were very positive and showed significant improvement in self-efficacy leading to improved anxiety, depression, stress and perceived support.”

University of South Florida Parkinson’s Disease and Movement Disorders Center is a Parkinson’s Foundation National Center of Excellence.

My letter to Dr. Clifton Gooch, Neurology Director at USF Health follows:

Dear Dr. Gooch,

I write representing the urgent concerns of the 10 regular adherents of Rock Steady Boxing/Tampa.

We need the help of your physicians and staff to ensure the future of the Tampa RSB program. Program Director Jordan Brannon (a USF grad) told us Monday that the program is financially not viable. Unless there are 20 active participants by year’s end, the program will close.

Brannon said she will redouble her recruitment efforts.

Evidence is overwhelming and unassailable of RSB’s restorative power for PWP. RSB is expanding rapidly nationwide and worldwide. We will be an outlier should we lose the Tampa program.

USF Neurology, through the Parkinson’s Foundation (Miami office), has financially supported Brannon in creating and expanding her Largo and Tampa RSB programs.

We request USF neurologists redouble their efforts to bring RSB to patients’ attention. A physician’s push is vital in motivating PWP to commit to a rigorous and regular exercise program.

The Byrd Center is justly proud of its sponsorship of the growing Jewish Community Center programing for PWP.

We in RSB/Tampa request equal footing.

Urgently.

Sincerely,

Gil Thelen (on behalf of RSB/Tampa adherents)

Dr. Gooch replied Oct. 24 as follows:

Mr. Thelen:

The USF Parkinson’s center has always been a strong supporter of Rock Steady Boxing, so I am confused by your email. I am copying Dr. Hauser for his reply.
Clifton Gooch MD
Dr. Gooch’s response, in its entirety:
“Mr. Thelen:

“The USF Parkinson’s center has always been a strong supporter of Rock Steady Boxing, so I am confused by your email. I am copying Dr. Hauser for his reply.
“Clifton Gooch MD”

 

 

 

 

 

 

 

Must Read, Parkinson's Disease, Parkinson's exercise, Research

PD Dyskinesias and Role of Inflammation in PD

Two interesting pieces just came across my electronic desk. One involves dyskinesia treatment. The other concerns growing evidence of the role of inflammation in PD.

They are worth attention.

https://www.acsh.org/news/2017/08/28/advance-treatment-parkinsons-disease-11749

https://psychcentral.com/news/2017/08/28/curbing-inflammation-may-reduce-risk-of-alzheimers-parkinsons/125250.html

Davis Phinney Foundation, Must Read, National Parkinson's Foundation, Parkinson Disease Foundation, Parkinson's Disease, Parkinson's Foundation, PDF, Research

The PD-Autoimmune Connection

Shuffling Editor note: I am intrigued by growing evidence that PD is an autoimmune disorder. This review article makes the point clearly. It appeared in Parkinson’s News Today by Magdalena Kegel.

“Parkinson’s disease may in part be driven by autoimmune processes, according to researchers who discovered that certain immune cells react to alpha-synuclein — a protein that accumulates in the brains of Parkinson’s patients.

“The findings, published in the journal Nature, raise the possibility that immunotherapy could be used to slow down disease processes in people with Parkinson’s. An immune reaction to alpha-synuclein could potentially also be used to identify people at risk of developing the disease.

“‘The idea that a malfunctioning immune system contributes to Parkinson’s dates back almost 100 years,” David Sulzer, PhD, a professor of neurobiology at Columbia University Medical Center and one of the study’s lead authors, said in a press release.

“’But until now, no one has been able to connect the dots. Our findings show that two fragments of alpha-synuclein, a protein that accumulates in the brain cells of people with Parkinson’s, can activate the T-cells involved in autoimmune attacks,” he said.

“The study, “T cells from patients with Parkinson’s disease recognize α-synuclein peptides,” suggested that immune T-cells react to neurons in which large amounts of abnormal alpha-synuclein has piled up.

“Together with colleagues at the La Jolla Institute for Allergy and Immunology, the research team took blood samples from 67 patients with Parkinson’s disease and 36 healthy controls of the same age and mixed them with fragments of alpha-synuclein and other neuronal proteins.

“The idea was to observe how immune cells present in the blood would react to the protein parts. While immune cells from healthy people did not react much to the presence of the nerve cell components, T-cells in patients’ blood reacted strongly to alpha-synuclein. This indicated that they had been primed to recognize the protein.

