She is blond and well tanned. Her spouse wears green trousers a matching polo shirt. They have been married for forty nine years, which explains some of their dynamics. The husband scoffs at his wife and rolls himself to the side of his chair, away from her. She conveys he has lost some memory. The wife knows the facts and conveys them easily without stammering. She answers many of the doctor’s questions, when she sees her spouse stuck on a syllable. Like the small steps the feet take, the person with PD may have problems articulating thoughts- both repeat a motion, though little change occurs.
The doctor asks about the schedule of medications, and the wife replies that her spouse may forget a dose when occupied, so the schedule is constantly changing, though he strives to take his pills every three hours. The doctor rips a page from the pad of paper on his desk and begins constructing a table that would make up a medication diary. He states he can be of little use unless he is aware of how the patient responds to his medication; how long it takes for the pills to take effect, whether he experiences dyskinesias, and when they occur. He asks the wife to attempt the diary for a period of two weeks, so that he can see where patterns emerge. Email it to me, he says. With that information they can modify the daily course of drugs.
She is pleased that the physician has discouraged the two doses of night- time medication. The doctor insists the patient must have six hours of sleep nightly, at least. To make this a possibility he recommends the drug Seroquel, to be taken in gradually increasing quantities until the patient finds he is sleeping through the entire night. An enlarged prostate means the man must rise to urinate several times in the night; Depends may be needed when the quality of sleep improves.
Diagnosed with the illness fifteen years ago, the gentleman underwent deep brain stimulation surgery a year and a half ago. The physician asks whether they have seen an improvement in symptoms, and the wife shakes her head, doubtful. Then she notes her spouse no longer has tremor at all. While he demonstrates his gait in the hallway outside the office, the patient’s arms swing freely. The arm swing, the wife notes is also much better, he used to carry his right arm next to his torso. He takes the same amount of dopamine replacement.
After the physical exam the wife mentions her spouse fell in a field and she was unable to help him to his feet. They had to wait for some time, until another person appeared to assist. She worries he will fall again and wonders whether the physician can help them acquire a motorized scooter. The doctor writes the couple a prescription for physical therapy, with attention to gait and balance with the request to evaluate and fit the patient with motorized scooter. The patient comments to the physician he is unlike other doctors, he has given them some time.