B12?

He’s a tall man lying on the examination table in the dark as the doctor peers over his face, a small flashlight in hand. They’re gauging his eye’s reaction to a light beam. Is there is some sluggishness in one eye, or do they respond equally well? The Chinese doctor is present today. A young medical student leans against the wall.

The doctor tests the sensation in his ankles with a tuning fork. Asking the patient to close his eyes, he inquires whether he can feel the vibration, he hesitates wanting to feel something. He can’t feel the buzzing. He feels it in his elbows. The top drawer of the desk has safety pins, and the doctor explains he wants to discover if he can tell the difference between sharp and dull. It’s hard for the man. He wants to feel something, and he’s waits for some sensation that doesn’t come. Brisk reflexes in the lower and upper extremities, with a lack of sensation; the patient has neuropathies in both legs. Two years ago he was told he had Parkinson’s disease. He’s been taking 25/200 Sinemet three times a day for some time and feels it has little effect on his ability to walk.

In the hallway we watch his gait. He doesn’t swing either arm and he turns in a shuffling pattern, rather than swinging into a bodily twist. The physician scans the documents he’s brought with him, noting the patient suffers from a megaloblastic anemia, associated with problems of the long sensory nerve fibers causing decreases in sensations from his lower extremities. In addition significant B12 deficiency affects white matter of the brain, and along with the decreased sensation from the legs, gait and balance become a problem. The doctor wonders about this. Could it be a lack of B12? Someone should have caught that before it impacted the patient so strongly. The tests have been thorough. They’ve performed an MRI of the thorax looking for cancers… He has lost sixty pounds in the last five years. Some of that may be accounted for in the loss of his brother. They traveled the coastal highway from Texas up California into New Foundland. With the death he felt no inclination to eat. These days he’ll cook a roast and gradually eat the meat, making a meal. For an easier dinner he’ll have a chicken pot pie.

He’s happy the doctor may have found the solution to his problems. He uses words like, “Golly.” In 1955 he began working for the phone company, digging ditches. He worked his way up becoming a lineman and climbing poles. When he retired he kept going to the same physician the company used. That was the general practitioner who diagnosed him with PD.

The doctor across the desk asks him to slowly stop taking the medication. He would like him to have a blood test, a thyroid evaluation, and an MRI of the neck due to the brisk reflexes in his extremities. The physician tells him he will call him when the results of the tests come to him, and they can coordinate what they’ll do next via the phone. The pale patient stands and shakes our hands before he and the medical student make their way down the hall.

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