Illness from the Islands

A psychiatrist in the Virgin Islands treated the patient for fourteen years. When the movement disorder specialist looked at the list of medications, he was impressed and satisfied with the regimen. Only after the patient had fallen, spent a week in the hospital then been transferred to a rehabilitation facility where he spent most of his time in bed, did his health appear to be threatened. A family member commented he couldn’t lift himself up from a lying position, when he first arrived in the States. With family care and physical therapy, he appeared at the clinic using a walker.

Seeking to know more of the patient’s history, the doctor asked about the first symptoms of illness. Tremor began in the right hand and after two years or so, spread to the left hand. The doctor commented two types of PD are generally recognized, the tremor dominant type and the rigid, akinetic kind. He commented the patient is lucky to have the tremor dominant type, though the illness is more apparent, it also progresses more slowly. On physical examination, the physician noted the patient was quite stiff in the neck and torso, but an increased level of Sinemet would relieve some of this. Happy the patient was having physical therapy, he recommended therapy continue until Medicare refused to cover the cost.

In addition to gradually increasing the level of Sinemet, for which he drew out a chart for the family, the doctor suggested the patient begin using the medication, Ditropan at night. The drug increases the bladder’s holding capacity, so one can sleep an entire night without the urge to urinate. On the cautious side, when given with other drugs, specifically Artane, it may increase a patient’s risk of acquiring a bladder infection. The physician warned the patient and family to be aware of this, and cut the patient’s dose of Artane to avoid possible problems. An adequate dose of Seroquel at night would ensure the patient falls asleep and remains so until the following morning. He stressed the patient avoid daytime napping and make an effort to exercise daily.

The doctor, not feeling rushed, as he allocates an hour for new patients, digressed a bit on medications. Artane, he stated, is one of the oldest drugs given to those with PD and is quite effective for tremor. To its detriment, the medication can interfere with short-term memory in patients over the age of 60, worsens constipation and interferes with bladder function. Sinemet, so named for sin emesis- Latin for without vomit, has three potential side effects- nausea; that’s why it’s best to take the drug with food, it can cause drops in blood pressure, and it may bring on hallucinations, especially in patients not sleeping well at night.

The physician urged the patient continue taking Mirapex and amantadine as he had previous been instructed. After the change in dosage of Sinemet, which would take approximately a month to fully accomplish, they could tweek the doses of other medications. In addition, he advised the patient to avoid protein- rich foods throughout the day, eating instead a diet rich in fruit, vegetables, and carbohydrates. Eating foods that lack amino acids enables Sinemet to act effectively and reduce symptoms of illness. At dinner, with the idea the evening will be quiet, spent reading or watching television and not line dancing, the patient should take the daily requirement of protein. The neutral amino acids in protein will interfere with the transport of levodopa from blood to brain, so the patient is apt to feel slower and not have the same response to medications, as when taken without protein during the day. To manage the illness effectively, it seems best to plan ahead of time what foods to eat at a particular meal. The doctor stressed he would like the patient to return in three months time, but that if problems arose to call his assistant, and he provided them a card with the appropriate office number.

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