Parkinson’s Disease
You never know what you will see at the Arlington Free Clinic. A 60 year old patient presented today for a routine follow up. I immediately noted the patient’s unbalanced and slow gait, his difficulty in getting to sit in the chair, and his soft, mumbling voice. He had the frozen look which is described as a “masked facies”. He ascribed his tremors to nervousness, and talked of his stiffness of his back and leg muscles. I asked him to walk down the hall. He had a forward posture and a shuffling gait. When I asked him to turn around, he was not able to do the maneuver without being frozen in place.
In short, he had all the features of Parkinson’s Disease, a debilitating neurologic disorder arising from a lack of dopamine produced by the substantia nigra in the brain. I spoke to his father, who said that he had his symptoms for 2-3 years. He had to be helped out of bed, had frequent falls, and had difficulty dressing himself.
The tragedy of this man was compounded by reading his old chart. A physician had seen him in October of the previous year, noted his parkinsonian symptoms, and referred him to a neurologist. The patient never went to the specialist. The patient was also seen by physicians who related his cognitive and altered mood symptoms to a psychological disorder. They placed the patient on an anti-psychotic 2 months ago which can actually cause Parkinson’s symptoms, although this medicine did not alter his pre-existing Parkinson’s symptoms and signs.
I referred him to a neurologist, and the staff made the appointment for him. We are arranging for him to have a walker.
As a clinician, we are trained to be objective and focus on the clinical situation at hand dispassionately. I did this. But on my way home, I developed pangs of sorrow remembering that my father suffered from an atypical form of Parkinson’s known as Lewy Body Dementia. The patient invariably reminded me of my father’s struggles and his eventual demise from complications of the disease. Physicians are human, too.
Hopefully, with appropriate therapy, the patient will improve and get unfrozen. Awakenings, a wonderful book written by the neurologist Oliver Sachs, and later made into a movie starring Robert DeNiro, depicts patients with a severe form of parkinsonism. These patients had encephalitis lethargica, caused as an immune reaction to the influenza virus of 1918-1919. These patients “woke up” with L-Dopa therapy, which unfortunately, was associated with many side effects or whose benefits were not long lasting.
The patient is to follow up with me in a month, after seeing the neurologist, and hopefully starting therapy. As Kurt Vonnegut once said,”so it goes”.