Different views by different consulants

My husband has had Peripheral Neuropathy for some years. His NHS physio suggested he may have Parkinsons instead/as well. He was due to get a routine follow-up appointment with his PN consultant but their computer systems were in process of being changed and he was told it could be some time before knowing when his appointment would be.

Because we were so worried we arranged to see a private consultant re the Parkinsons on Monday. He conducted various physical checks and declared (I checked with him twice on this) it was not Parkinsons - at least it was too early to make that connection. He did, however, notice my husband struggling with aspects of his mobility and has prescribed a medication (almost as an afterthought it seems). However, neither my husband’s GP nor my husband has yet had the report from him and we can’t remember what this drug is called. My husband thinks it began with an “S” or a soft “C” but it was not Seratonin.

The day after we were surprised to get an email notifying my husband of an appointment with the NHS consultant today, so off we went. We told him about the private session on Monday and he was definitely not pleased. In his view my husband now has two consultants (the private guy is a Professor, the NHS guy is plain Doctor) and needs to choose which one he is going to rely on. We hadn’t seen it that way at all. We didn’t have a choice of private consultant, he was the only Parkinson’s specialist at our local private hospital.

I add that we have been happy with the medical care from the NHS doctor over the past 7 years but have sometimes found him to be quite snappy and condescending (not sure if that is the right word). He often “talks over us” (particularly me).

All that said, he did settle down and has advised my husband to go with the advice of the Professior for now and try this drug. That seems fair.

However, he was a tad scathing that the Professor had not suggested a DATscan, and advised that he would have considered that himself - and may still do that after a few weeks on the drug.

Our problem is that we are hoping to go on an expensive cruise holiday in January and have only 7 weeks before we pay the highly expensive balance. We need to have medical insurance in place before then or any cancellation will not be covered - and it is a fortune to lose.

So finally, does anyone know how quickly the NHS might arrange a DAT-scan, and if it isn’t quick whether or not you think we should pay for a private scan, and risk the wrath of the NHS consultant yet again?

Thanks for anyone who might have a view.

Meg

Good afternoon Meg … What an interesting post to get our teeth into. I am 71 years old and was diagnosed with Atypical Parkinson’s following what they said was a positive Datscan in June 2023 and brain Mri scan. I also had positive tests for Peripheral Neuropathy. I was put on Amitriptyline for the peripheral neuropathy which is excellent. I am on Sinemet and Rasagiline for my Parkinson’s. Up to 55% of people with Parkinson’s have peripheral neuropathy.

I have recently seen a top neurologist as the Sinemet I take causes fairly severe sleep issues. Insomnia, Restless leg, nightmares, fatigue. He reexamined my positive datscan and he thought it normal. He sent it away for an expert second opinion and that came back marginal for Parkinson’s. So I have had 3 different datscan opinions. A positive or normal datscan hasn’t made any difference to my treatment.

The proof that I have Parkinson’s is that taking the Sinemet [Parkinson’s medication]
helps my poor balance and mobility. If anyone tries a range of Parkinson’s medication and none work then it is unlikely that they have Parkinson’s.

The current treatment for Parkinson’s like symptoms is to take Parkinson’s medication on a trial & error basis. A positive or negative datscan will make zero difference to how you are treated. So in my opinion my having a datscan was a waist of time and money.

I do have gait freezing which this latest neurologist says is not Parkinson’s. He has no idea what it is.

Any questions please ask.

Steve2

There is no cure for Parkinson’s all they can do is treat the symptoms. If the symptoms do not bother your husband then why bother taking the medication. Medication comes with side effects as I to my cost have found out.

I play Indoor Bowls and if I do not take my Parkinson’s medication then I lose my balance and fall over. My record is falling over 6 times during a bowls match. I was
carted off after about an hour due to the club’s health and safety rules.

I now only take my medication if I am playing bowls & I only take my medication then at 7am & 1pm, I do not take the evening dose.

My neurologist is happy for me to take my medication as and when I want to.

Of course everyone is different & what works for some doesn’t work for others.

Steve2

Hello Meg, thank you for sharing you and your husband’s experience. We’re glad that you have seen medical professionals, including your husband’s GP and consultants, to find out more and that your husband has been prescribed medication to help. It sounds frustrating that the computer system change meant you couldn’t find out how long it would be until your appointment. It must have been confusing when you were told that you could not be under the care of two people.

