Diagnosed in 1992

She was diagnosed with Parkinson’s disease in 1992. Today her husband pushes her in a wheelchair. Her body is alive with movement. Her torso stretches diagonally across the seat, her arms twisting at her sides. At times her legs extend straight out from her hip joints. The motion doesn’t dissuade her from speaking. Her voice is strong, not whispery. Her questions and comments reveal the clarity of her mind.

The husband pulls his chair up to the physician’s desk and takes several sheets he’s folded, from his pocket. The first lists the medications his wife takes. The doctor explains the patient has symptoms that are difficult to treat. The dyskinesias she endures occur at peak dose and end dose. They occur randomly while she is on and off. The doctor presses the husband to document his wife’s movements throughout the day, for two weeks. While he prepares a chart he describes the “on” and “off” states to the caregiver. The husband questions the state his wife is currently in- though she writhes in motion, her muscles are rigid. Forty minutes later, her movements are more contained. Her feet rest on the floor and the muscles at her wrists and elbows are supple.

She is slender. Whether she was always so slim is questionable. The doctor asks whether she has trouble eating and she responds she must cut her meat into very small pieces. Her peach-colored blouse looks like linen and is carefully ironed. Her skin is olive, her hair dark and she smiles.

The doctor says they must slowly cut back on the Sinemet. The patient will become increasingly more rigid, but they plan to replace the decreasing medication with ropinirole, until the Neupro patch arrives in July. The dopamine agonist brings on less dyskinesia. The physician directs the spouse to decrease the Sinemet, so that in two weeks time she has weaned herself from the medication. At the same time he is to continually increase the ropinirole until she is taking seven pills daily. Though the Neupro patch may provide some relief for her dyskinesias, she is a suitable candidate for neurosurgery. Such patients typically have complex motor fluctuations, as does the patient’s wife. The doctor turns the sheet of paper over and draws a diagram of the surgery. He describes the electrodes that send signals to the brain. The wires run under the skin down the neck and connect to a battery pack that is worn in the chest. Bilateral surgery requires two packs, that are hidden beneath the skin on either sides of the torso.

The doctor prints out refills for the prescriptions, a consult with the neurosurgeon and a request for physical therapy with attention to breathing exercises. He asks the caregiver to call in two weeks and report on how his wife fares without Sinemet, and only ropinirole to control her symptoms.

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