His belly fits snuggly beneath a yellow polo shirt. His arms move naturally and freely with every step while he walks in the hallway. He turns without hesitation, wearing black athletic shoes and shorts, and returns to his seat in the small office. In the chair he comments when his medication is not working he can barely move his feet. The spouse beside him is tall with thick graying hair tied away from her face. Before resuming his seat the doctor confides that in the old days before levodopa, people with PD would gradually bend at the waist, until becoming quite stooped in posture. He demonstrates the posture rounding his shoulders and allowing his head to sag forward. The spinal bones would acclimate and take on the imposed curve in the back, so the permanent posture became bowed forward, though It’s hard to imagine this large man impeded by illness.
He asks about the blue pill he takes at night, relating that when he takes it, it’s hard for him to get up in the morning. He won’t take it for fear he’ll lose his job. The doctor comments, it’s not an all or nothing proposition. They can cut the dose by half. Doxepin has several benefits; it has anti- depressant effects, inhibits the bladder and increases sleep.
The physician notes the patient’s blood pressure, 94/ 57 taken while sitting. He comments it would be even lower if the nurse had taken it while standing. It’s too low for someone who works outside and is liable to become dehydrated and have his pressure fall even lower; he’s apt to faint. Medications for Parkinson’s disease cause blood pressure to drop, while the illness affects the ability of smooth muscle in blood cells to contract, allowing blood to pool in the lower body when standing and working for prolonged periods of time. He checks the other medications and notes the patient takes three other drugs to lower his blood pressure, and wonders aloud who manages his general health. His spouse, in the chair by his side, replies he will see the general practitioner the following morning, and should discuss which of the three medications would be best to forgo.