“The response could explain why genetic studies of Parkinson’s disease have repeatedly flagged a genetic region, which is responsible for the immune system’s ability to tell the body’s own structures from foreign ones found on microbes and tumors.

“Sulzer’s lab had shown three years ago that dopamine neurons have proteins on their surfaces that act as flags that aid the immune system in recognizing foreign structures. They suggested in 2014 that T-cells had the potential to attack these neurons in an autoimmune process.

“The new study provided evidence of how this might happen. According to Sulzer, the T-cells might start reacting to neurons when they start accumulating abnormal alpha-synuclein, mistakenly thinking they are a foreign structure.

“In most cases of Parkinson’s, dopamine neurons become filled with structures called Lewy bodies, which are primarily composed of a misfolded form of alpha-synuclein,” Sulzer said.

“Young, healthy cells break down and recycle old or damaged proteins,” he said. “But that recycling process declines with age and with certain diseases, including Parkinson’s. If abnormal alpha-synuclein begins to accumulate, and the immune system hasn’t seen it before, the protein could be mistaken as a pathogen that needs to be attacked.”

“But so far, researchers do not know if the immune response is what triggers Parkinson’s in the first place, or if it drives disease progression once the disease has been triggered by other factors.

“”These findings, however, could provide a much-needed diagnostic test for Parkinson’s disease, and could help us to identify individuals at risk or in the early stages of the disease,” said study co-leader Alessandro Sette, a professor in the Center for Infectious Disease at La Jolla.'”

 

 

Davis Phinney Foundation, Must Read, National Parkinson's Foundation, Palliative Care, Parkinson Disease Foundation

Filling PD’s Information Hole

It’s time to target the information/care abyss awaiting most Parkies at diagnosis.

A group primarily of Tampa PD SELF graduates is teaming with a University of South Florida advertising class to find and recommend ways to fill that huge hole.

The project is an extraordinary opportunity to address the disconnect between PD diagnosis and orderly provision of validated information and appropriate care.

Coby O’Brian, a senior instructor in the USF School of Mass Communications, is dedicating an upcoming class to understanding the disconnect, then creating information campaigns to end it.

In short, the campaign’s intent is to identify and reach new Parkies, place solid PD information in diagnosing  physicians’ offices and provide PD-savvy mentors for the new Parkies.

The 33 students are divided into three-person teams. Each team will examine in depth the role and responsibilities of PD care providers, such as speech therapists or internists. The teams’ findings will be rolled into a recommended marketing campaign.

Each team will be assigned an experienced PD mentor. The mentor will meet with the team at least once in person. After that, the communications can be virtual.

The mentors will assist students understand how Parkies interact with medical care providers and vice versa. They will also help the teams develop their action plans.

A word about Coby, a one-time ad operative. He is smart, aggressive, sometimes brash, often loud……and relentless. Coby’s father has PD. Coby “gets” PD. I “get” him.

 

 

Must Read, Uncategorized

Humanizing Jesus

manger
Fellow Parkies and other Shuffling Editor readers:

I found this  gem of an essay particularly moving on Christmas Day. It underlines the deepening spirituality  that the PD journey often brings. It certainly has done that for me.  I hope you enjoy it as much as I did.

A very Merry Christmas,

Gil Thelen, The Shuffling Editor 

http://www.nytimes.com/2016/12/23/opinion/humanizing-jesus.html?emc=edit_th_20161224&nl=todaysheadlines&nlid=52114048&_r=0

By Peter Wehner

Early in my Christian pilgrimage, as a young man struggling to understand the implications of a story I had only a surface knowledge of, I stumbled onto a theological insight. For followers of Jesus, salvation was based not on his life so much as his death. Jesus could have been incarnated as a man and been crucified within days. That’s all that was needed for his death to serve as an atonement, but that’s not what happened. God clearly wanted to instruct us about how we should live in this life, too. He became not just the author of the human drama but an actor in it.

According to the Christian Scriptures, Jesus had a life story — born in a manger in Bethlehem, later moving to Nazareth, and dying in his 30s, just outside Jerusalem. The fact that we’re so familiar with the story has inured us to just how jarring and unexpected it was. God came to earth “not in a raging whirlwind nor in a devouring fire,” in the words of Philip Yancey, author of “The Jesus I Never Knew,” but in humility, without power or wealth, in a world marked by strife and terror.

Jesus spent his infancy in Egypt as a refugee, Mr. Yancey points out, and the circumstances of his birth raised the specter of scandal. His life, then, was a profoundly human one, involving work and rest, friendships and betrayals, delight and sorrow. This has deep implications for how Christians should understand and approach life.

