Pretty Woman

I notice the beauty in her face right away. She has an expansive aura and emanates a positive sense. Though as she sits, dyskinesia makes her turn in her chair, twisting her arms and legs and then turning her head to one side. The involuntary movements are what trouble her the most, and have been for some years. She wears a cotton blouse with cutwork, and her hair is tastefully brown so she appears much younger than the seventy- some years. She has come for her six- month evaluation.
The physician states the patient was diagnosed approximately fifteen years ago, with dyskinesia beginning during her eighth year of the illness. The patient enlightens the doctor with her regimen of medication. She takes Sinemet around the clock, waking throughout the evening roughly every two hours. The feeling of wearing- off causes her to panic, and she feels like she cannot breathe. Medication throughout the night results in poor sleep quality. The specialist feels she is over- medicated, and recommends she begin taking Seroquel at night. With several hours of sleep, the world appears a saner place. The patient also suffers from fibromyalgia, rheumatoid arthritis, and depression three other reasons the patient requires time in total body relaxation.
The physician recommends deep brain stimulation surgery in very specific situations and in this patient’s case, he thinks the intervention might bring considerable relief from the complex motor fluctuations with dyskinesias. His second recommendation is using the Neupro patch. The patch is placed on areas of the body not prone to sweating, and the area is changed daily to avoid skin reactions. Rotigitine (the generic name for Neupro), is a drug that mimics the actions of dopamine in the brain and does not require transformation into dopamine like levodopa (Sinemet). It is absorbed slowly through the skin, rather than through the intestines. It has a much longer effect and may be effective in people who suffer from motor fluctuations, or variability in their response to medication.
In addition to the patch the specialist also recommends the patient begin using a “liquid Sinemet” formula mixing her Sinemet in the morning with some vitamin C to stabilize and maintain freshness of the solution and sufficient water. The recipe is available on line. She is to sip the concoction every few hours during the day to maintain the level of dopamine at a nearly steady- state, thereby reducing the times when she may be wearing- off.
The doctor is pleased the patient has appeared with a caregiver, though she is only present four hours daily. When he spoke with the patient’s daughter, she conveyed some interest in having her mother placed in an adult – living facility, where she would get more attention. The patient reports she is quite fine, and independent on her own. The doctor recommends she return in six months time, when she can describe how well she sleeps.

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