A patient arrived for the first time at clinic today with striking symptoms of Parkinson’s disease. A very detailed history of when the first signs occurred followed, with acute insight into what presented and how the initial feeling of pain in one arm got interpreted as a muscle strain. After noticing the pain persisted throughout the day, for several days, then months the patient noted decreased strength in the arm. Objects once easily manipulated spilled onto the kitchen floor.
The patient lay on the bed at night wondering whether the spouse would notice the bed shaking. The inner tremor continued as did the pain in the arm. The specialist comments that studies have been done on patients who feel an inner sense of tremor, and that the symptom, once thought to correlate with anxiety, was shown to correspond with depression.
The patient nods in understanding and seeks to relate more of the history; bringing a foot into the air as one does in ascending a step, has become problematic. In order to perform the feat, the patient is forced to hang on to the railing. Akin to this issue, is the inability to rise from a chair without using the arms. In eating lunch, the patient finds his arm has lost the fluidity of movement it had. It is almost as though the arm and hand holding the fork, move in ratchet-like motion.
The physician states two over -the- counter measures may be useful are coenzyme Co Q10 at 900-1200 mg/day and creatine at 20 grams/day. The two have been found to improve mitochondrial function. The doctor comments the autonomic nervous system becomes involved in PD, and patients typically find themselves contending with constipation. The patient nods in agreement, relating some relief of the symptom through a remedy by Planetary Herbal Formulas, something called Triphala. Frequent urination is another symptom the patient notes, occurring at night. The doctor responds that many patients comment on this.
The patient concedes that the weight loss through healthy eating of many fruits, vegetable and whole grains was intended, thirty three pounds came off rather easily in the last year. The physician asks the patient to move to the examination table. While moving, the patient clasps every stable surface on the way to the exam table. The physician asks to see the patient walk, and the feet appear to be magnetically fastened to the floor. The patient has no arm swing. To gauge the ability to recover from a perturbation in balance, the physician cues the patient about what he plans to do, then jostles the patient’s shoulders. The patient throws the arms wide and has extreme difficulty righting the torso under the feet. Problems with recovering from a balance disturbance typically present themselves in Stage III illness.
Back in the confines of the small office, the specialist explains that when a patient’s signs or symptoms create impairments that conflict with working, or performing routine activities, he prescribes medications to dampen symptoms of PD. Most drugs have secondary affects. Though both creatine and Co-Q10 will do nothing to quiet the issues, they may delay the worst of the illness. Rasagaline, or Azilect is a prescription medication proven to delay the need for levodopa in PD patients. An MAO inhibitor, it carries a black- box warning because it may bring on a hypertensive crisis when combined with red wine and aged cheeses.
The patient stretches an arm over the notes the physician provides, and divulges that rather than taking the drugs more time needs to be given to an alternative method. The medications will be there, available when hope runs out that other means may alleviate the most troubling symptoms. Yes, the physician agrees, this is a patient decision; yet he wants the patient to return in four months to check on progress.