The average age of diagnosis of PD in the US is sixty and he’s fifty-seven. His left hand and wrist move as he enters. He’s a large man wearing dirty dark grey crocs. His wife has grey shoulder-length hair. Her face is tan, her expressions mobile as the physician speaks.
On physical exam the rigidity in the left hand and wrist are obvious. The right side has only a hint of rigidity. The patient feels his symptoms have begun in the right side, as well. He has decreased reflexes in upper and lower limbs, and has decreased sensation to the tuning fork in both ankles and hands. The doctor notes the neuropathy may be the result of long standing hypertension. The lack of sensation in the feet- the patient states both balls of his feet lack feeling- will put him at risk for walking issues. Though when he strolls in the hall, his left arm lacks a swing and his gait is wide-based, yet fluid and deliberate, a bit slow.
He has been told by two neurologists, he has PD. He’d taken the medication for a month, nightly as directed by the doctor. The physician looks at him with incredulity. Sinemet- carbidopa/levodopa is not ususally given solely at night, unless the patient is having trouble turning in bed, or for treatment of restless leg syndrome. Yet taken only once a day, the effect would be very little. The patient confirms this, the medication did nothing for him. The physician across the desk agrees, to see any affect, you need to take a therapeutic dose.
The physician takes a blank sheet from the printer and begins explaining he would like the patient to begin by only taking a half a pill a day, with each meal and escalate the dose until he is taking two and a half pills per day with each meal. In the chart he makes, it will take the patient forty seven days to reach this goal. He reminds the couple, in the staircase of increasing doses, you can go backwards, and stay on the same step. What he discourages is jumping way back to the ground. The doctor comments that if they see little effect, when at or near the ultimate dose, they need to take an additional step. They can choose to decrease the protein intake during meals, or increase the dose of Sinemet, slightly. He explains the medication to get to the brain requires active transport, and the neutral amino acids, especially in milk and cheese compete to cross the blood brain barrier.
The doctor states the patient appears to be a classic case of PD. The patient agrees, he has always felt he had the illness. The physician encourages the patient and his wife to exercise. The increased blood flow to the brain will aid in re-sprouting neurons in the hippocampus- it will be good for his short-term memory as well as his over-all health. The wife is shaking her head. They’ve bought a membership to the YMCA, now they will have to go.