Es Dificil

His mother tongue is Spanish. He and the movement disorder physician speak with ease, though dyskinesia causes him to throw his arms and head in random motions while he sits in the chair. Animated, he rises from the chair to demonstrate how his left arm gets stuck above his head, and he can’t get it down. Rigidity is his chief concern, being worst on the left side of the body, spreading from the left arm up the shoulder, neck and encompassing his head. He recounts that side of his body feels wooden. Again he rises to illustrate how he kept his right arm from swinging when he was first diagnosed with the illness. That was seven years ago, when he was thirty- nine and working as a truck driver. Today he receives disability benefits because the illness keeps him from working.
The doctor explains that being stuck in a certain posture has a name, dystonia and it is a form of dyskinesia, which falls in the category of motor fluctuations. The patient reveals in the beginning of the illness, nobody could tell he was ill, not even his wife knew he was taking medications. The doctor comments in Spanish, that piece of time is called the honeymoon period, in his words, luna de miel. Now a dose of Sinemet will last at the longest, two hours. He reveals his abdomen, lifting his shirt, stating he can’t eat like he used too. Dyskinesia even bothers him at night when he is sleeping. He begins moving and wakens, not getting more than four hours sleep. The physician comments he is the type of patient who would probably do quite well with deep brain stimulation surgery. The doctor recommends a visit to the neurosurgeon, who also speaks Spanish.
Before seeking surgery the specialist would like to try a few other methods that might help to bring the dyskinesia under more control. He describes how patients can prepare a concoction of Sinemet and vitamin C in water each morning and sip it during the day. The vessel for the liquid must not allow light to penetrate and degrade the medication, and the mixture must be kept cool. The doctor advises him to keep the fluid in a thermos, or in the refrigerator, if at home. The doctor describes Parcopa, a fast- acting source of levodopa that gains access to the brain through the mucosa of the mouth. Patients use the method commonly in the morning when desiring to experience some effect of medication quickly, say within fifteen minutes. While under the effect of the Parcopa, the doctor urges him to prepare the liquid prescription. Lastly, the last dose of medication in the day will be a controlled release formulation of Sinemet, along with the anti-depressant Trazadone.
The patient comes from a family of considerable longevity, his father at ninety walks five miles a day. The man is healthier than he is, he comments. He works out regularly to maintain his health and the physician comments he would prefer he focus on aerobic exercise and stretching rather than weight- lifting. Studies with monkeys have shown thirty minutes of aerobic exercise daily will cause dying neurons to re- sprout. At the grocery near his home, a younger woman regularly flirts with him. He is so ashamed of his illness, that when she questions why he runs away from her so soon, he tells her he is gay.


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