After several months, a couple returns for a follow up appointment. The physician comments on the wife’s Boston accent. He calls it endearing, when she tells him where she’s from. Months ago he instructed the patient to cut back on drinking milk throughout the day. The proteins compete with levodopa entry into the brain where it is transformed into dopamine. Concerned about his weight loss, the patient takes a nutritional supplement as well. At an appointment with his barber, he found he was unable to rise from the chair; he had drunk an Ensure before the haircut and the proteins made the medication ineffective. The doctor explains again a vegetarian diet for daylight hours will allow him to function optimally. The woman reinforces the doctor’s comments about food. No ice cream during the day.
The wife reports that he hasn’t been taking the Seroquel at night. Now he sleeps in a bedroom by himself, where she no longer is bothered by his thrashing at night, and speaking loudly in his sleep. The physician shakes his head and states that he needs the Seroquel because his sleep architecture is awry. He will be more rested when the quality of his sleep improves. Enhanced sleep quality creates a more rested person with more energy to perform tasks during the day.
The wife notes she thinks the quality of her spouse’s life is pretty poor. He watches TV and dozes throughout the day. He comments he would like to get out in the yard and work, yet he lacks the vitality to do so. Shaking his head in assent the physician states people with PD can experience apathy, or an acute lack of motivation that is apart from depression.
On physical examination the doctor finds the patient’s limbs loose and supple. As the pair leaves the spouse walks warily, his feet spread wide under his lightening frame, his arms wide, ready to grasp something, should he fall.