Latin and Handsome

He’s Latin, the kind of patient that when I learn he is sixty- one, I am surprised, he could be forty- seven. His hair is still mostly dark and his daughter- in- law accompanies him, when he comes in for a second opinion on his diagnosis. Shuffling gait and increased muscle stiffness are the two symptoms that initially warranted a physician’s visit. When the first neurologist gave him a scant ten minutes of his time, he sought a second opinion.
The disease is apparent in the lack of expression in his face. An attractive man with dark features, his face lacks the spontaneous motion typical of healthy people; even the fixed way he holds his head indicates some level of rigidity. He has had three surgeries on his back and neck due to collapsed and herniated disks and his brisk and spreading reflexes indicate the long cortico-spinal tracts running through the spinal cord were injured at a previous time. His gait also is peculiarly parkinsonian. Though he lifts his feet adequately, his torso and in particular his arms, fail to oscillate with the motion of his legs and feet. When he gets to the wall and needs to turn around, he takes several steps, rather than turning on his heel and swiveling his trunk.
The previous neurologist gave him a prescription for Stalevo. The dose was either too low to see any improvement in symptoms, or the proteins in his diet blocked the conversion of levodopa to dopamine in the brain. The specialist in movement disorders cautions the patient, telling him dietary proteins; especially those in milk interfere with the way medicine gets transported to the brain. If he is unable or unwilling to reduce the morning and lunchtime proteins, he will need to take a larger dose of the medication to see its effect upon his muscles. With this in mind, the physician writes out a chart of how to increase the dosage of medication. Every three days the patient is to increase the dose by half a tablet, at one meal. When he sees the medication is enabling him to move more freely throughout entire day, he is to cease increasing the dose, and stay at that level of medication. The doctor indicates, this is a stairway in which you can go forward and go backward, to attain the appropriate dose.
In addition to regular medications, the physician recommends the patient also use an over the counter supplement, enzyme CoQ10. Laboratory studies indicated the antioxidant at doses of 1200 mg/per day, were capable of slowing the process of disease. Though few patients can afford to buy such high levels of the supplement, they may receive some health benefits from a lower dose; the doctor indicates 300mg/day.
Other issues concern the patient. He worries about his constipation. The physician recommends changing the diet to include a large amount of fiber and copious water, as well as a stool softener. A previous MRI indicated the patient has decreased blood flow to the brain. For this, he received a prescription for persantine, which decreases the stickiness of platelets, thereby increasing blood flow. The specialist also notes that with time Parkinson’s disease affects the autonomic nervous system, which includes bowel, bladder and sexual function. He states many of his patients ask for a prescription for Viagra, and he has no problem prescribing it, as it doesn’t interfere with any of the medications and he is not taking medications to prevent angina. The specialist asks the patient to make another appointment in four months, so he can see how he is faring.


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