A DaTSCAN is a type of SPECT scan which is a type of imaging test that shows how blood flows to tissues (muscles, for example) and organs. A dopamine transporter scan, known as a DaTSCAN, is a type of SPECT scan that can tell your specialist if you’ve lost dopamine-producing brain cells. It’s the loss of these cells that causes Parkinson’s to develop. You can find out more on out more here: How is Parkinson's diagnosed? | Parkinson's UK.

We’re glad to hear that your experience has generally been good with your NHS Doctor and they have been supportive to you and your husband, recommending what tests are needed. However, we are sorry that this is not always the case and sometimes you are talked over.

We’re here for you. We have a helpline where we can put you in touch with one of our Parkinson’s nurses who can offer their advice and guidance as you navigate through this process and hopefully you can find out more information about usual time scales for the test and results. It’s free to call and totally confidential: 0808 800 0303.

We hope you’re able to get the answers and support you need :blue_heart:

Parkinson’s UK Moderation Team

Thanks Steve2, this is most helpful. In particular we recognise the drug Sinemet as being that which the new consultant is prescribing, and what it is for. I think the idea is that if it helps (he does have muscle stiffness and unsteady movement) it can point to being Parkinsons, so we shall see if that happens. Not good news, of course, but sometimes not knowing is no use at all.

Did you have any comment to make on the attitude of the NHS chap to us having sought a private opinion - which was only because we couldn’t get an answer as to when we might get an NHS appointment? NHS delays are sadly common these days.

This is probably the wrong forum, but I can’t see how we can go ahead with travel insurance for our upcoming cruise as we do not have a diagnosis yet. It may be that the Sinemet does it should which then points to PD, but if it doesn’t work then it is up to the insurers to decided I suppose.

Enjoy your bowls - my husband used to play, and was pretty good at it!

Morning Meg … You do not say how old your hubby is or if he has any additional conditions or whether his Parkinson’s like symptoms bother him at all.

Having been diagnosed with Parkinson’s just over 2 years ago and having had strange symptoms for 5 years before that I have kind of got used to it now. Diagnosis was a shock but no big deal. I did try Madopar originally but that did not work just made my brain feel hot. Sinemet I get on with. You should start with 1 pill a day for a week, then 2 pills a day, then 3 pills a day for a week, then 2 pills 3 times a day.

Aged 59 I was diagnosed with an aggressive form of Prostate Cancer, now that was terrifying. But I had my prostate removed and things are ok.

I had to give up golf though Parkinson’s. I do miss playing. But I enjoy bowls.
Also I cannot go for a walk or go shopping. Also eating is amusing as I often stab myself with my fork [missed my mouth again].

My first NHS neurologist was a locum from Armenia. His speciality was Peripheral Neuropathy. He was excellent at getting me a datscan, mri brainscan and mri spine scan done very quickly. But quite useless after that. He left the NHS and I have not seen any other NHS neurologist since. I do have an excellent NHS male Parkinson’s Nurse. He is all I need really.

The private neurologists I saw were both excellent. But there isn’t really anything they can do. The examinations I had were thorough and what they were doing was well explained to me.

As regards your NHS neurologist … if he was any good he’d be in the private sector. His nose was put out of joint but he agreed that taking Sinemet was the way forward.
You will have to wait and see if it helps your husbands symptoms.

As to your travel insurance you should inform the travel insurance company that your husband is being investigated for Parkinson’s. They may increase your premium, do shop around. But it is not as though your husband has had a heart attack. The main danger of Parkinson’s, insurance wise, is that he might fall over. I would certainly go on the cruise.

Regular daily exercise is important.

Best wishes
Steve2

Dear Meg,
the „fight“ with doctor‘s egos sounds very familiar to me. I experienced this to the point where I was literally kicked out of the premises just because I was politely challenging the proposed therapy, asking „why“ or seeking advice and support for some different treatment options. And no, this post isn’t about criticising the doctors. They can be of great help- sometimes. But in case of PD, they are really facing the unknown, they have very limited options to fight it (while balancing the side effects), no time to dig into the details and the rising expectations of the community to solve the issue and make everything disappear so we can go back to our previous lives. This is impossible, and very frustrating for them too…

So I very much agree here with Steve: finding your own way by building your own opinion and experience is probably the best option. It requires some time and patience (trial and error), but in the end PD is our problem and so the choices and the decisions related to it are with us as well. Wishing you both all the best !

