""The diagnosis of Parkinson's is largely determined by response to the medication. Which is a rather backwards way of arriving at a diagnosis. There are a number of different cause for parkinsonian tremors, but there are certain medications to which only Parkinson's responds."
Those were the words of Dr. Connie Chen, the neurologist we visited today. Dr. Chen is in the same practice as was Dr. Marder, whom we all remember from Dad's last neurological fling, now what, 10, 12 years ago? Dr. Chen is a young woman, Johns-Hopkins educated who joined Neurology Texas " serving as the Hospitalist for the practice in order to focus on her primary interests—neurocritical care and stroke." We all liked her a lot. She is quick to listen, very direct and very communicative about what she is thinking. And she has a vintage Godzilla movie poster in her office. She says it belongs to her office-mate, but that she very much approves.
She said Dad's long time tremor in his arm is a parkinsonian tremor. His tremor(s) were aggravated by the trauma of the valve failure, the surgery and apparent stroke, hence the severe tremors in his arm and leg. When he went back in the hospital last weekend two medications were prescribed: Primidone and Ropinirol. Primidone is a general anticonvulsant which reduces tremor or seizure. It works by controlling abnormal electrical releases in the brain. Primidone is not for Parkinsons. Ropinirole is.
"Parkinson's disease occurs when the nerve cells in the brain that make dopamine are slowly destroyed." Ropinirole is a "dopamine agonist" which "stimulates the parts of the human brain influenced by dopamine. In effect, the brain is tricked into thinking it is receiving the dopamine it needs." Ropinirole is designed for Parkinson's. Dad has responded to treatment.
Dr. Chen said that Dad's PD appears to have been on a slow track. How the traumatic events of the last two months will affect that track remains to be seen. Again, she reiterated that Dad is in good physical health. He has good muscular strength and motor control on both sides of his body, blood pressure's good and the tires fair. And some of the aspects of his health that concern us are the normal effects of significant trauma on an 86 year old man.
Treatment: I quote the from Dr. Chen's discharge notes, "small increase in ropinirole to 0.25mg per day. Watch for side effects: nausea, sleepiness, hallucinations. I would rather undertreat than overtreat in your situation. Let's increase your medications only if your fine motor treatment is servely affected."
On the stroke front: she wants to "continue the stroke work-up with MRI of brain and MRA of head and neck. I suspect it will show us older small strokes.... See me in 6-8 weeks. If you perceive more cognitive problems that are worsening, then please let me know." The MRI is scheduled for next Monday.
I know the diagnosis depressed Dad even further. When she asked about hallucinations, he said he has "a lot of dark thoughts about his condition especially thinking about his future." Dr. Chen said, "that's not hallucination, that's depression."
We talked about his depression while Dr. Chen was out of the office on a phone call. I told him that I thought he was still in shock. He went into all of this thinking that he was a relatively healthy man and that's still his self-image. Except in the last month he's had heart disease, heart surgery, strokes and now Parkinson's Disease. I have to admit, that's a bit much! Denial, Anger, Depression, Acceptance. Stages of Grief. I cycled through several times during my PKD period and wrote about it in my blog. I suggested he might think about some counseling. I would hope that he could talk to Patty Willette and she could help steer him into some help.
I asked Mom how she was handling her cancer. She said she's been ready for it a long time and it's had a designated place on the shelf. She thought for a while she might dodge it, but when it was diagnosed, she just put it where it was supposed to go. I suggested she recognized it by the angle of its elbow. We all smiled. We needed to.
Rough day, rough news. I don't think anyone saw this diagnosis coming.