Ten Years

Having seen the patient repeatedly over a span of ten years he expresses his frustration when he learns she only tried the Seroquel twice, and never at a high enough dose to cause her to sleep solidly for several hours. It gave her a nightmare, she claims. At that dose, it could have no effect, counters the physician. You were probably upset about something else in your life. She raises her voice telling him he is not listening to what she has to say. While she speaks, her body contorts with dyskinesias.
The physician wants to know when the dyskinesias begin. The patient answers it depends upon when she takes her medications, and that depends on what she has done the night before. He directs her to tell him about this morning because her dyskinesias suggest she is overmedicating. She needs to stop taking the Sinemet throughout the night, and sleep continuously for several hours. If she were sleep as he recommends, she would have to wear Depends or something comparable, because she would not wake to use the toilet. The friend nods in understanding, but the patient is still upset. This is no quality of life, the physician comments, looking at the patient. You have to cut back on the Sinemet.
She tells him she feels she can’t breathe, and thinks she will die. Adamantly, he tells her patients with Parkinson’s disease do not die that way… he admits though it can be very scary. The friend asks, Is there nothing that can be done, when she feels that way?
The doctor shakes his head and tells her, there is nothing to use on a regular basis. The episodes pass, it’s like childbirth… though your anxiety about the symptoms makes it worse and heightens the feeling. Then he explains respiratory dyskinesias affect the muscles of the diaphragm and intercostal muscles between ribs, inhibiting regular movement of the chest muscles in normal breathing. The real solution is to regulate the Sinemet so dyskinesias don’t occur. And seroquel might be helpful as well.
The physician instructs her to resume making the liquid Sinemet each morning and he writes out the recipe which he tells her to sip every hour and a half, during the day. She must keep it away from light, in a thermos, in the refrigerator and pour out the excess she does not use. She understands the recipe, she has used the method before. When she tells him she has someone visiting every morning for four hours he is pleased, he adds she also needs a pet. She nods and tells the doctor about the cat who lives with her. He nods and inquires, What does the cat think about the dyskinesias?
He goes into another room, he knows when I am not feeling well, she says. Sometimes he curls up with me when I nap.

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