Possible mild Parkinson's Disease - the clinical picture is not definitive. The DAT scan showed borderline
abnormality on the right side (which would affect the left body), but the patient has more prominent
symptoms on the right side. There is no cogwheeling, rigidity or bradykinesia on examination, though
there is a mild postural tremor in the right hand and slight intention tremor on the left when approaching
the nose.
2. Lumbar facet joint hypertrophy at L4/5 - this may be contributing to his difficulty straightening up and
walking problems.
3. Recent left leg numbness episode - this could potentially represent a small stroke given his risk factors
including atrial fibrillation, though he is on Apixaban.
4. Sleep disturbance - ongoing difficulties with sleep, possibly worsened since stopping Parkinson's
medications.
Management:
I will restart levodopa/Carbidopa (Co-careldopa) at a lower dose - one tablet twice daily (morning and
midday) with option to take two tablets in the morning before playing bowls.
I will restart Rasagiline one tablet daily for potential neuroprotective benefit.
I have asked the patient to perform back stretching exercises - bringing knees up to chest while lying
down, especially before getting out of bed or chair.
I will arrange a repeat MRI brain to investigate the recent numbness episode through the patient's
insurance at the AMEX stadium.
I will request the GP to prescribe a short-term Z-drug sleeping medication for maximum three weeks.
Follow-Up: I will review in one year unless significant changes occur.
Yours sincerely,
I saw my neurologist Privately for the second time on Thursday. It was an interesting meeting and we talked about my being off Parkinson’s medication completely for the past 6 to 7 weeks.
The difference between being and not being on Parkinson’s medication was marginal for me. The only measurable difference was my having balance problems in the past two weeks, which led to me cancelling 3 games of Indoor bowls and only able to play five times.
The above is his opinion.
Going forward he has suggested I vary the amount of Parkinson’s medication I take.
If I intend to play bowls I take more pills if I am not playing bowls I take less Parkinson’s medication.
Thank you for sharing this update with us Steve. It sounds like you’re doing the right thing by speaking with health specialists about your medication, which we’d always advise.
We hope that you’re feeling ok about your treatment, and remember we’re here if you need us. Our helpline is just a phone call away: 0808 800 0303.
Hi Steve L4/5 gives me problems as well ,
Sitting and walking and trying to do jobs is a pain literally.
I had severe pain in my legs for about six months numerous doctor’s visits , eventually I went to a chiropractor who diagnosed me instantly Parkinson’s and back problems.
It’s ok provided I don’t try to do too much.
The whole diagnostics took a year.
I was in tears with the pain , why the doctors didn’t connect the dots is beyond me.
I am glad I went to the chiropractor she sent a letter to the Doctors surgery and then things started to happen, they got moving.
I have hernia and a prostate problem as well
, I think as you get older bits of the body complain…
I think the back problems are an old injury I had in my twenties.
You still lead in problems chart but I am catching you up.
I had an amended report from my neurologist today. See below.
Best wishes
Steve2
On examination, he had normal facial expression, normal voice and normal in enunciation of speech. He
took quite a long time to get out of the chair and was initially oddly bent at they hips bilaterally but
gradually straightened up and as he walked. He appeared to have some old hesitancy of initiating gate
when starting to walk but it was not typically parkinsonian in appearance. He had an intermittent postural
tremor of the right hand which looked organic and there was also an intention tremor mild intention
tremor in the left hand particularly on approaching the nose. There was no cogwheeling or rigidity and no
bradykinesia or hypokinesia of fine finger movements. Waving was well performed as were other rapid
alternating movements of the hands. Foot tapping was also normal. He appeared slightly unsteady on his
feet, he had very good arm swing bilaterally, but his gait appeared oddly robotic.
MRI Lumbar spine from June last year showed facet joint hypertrophy at L4/5.
DAT scan re-reported by Prof xxxxxxxx, was within normal limits with only borderline caudate-putamen ratio on the right side.