Falling Was The Earliest Sign

The patient fell several times before a neurologist ever diagnosed him with Parkinson’s disease. Falling is not a typical first symptom for someone with classical PD. The doctor asks about the first indication that hinted the patient should see a neurologist. Though the patient speaks clearly, he does not remember details well. The wife comments she thinks it was dragging of the right foot. She comments at the time, she feared her husband might have had a stroke.
There are other significant problems. The patient underwent a quadruple bypass on the vessels of his heart, and has a pacemaker. The movement disorders specialist comments though the surgeon may have cleared the blockages feeding the heart, the vessels feeding the brain have the same buildup of plaque. Patients with vascular disease may begin to show symptoms of lower body parkinsonism due to small vessel disease; shuffling gait with full arm swing. Another illness neurologists like to rule out in patients who can undergo an MRI, is normal pressure hydrocephalus. A prominent symptom in the illness along with the shuffling gait is substantial change in the person’s cognition; problem solving suffers, memory fades, the ability to plan and change plans as problems arise, becomes hard to accomplish. Because of the pace maker in his chest, the patient cannot undergo an MRI. A CAT scan, the doctor concedes, reveals little information about prior strokes the patient may have suffered.
The wife confesses the greatest problem really is the patient has become limited in what he can do. An artistic person, he does not paint or work with wood anymore, due to his frequent falls. The physician comments that maintaining an artistic outlet is very important. The stimulation artwork gives the brain as one draws or paints, is about problem solving; for example depicting a three dimensional object in a two dimensional plane. The doctor encouraged the couple to pursue an art store that sells easels that will roll up to a person’s chair. He also suggested it might be time to look into acquiring an electric cart. Access to the mall, the movies or the boardwalk should not limit the patient because his balance is poor. Along with the cart, they would need to purchase the carrier that fastens to the back of the car. Insurance will cover a large fraction of the cost, and it will help the couple maintain an active life. The last tool the doctor would like to see the patient using is a stationary bike, optimally with a chair seat, so there is no easy way to fall off.
The doctor reviews the medications the patient takes and comments the amount of levodopa is inadequate to provide a therapeutic dose, which is approximately two and a half pills of 25/100, four times per day. He draws a step- wise chart that indicates when the patient should increase the medication by a half pill. He instructs the patient to stop at a dose if he feels the medication is driving his blood pressure too low, though he cautions the patient may need to begin wearing TED hose, if low blood pressure remains an obstacle to achieving an adequate dose of medication. Proteins in the diet are very important the physician says, because they will compete with the medication to get across the blood brain barrier. A diet rich in dairy products will especially cause havoc with medication, due the quantity of free amino acids. He advised the patient to try and eat a protein- free breakfast and a low protein lunch, saving the protein filled meal for the evening, when he can anticipate being home, and feeling less effect from the medication. The doctor asked the couple to return in four months time, with a report on how things have gone.


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