Setting: Office like environment with wife, husband and clinician
“Mr and Mrs D I’m very glad that you came in and we talked today. After listening to what you’ve seen happen over the last year and with the information from my history and physical and complete neurological exam I believe Mr R.D. has a disease called Parkinson’s.”
“This is a disease where your brain doesn’t make enough of a chemical called dopamine. This chemical helps send signals to parts of your brain that make your body move. So without enough of it your movements can be uncoordinated and sometimes uncontrollable, like the constant movement of your hands and your posture.”
“To accurately diagnose you will draw some blood and run some tests. We may also do some other radiologic tests like a CT scan or an MRI scan. We might even give you a medicine called Levodopa, and if it resolves some of your symptoms then that is also a positive indication you have the disease. “
“In addition to the uncontrolled movements and posture, the complaints about the constipation and urinary problems can be attributed to this disease. Initially, you said that naps helped with his symptoms; however getting enough and quality sleep at night may become more difficult. He might start feeling some pains in his body and/or tingling and numbness. You may also notice some uncontrollable eye tremors or twitching.”
“People with Parkinson’s may also feel depressed or anxious, not because they are necessarily sad about having a disease but because of how it also affects the part of your brain that is involved in how we respond and our emotions. And the disease also explains why it takes him longer to do math problems because it can start to affect memory.”
“ There are somethings that you both can do to participate in his care. Important next steps will be starting therapy to help keep your body functioning as best as it can, such as physical and occupational therapy. Because you are prone to losing your balance easily we will want to make sure that you keep your home safe and help keep walkways clear and increase fall safety. We will also want to continue to evaluate your swallowing and eating ability. People with Parkinson’s can develop trouble chewing and swallowing and we may need to change what foods you eat to help make sure you don’t choke. ”
“Medicines used to help treat the symptoms are the Levodopa drug that we might have you try initially, plus maybe other medicines that either help your body keep the chemical in your system longer. Sometimes there are surgeries that can be done, either on your brain or to implant a device that might be able to help with the uncontrolled movements but we will continue to have regular appointments to evaluate what we all think is the best treatment at that time.”
“Do you have any questions?”
Wife: “Is there a cure?”
“No, unfortunately there isn’t a cure but all the treatments and medications we just talked about can help maintain your husband functioning at his best in regards to the effects of the disease.”
Wife: “Okay”
“Okay so let’s start putting some of those things that we just discussed into action…”