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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How To Treat Parkinsons ?

hi doc,my grnadpa is suffering from parkinson's from last4-5 years ,,he is having regular tablets of pre-dopa ....but 2 1/2 moths back he was given dulcolex when he was not getting stools for 4 days during 2 nd day 1 dulcolex was given and 3 r d day 1 more was given since the prvious one had no effect.,,,,same was repeated on 4 th day....and the fifth day the combine effect caused heavy cosntipation for 2 days and he was so heavily affected by that he somehow survived ,,he is 82 now,,,but instead of recovering from that he started showing multiple problems,,,few days after that he had prostate problem dur to accumalation of urine...and then we disovered that he had hernia of which he kept us unaware ,,,doctor predicted that he had hernia since last4-5 years and he dint tell a bit of that ,,,so in this weakened condition hernia jus proved to be additional complication....he was totally bad ridden ,,both urine and excretion are totally cleared off on bed....during subsequent treatment his helath was pullsating ,,, whever he use to recover a bit and then again he wud become weak,,,a 1 month after he started having problems with cognitive abilities,,,but his health was recovering,,,it showed good signs of recovery but since last 9-10 days healh is deteriorating at faster rate he now rarely opens his eys,,,hardly speaks,,he refuses to eat food,,but he his continously chanting names of GOD RAMA,the whole day,,,he doesnt move his body...his body movements are like more or less locked...he has problem swallowing the food,,,

now d doctors have recomened to stop all kinds of tabs...so now after that we rehospitalised him,,,and CT scan was performed today...and it showed :->"acute/subacute infarct with necrosis in the left internal capsule of size 0.8 X 0.6 cm "...and 1 more thing to tell u about patients mental condition is that "he himself has decided since last 5-6 months that he has lived his life to the full,,he has seen his happy family...and now he shud be on the path to heaven..even that full day chanting is indicative of that.....would u please diagnose based on CT scan report ,,,do we still hope on him....his urine reports are normal BP: 70-120<blood creatinine ,,urea and electrolytes are also normalBlood report ::haemoglobin ::11.4 dm'dl ( 13.5 is min value)WBC count11550 cells/mm3 ( within limits)neutrophiles ::75% ( max is 70 %)stab cells - 07 %eosinophiles - 02 % ( within normal levels)basophiles 0% ( within normal levels)lymphocytes - 15 % ( within normal levels)wid slight hypochormia and microcytes present poikilocytes present ( mild) ..mild anisocytes,,,mild degree of stomatocytes...WBCs normal morphologyplatelets seen in discrete in clumps and are adequate..
Fri, 24 Oct 2014
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Internal Medicine Specialist 's  Response
Hi,

Thank you for your query. I can understand your concerns.
It seems that your dad had 'on' and 'off 'phenomenon while on levodopa i.e he remained locked (severe bradykinesia-when the effect of levodopa wears off).They can be relieved by increasing the dose of levodopa or smaller but more frequent doses, or by converting to a slow release preparation.
It also appears that he has suffered a stroke i.e ischemic infarct left internal capsule-which might have caused right sided weakness of his body.
An elevated WBC count with predominat neutrophils (75%) point towards additional bacterial infection probably urinary tract infection in bed-ridden patient.
Various co-morbidities are not uncommon at his age.He needs supportive care
Parkinsonian patient may have gastrointestinal and other symptoms
like constipation.
Early onset dementia suggests 'parkinsonism-plus syndromes'/ Atherosclerotic parkinsonism (loss of memory is very common).




Regards

Dr. T.K. Biswas M.D.
Mumbai
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How To Treat Parkinsons ?

Hi, Thank you for your query. I can understand your concerns. It seems that your dad had on and off phenomenon while on levodopa i.e he remained locked (severe bradykinesia-when the effect of levodopa wears off).They can be relieved by increasing the dose of levodopa or smaller but more frequent doses, or by converting to a slow release preparation. It also appears that he has suffered a stroke i.e ischemic infarct left internal capsule-which might have caused right sided weakness of his body. An elevated WBC count with predominat neutrophils (75%) point towards additional bacterial infection probably urinary tract infection in bed-ridden patient. Various co-morbidities are not uncommon at his age.He needs supportive care Parkinsonian patient may have gastrointestinal and other symptoms like constipation. Early onset dementia suggests parkinsonism-plus syndromes / Atherosclerotic parkinsonism (loss of memory is very common). Regards Dr. T.K. Biswas M.D. Mumbai