Small and Golden-haired

He’s small, golden haired and his voice is soft. Sitting in the chair opposite the movement disorders expert, his left hand jiggles as he rests it in his lap. After having a heart attack and triple by- pass surgery he noticed the tremor in his left hand. Sometimes now, he feels the toes of his left foot curl inward and his right hand seems shaky. An optician, he needs steady hands when he must retrieve an object from a patient’s eye. Sometimes his voice slurs, and he has to carefully enunciate his words, otherwise patients do not understand him. He and his wife have formed a plan; he plans to retire and give his practice to a younger man who has been working with him for several years.
The physician comments many people observe the first signs of illness after a trauma. The incident may be psychological, as in the death of a loved one, or a physical insult, as in a car accident. Both types of trauma exert an impact on the physical wellness of a person, allowing symptoms gone unnoticed, to suddenly become apparent. In Parkinson’s disease, physical manifestation of the disease presents when the majority of dopamine producing cells in the substantia nigra have died away.
Unlike other patients that come with a multitude of problems, typically… diabetes, high blood pressure, gastric reflux, degeneration of the disks in the back, diminished sensation in the feet, brought on by chronic high blood sugar, this patient appears healthy. He is slim, fit and well groomed. The pink button down shirt suits him. His voice is low, lacking volume, – comments the doctor, who asks whether this has always been the case. No, he admits, his voice has become much softer.
On physical evaluation the doctor finds minor rigidity in the left hand. A suggestion of rigidity is barely perceptible on the right side. In evaluating gait, the patient holds his left arm much more rigidly to his side, than the right that swings naturally with his stride. Fine motor movements decrease in amplitude and slow with repetition on the left side. Reflexes of both legs and arms are brisk, suggesting some other agent of illness at work. Parkinson’s disease patients who do not have other medical problems have normal reflexes. The physician asks whether he has had an MRI, and the patient states the most recent test reported areas of ischemia in the brain. The specialist shakes his head, agreeing the finding of brisk reflexes suggests he may have suffered a small lacunar stroke.
The doctor encourages the patient to exercise aerobically at least three times a week. He cites a research study conducted on parkinsonian monkey, in which they were trained to run on a treadmill. The running time gradually increased until they were jogging up to three hours per day. Animals who exercised were able to overcome the weakness and rigidity on one side of the body while the animals who were sedentary continued to drag one side of the body. When all the animals were sacrificed, and researchers found that those animals who had become athletes, had caused their remaining dopaminergic cells to re- sprout….Hence solid evidence, at least in monkeys, that regular aerobic exercise is good for the brain.

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