Her white hair, curled at the ends, her green cotton sweater and yellow capri’s attest to her casual sense of style. She stretches her long legs out in front of the chair she slumps in and tells the doctor her concerns. The book in her arm, has the title something like, Fifty Medications the Doctor’s Don’t Tell You About. She’s got the pages which mention Parkinson’s disease, tagged. The doctor checks the back and looks up the pages that speak to his specialty. Published in 1993, the text has nothing the physician is unaware of. A patient would hope her neurologist, who also has a PhD in Pharmacology, knows his craft.
The patient has none of the resting tremor, the stony facial expression, or slowness that regularly accompanies the illness. Her major concern is her ability to walk. She is hesitant in expressing it as a concern, she ventures really she fears her balance is declining. She’s never fallen. Several years ago she underwent some ‘walking therapy’ and felt it really helped. The doctor agrees she would benefit from physical therapy and writes her an order for PT. He also urges her to begin a daily regimen for her cardiovascular health. With a pacemaker and coronary artery disease, he asks her to check with her cardiologist before beginning. He’d like her to begin using a stationary bicycle. In the beginning, this would be a five minute commitment, though he would like her to increase her time by five minutes every week until she is spending twenty minutes on the bike. Additionally, he’d like her to raise her heart rate to eighty percent of her maximum for her age. With a pencil, he figures out what this figure would be.
He encourages her to participate in the yoga class being offered at her community center. The activity is very good for stretching out the joints and muscles, especially helpful for those with PD, who tend to get stiff and slumped. Balance is also addressed. Swimming is another activity that would complement her health.
Her spouse depends on her. She is the caregiver. She knows it will be her downfall, she’s aware of the demands that tax her. She thought he was talking in his sleep, but in fact he was wheezing. It was five in the morning. He seldom wakes her, generally.
On physical examination her limbs are loose, without rigidity. In medical terms she would be regarded as, “on”. Freezing also bothers her. She asks about it, but the doctor confesses, there are no medications that simply address freezing. She has written down the prescription for exercise, and mentions her handwriting has deteriorated, though that simply must be her age. The doctor faces the computer screen, typing in her renewals for medication and does not comment.
In her eighties, this patient has beauty in her face. Her blue eyes and features have a life behind them that is hidden from those of us who are not her friends, though we may see hints of her joy.