Respiratory Dyskinesia

She calls frequently seeking help for irregular, fast chest wall and diaphragm movements that make her feel she can’t breathe and that death is imminent. The doctor explains that these irregular movements are leveodopa-induced dyskinesias, known by experts in Parkinson’s Disease as respiratory dyskinesias. She wasn’t due back for another four months. Her caregiver, a woman with dark blonde bushy hair, takes care of her medications, pulling bottles from her large bag to check how many refills remain.

The problem is the pharmacist. He cancels the previous levodopa medication when she gives him a fresh prescription for a new type of dopamine replacement. The doctor throws his hands up at this, exclaiming the job of the pharmacy is to fill the prescription correctly, not to judge if a medication should be replaced.

“They should have called me, if there was some discrepancy about the medication.” His jaw set, his hands express his agitation. The patient shakes her head conceding it is an awful situation.

She is prepared though, having brought a list of concerns with her. What can be done for constipation? The problem affects most people with PD. The remedies are not consistently reliable and the doctor urges the patient to incorporate all the methods; eat prunes, drink enough water, eat enough fiber, and get regular exercise. Miralax taken daily helps pass stool by increasing its fluid content. Other patients have tried senna leaf teas, though they can induce abdominal cramping and diarrhea.

The patient worries her blood pressure gets too high during the day- sometimes rising to a systolic level of 180. The doctor mentions she takes a medication to regulate her high pressure, and should not worry needlessly. The medication, Sinemet tends to reduce blood pressure further.

The physician leans back in his chair and urges the patient must find an outlet for her anxieties, and that yoga might be helpful in controlling the dyskinesias that obstruct her ability to breathe. He mentions the mind – body connection, asking the caregiver for the usual time dyskinesia’s are worse. She replies when they have a visitor coming, when the patient gets angry or frustrated, or any other stressful time.


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