For one thing, the Incarnation dignifies the everyday. There has been a temptation throughout Christian history to denigrate the things of this world, from material comforts to the human body, viewing them as lowly and tainted. But this concept is at odds with what Jesus’ life taught, which is that while worldly things can be corrupted, they can also be elevated and sanctified.

Consider that Jesus was incarnated in a human body. He was a child in need of care and protection. He was a carpenter, a craftsman who worked creatively with his hands. His first miracle was at the wedding in Cana, where he transformed water into wine. There was joy and purpose to be found in the commonplace. The Incarnation also bestowed worth on people considered contemptible, unessential and valueless — “the least of these,” as Jesus put it.

Indeed, one of the indictments of him by the religious authorities of his day was that he was a “friend of sinners.” Jesus’ love was “undiscriminating and inclusive,” according to the writer Garry Wills, “not gradated and exclusive.” He spent most of his time with those who were forsaken, poor, powerless and considered unclean. In a patriarchal society, Jesus gave women an honored place. He not only associated with them, but they were among his disciples, the object of his public praise, the first people he spoke to after his resurrection.

The most intense confrontations Jesus had weren’t with those with loose morals but with religious leaders, the upholders of the “holiness code” whom he called out for their arrogance, hypocrisy and lack of mercy. In the Temple courts, Jesus told the chief priests, “I tell you the truth, the tax collectors and the prostitutes are entering the kingdom of God ahead of you.” In the words of Professor Wills, “He walks through social barriers and taboos as if they were cobwebs.”

The Incarnation also underscores the importance of relationships, and particularly friendships. The Rev. James Forsyth, the winsome and gifted pastor of McLean Presbyterian Church in Virginia, which my family attends, says friendship is not a luxury; it is at the very essence of who we are. The three persons of the Christian Godhead — Father, Son and Holy Spirit — speak to the centrality of community. When we are in a friendship, according to Mr. Forsyth, we are “participating in something divine.” That is, fellowship and friendship were present in the Trinity and are therefore of immense worth to us. I’ve experienced that in my own life, when friends served as God’s proxies, dispensing grace I could not receive in solitude.

In some rather remarkable verses in the New Testament, Jesus told his disciples: “I no longer call you servants, because a servant does not know his master’s business. Instead, I have called you friends, for everything that I learned from my Father I have made known to you.” God’s emissary on earth had a core group of intimate friends — Peter, James, John and perhaps his most faithful friend, Mary of Magdala. These are people Jesus confided in, relied on, celebrated with and mourned with. He not only praised friendship; he modeled it. It’s difficult for us now to appreciate the shock it was considered then — that the “image of the invisible God,” in the words of St. Paul, not only didn’t compromise his divinity by taking on human flesh, he actually found succor in human relationships.

The Incarnation is also evidence that God is not an impersonal, indifferent deity. Instead of maintaining a divine distance from life’s experiences, including its grief and hardship, Jesus shared in them. This can be seen in the moving events surrounding the death of Lazarus, the brother of Martha and Mary of Bethany. Here is the account from the Gospel of John:

When Mary reached the place where Jesus was and saw him, she fell at his feet and said, “Lord, if you had been here, my brother would not have died.” When Jesus saw her weeping, and the Jews who had come along with her also weeping, he was deeply moved in spirit and troubled. “Where have you laid him?” he asked. “Come and see, Lord,” they replied. Jesus wept. Then the Jews said, “See how he loved him!”

In the account in John, Jesus raises Lazarus from the dead. The point here, though, is that Jesus not only had sympathy with those who were suffering but experienced grief to the point of tears. Contrary to the “health and wealth” gospel, which argues that God will deliver prosperity to those who have faith in him, Christianity does not promise an end to suffering even among the most faithful, at least not yet. But it does promise that God can bestow mercy amid our struggles, that in time he can repair the broken areas of our lives.

Jesus was not a systematic theologian; that work was left largely to St. Paul and others. While he certainly argued for the importance of righteousness, Jesus was far less concerned about rules than he was about relationships and reconciliation — with one another and with God. For some of us, Christmas is a reminder that while moral rules can be issued on stone tablets, grace and redemption are finally and fully found in a story of love, when the divine became human. I didn’t enter Jesus’ world; he entered mine.

Peter Wehner, a senior fellow at the Ethics and Public Policy Center, served in the last three Republican administrations and is a contributing opinion writer.