The patient arrives with her grand-daughter who reports she is the caretaker. Her grandmother speaks only Spanish and her hearing has deteriorated. At home she uses a walker to get through her house, outside she uses a four-pronged cane.
In 2007 she was told she had Parkinson’s disease, and received a prescription for Sinemet and Comtan. The physician asks whether she feels some improvement of her symptoms with the dosage she takes. The older woman is noncommittal. The dosage is quite low and she only takes it three times a day. The physician asks what her presenting symptoms were, that led her to seek a doctor, five years ago. She reports some tremor in her right hand, and that she had fallen twice; once in the bathroom, another time when getting from the bed.
The doctor enlightens the grand-daughter that few people who come to see him for the first time, when they are eighty-four truly have Parkinson’s disease. The illness is most often diagnosed when people hit their sixties, though it’s possible that someone who abhors the doctor might defer the first visit for a few years. If most people put off the visit until they were in their eighties, they would arrive in a stooped posture, a whispery voice, masked facial expression and all movements would be slow and rigid.
Her grandmother sits upright in the chair, with an expressive face and a natural quality to her speech. Testing her arms and wrists for rigidity, the doctor feels the muscles surrounding her joints are supple and loose. He tells the caregiver he thinks she suffers from lower-body parkinsonism; a type of illness brought on by microvascular disease caused by long-term hypertension. In patients with this sort of problem, they rarely see any affect from medication until the dosage is quite high. He begins making a schedule for increasing the dosage of Sinemet until she takes two and a half pills four times throughout the day. Increasing the dosage by half a pill, the schedule will take more than two months to complete. He also suggests the patient have an MRI of the brain, and prints out a prescription to have the test done. Encouraging the patient to exercise on a stationary bike may be tricky. She suffers from two degenerative disks in her lower spine and her left knee pains her constantly. The doctor feels she must continue to take the pain medications, though exercise may allay some discomfort and will help increase her general health.
With straight red hair, cut and curled at the ends, the grand-daughter straightens several locks of her hair, as they leave. She comments if her grandmother catches sight of herself in a mirror, she would be horrified and question why she let her be in public in such disarray, asking her aren’t you supposed to care for me?