P.S. As for the cruise - go for it! I have done four so far and just booked the fifth one for the next year. PD alone is not the reason to refrain from doing it. Just make sure you fully inform the shipping company upfront. You will get all the support you need.

Hello madmeg

To start with your travel insurance issue first, purely out of interest, I put travel insurance when you don’t have a diagnosis and was amazed by how much came up these being three selected at random

Travel Insurance for Undiagnosed Medical Conditions | Just Travel Cover.

https://www.co-operative.coop/media/news-releases/co-op-insurance-offers-travel-insurance-cover-for-those-with-undiagnosed

I admit I have only skimmed them but you may find something in one of them that helps or maybe do your own search along similar lines.

With regard to the attitude of thankfully few professionals, I have learnt over the years to stand my ground and say so. I treat them with courtesy and respect and have a right to expect that in return. If I don’t understand, it is for them to answer my questions in plain english not for me to feel I am wasting their time. I am not a naturally confrontational person but I will do it if I have to because it is me who is living with Parkinson’s not them. It is not an easy thing to do, but do try not to just be accepting of something that doesn’t suit you. I find such people are not used to being challenged and the trick or skill if you like, is to keep calm, think about what you are going to say before you say it - don’t just react - then say it quietly but firmly, You might be surprised at the reaction you get but the main thing is you’ve made your point and in so doing it won’t fester in your brain becoming a bigger issue than it might otherwise be.

I hope you get the answers you need soon but most of all I wish you and your husband a wonderful holiday - with the right insurance cover that hopefully you won’t need lol.
Tot

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Well everone, husband has been on Sinemet now for over 3 weeks. Two weeks at 1 tab 3 times daily then 2 tabs 3 times daily. He is due to stay on this dose for another week but the GP only issued enough to last till tomorrow night (so 36 tabs short). We only noticed this yesterday.

The trial period seems to have done nothing at all - no improvement and no side-effects.

Phoned the surgery today to ask (a) should he get another prescription for the missing week or (b) should he start to wean himself off it in case he doesn’t get any more? We assume there is no point in continuing the drug if it doesn’t work.

The doctor said it was up to the private consultant who suggested the trial so we should contact him. Trouble is he is only at the private hospital we saw him at on Thursday evenings. Also his follow-up letter to the GP (copied to us) appears to say he passed care back to the NHS after this appointment.

The dose of each tablet is 12.5/50mg if that helps.

The NHS consultant who was “miffed” might be a better bet but we’ve left messages and emailed to no avail.

If hubby does not get any more tabs or advice we plan to start reducing the dose to zero by Sunday night. Does this seem sensible in the absence of any proper advice?

Why is it so difficult?

Meg

Good evening Meg … The sensible thing to do if you are short of the Sinemet tablets is to reduce to 1 tablet 3 times a day. Do not go cold turkey. Then contact your Parkinson’s team, whoever you decide that might be, as soon as you can.

I am on Sinemet and have found that it 100% helps. I was on Madopar for 10 days which made no difference so I was told to stop it. A similar situation to how you are with Sinemet.

If none of the Parkinson’s medication makes any difference then it is most likely your husband does not have Parkinson’s.

Best wishes
Steve2

Thanks Steve. We tried the surgery doctor, the pharmacist, and both private and NHS consultant, none of whom have got back to us. So as you have suggested he is weaning himself off Sinement over 3 days. It will have to do.

Where is the help when you need it? Why did the GP leave him 36 tabs short with no follow-up plan? Hey ho, good news that he probably doesn’t have Parkinsons but the symptoms of PN are still awful for him.

Meg

Meant to add, thank goodness for the kindness of people on Forums like this. I had cancer treatment last year (no complaints at all) but there were always people in the same boat there for help and reassurance on the McMillan forum.

It is unusual for a GP to prescribe Parkinson’s medication. Whenever I see my GP about something that may be Parkinson’s related she says see my Parkinson’s nurse.

There is a lot of guesswork with giving a Parkinson’s diagnosis.

Prescribing a drug like Sinemet for Parkinson’s symptoms is the right move. As it has made no difference then your husband might have been misdiagnosed.

Prescribing pills is all they can do.

Sinemet worked for me almost immediately. When I am on Sinemet my balance is good, when I was off Sinemet my balance was often bad.

Best wishes
Steve2