[harley]

hospital stay of four days was only partially due to med interaction.. most was anxciety.. here are some of the direct findings and quotes taken from my 16 page s of records taken from neurology, rehab psychology, and psychiatry depts while tthere.

the stuff i found most interesting i will type in bold font

neurology priliminary report

admission.. chief complaint.. increased rigidity

patient here today with acute worsening of rigidity at home. reports rigidity throuughout her body has worsened dramatically and is concerned "something is terribly wrong" has pain in the form of parasthesias in legs/feet bilaterally which is also unbearable. she has been taking xanax at hme to try to alleviate these symptoms with no relief. she is accompanied by her husband today.

when intervied away from husbamd she reports increase in the amount of stress at home. there has been verbal and emotional abuse. she denies physicical abuse, yet reports being left on the ground for long periods of time after falls. she endorses that some of her symptoms seem to worsen with sinemet doses. she gets increased rigidity and increased freezing after dose.

in ED, she was given benedryl 25ivx3 as well as sinemet 2/100. remarkable improvement with benedryl each time, with almost complete resolution of symptoms..

past medical history
parkinsons disease
dbs
history of encephalitis at the age of 15 with no residual structural abnormalities on brain mri. recovered fully

yada yada yada

physical exam
appears anxious and uncomfortable.
yada yada
motor: nl bulk, increased tone r arm/leg, L arm, leg- paratonia rather than cogwheeling. no PD, 5/5 strength in b/l U and LE
yada
movements: slight tremor in r arm/leg with posture, not pillrolling, less at rest. bradykinetic throughout exam
gait: lurching gait, not shuffling. unsteady, requiring assistance

yada yada

hospial coursee:
50 yo woman with parkinsons disease, dbs, on several pd agents here with worsening anxiety and increase in rigidity who on exam has findings tha are not as consistent with parkinsons pathology but difficult to fully sort out. it is evident with further history that she has an inadequate home situation that is causing her increased stress. . she was admitted to neurology to further sort out her motor symptoms and fluctuations. her main findings on exam were fluctuatingparatonia, tremor and gait disturbance which were thought mostly to be duee to anxiety or med fluctuations from parkinsons disease, although atypical there were times (after benedryl or early morning) that the symptoms were gone completely

final report

patient much improved this morning. sitting, eating breakfast, no tremor, no rigidity. later on rounds when pt was seen with her husband in the room, pt wasss in bed, had visible tremor of upper and lower extr and complained of signicant rigidiy. pt now stated that she needs an increase in sinemet .
yada

throughout the 4 day hospital course we made several changes to her parkinsons meds. pschiatry recomended discontinuing trileptal because of possible serotonin syndrome when used with selegiline. clonazpam was increased to 2 mg a day. patient did well with med changes

final report

sitting in chair, eating breakfast
yada
motor: no rigidity, no tremor
gait: up, without walker, steady

assessment/plan
findings not consistent with parkinson's pathology, difficult to sort out.

1. PD: symptoms waxing and waning. anxiety seems to be a significantly contributing to pt's symptomatology. pt appears worse when husband is present in the room.


yada

attending statement..

my exam of pt was 3 hours after dr r's. his exam was 1-2 hours after sinemet dose, mine was 4-5 hours after. husband was present for my exam which was very different. very increased in tone in bilateral arms. pt seemed to be resisting me. she was lying in bed and could stand with walker but couldnt walk. hard to know if this is fluctation or if there was embellishment.

since clonazapan increase, pt has been leaving room for frequent smoking breaks. it is my belief that anxiety is playing a major role.

home situation: social work has documentd her concerns and given her multiple resources. a report was made to the adult protection agency. on discharge she has decided to stay in her rv

she is not planning on moving back with her husband at this time.

that is part of the hosp statement. i am tired now.. see my shrink tomorrow. will report more then.

[Evon]

Harley, I hope your are doing better. Your story is very familiar to me. Last year I had a a lot of stress due to a relationship I was having with a man who at first seemed very genuine but as time went by I realized he was using me and others to get money to pay off his increasing debts. I am not sure what to believe now as it all seems so surreal. I do know that my P.D. symptoms went crazy, I had dystonia that was so painful I was in tears and had increases in my meds which didn't seem to help. It seemed as though the meds were bringing on the symptoms that I was trying to get rid of. Since I have been removed from the situation for about 4 months now I have gone back to feeling better and have reduced the meds to what they were before all this mess started. In hind site I realize my body was reacting to the huge stress load and it was out of control. Your need to stay away from whatever it is that has set you back. You need to be strong and take charge, you will feel a lot better if you do.

[lou_lou]

PD: symptoms waxing and waning. anxiety seems to be a significantly contributing to patient's symptomatology. pt appears worse when husband is present in the room.

yes - my ex was the punisher of my life -divorce set me free but ex-took
hostages - our son -
cest la vie - dear harley darlin
my father used to say -or perhaps it was rosanne rosanadana from SNL
-its always something?
I can get the same uncomfortable edgie nervous electricity from the air
around people -that have strong emotions or hyper -people that remind you
that you are going to be late?

[reverett123]

Our medical philosophy divides us into artificial systems in hopes of understanding the whole. Endocrine, immune, and nervous are labels for portions of us most involved in PD.

Each of these sends out chemical messengers and receives those of the others and react. Ron's tooth gets infected, the systems react. Harley's spouse enters the room, ditto. Stressors of any type perturb the system. Each time it gets a little harder to put things to rights.

[Fiona]

Yeah. Me too. Thanks for sharing this, Harley - very personal material - I do appreciate that. It seems remarkable that they didn't even think you had PD at certain times!!! The brain sure is kind of plastic, and that emtional/physical nexus/matrix that PD straddles very clearly can really shape a lot of our experience...

[stevem53]

Stress is like Kryptonite to a parkie..When I have something upsetting, or bothersome on my mind, I get progressively worse, especially when it involves the confrontation of a person who is causing the stress/upset..Near the end of my relationship with my ex girlfriend, she came down for a week, and I felt trapped because I didnt want to be with her, and I spent more time laying on the couch than I cared to..I felt like jumping out of my skin

I also had a friend that I wasnt getting along with..(through no fault of my own)..and every encounter with this guy in the course of about a year was was like oil and water..Come to find out, he was miserable because he was bottling up some personal problems, and wasnt very pleasant to be around..Now that his troubles have passed, we get along fine, and I dont get a pit in my stomach, and a feeling of dread when I see him turn into the dock parking lot..As a matter of fact we are going clamming..(steamer clams)..tomorrow..He is going to dig, and Im going to pick/sort, and bag the clams

Stress sucks!!!!..The mental crap from this disease really throws me for a loop when Im not at peace

[smithclayriley]

Harley your report says it all. Please read it every day. Your answer is there. I hope that you will see your strength. Choosing yourself and ending what sounds like a very stressful marriage is an option. I don't mean to sound flip but reading your story it really stands out. My heart goes out to you.