Is the Illness PD??

The couple is still not sure whether the spouse benefits from taking Sinemet. His expression is immobile and he sits like a statue in the seat across from the doctor, not twitching, not blinking, not moving at all. The wife answers most questions after considering them, she raises her hand, adjusts her glasses, pats her husband on the wrist, puts her head down as she thinks. All the simple random movements people make while in conversation, the husband lacks.
The patient feels he is rigid, but on physical examination, the muscles surrounding the joints are loose and supple. The patient walks well, swinging both arms though he takes small steps and turns using two feet, rather than spinning on one foot. The physician comments patients with lower body PD, also called vascular PD retain their ability to swing their arms.
Behind the desk, the physician considers the amount of Sinemet the patient takes daily, noting it is a moderate dose. He inquires into what the spouse has for breakfast and explains that dietary proteins and Sinemet compete for uptake into the brain. In order to maximize the effect of medication, many patients need to cut back on the proteins they ingest during breakfast and lunch, and have their day’s allotment of protein rich food in the evening, when they do not intend to go to the county fair, or dancing.
The wife responds they are accustomed to eating a large breakfast with eggs, bacon and cereal, as well as coffee with milk. Near three o’clock, they have their main meal and later in the evening, they have something light. The spouse realizes this is the reverse of what the physician is advocating. The patient walks in the mornings after breakfast, and he has an exercise routine he begins at five in the afternoon; he seems not to feel especially slow or encumbered by the amount of protein he takes in.
The doctor concedes he may not have true Parkinson’s disease, but may have a variant, like vascular PD, which responds less to dopaminergic medication. The physician urges the pair to try to cut down on the morning proteins, to see whether the spouse feels some difference- less slowness and less rigidity. If he is averse to cutting back on proteins, he can increase the daily dose of Sinemet to 2.5 tablets 4 times/day. They may also try accomplishing a blend of the two strategies, decreasing proteins a bit, and increasing the Sinemet a bit, with the goal to find out whether the medication decreases the patient’s rigidity and slowness of movement. If the patient feels no benefit from the medication, there is no reason to continue taking it. Sinemet is only for the relief of symptoms; it does not affect the underlying course of any disease.

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