Q. When you diagnosed me with Parkinson’s disease, you seemed to nail it pretty quickly. Normally, it's difficult to diagnose PD, isn’t it? What are the specific nuances you are looking for?
Dr. Wagner: Observation is key. You can look at a person across the room, watch their facial expressions; do they stare? Do they shift in posture? PD patients don’t tend to shift. Shuffling, stooped posture, balance, and softer speech are sure signs that Parkinson’s disease is the culprit.
Q. Do you have any theories as to what causes PD?
Dr. Wagner: My thought is that it is environmentally related. People who live on farms, or others with exposure to insecticides.
From a Reader:
Q. I have had a sudden, yet gradual development of hypokinesia, e.g. rising from a chair (but with help of using the arms) or difficulty in turning of the body in bed. Does it call for an increase of the present dosage of dopamine or something else to do?
Dr. Wagner: It calls for an increase of medication. The timing of the dosage may be need to examined. Or you may need a longer-acting dopamine agonist. The better solution is Neupro, a patch that delivered continuous 24-hour dopamine agonist, which was taken off the market. It seems that it was taken off the market as the acting ingredient wasn’t working as well as it should. The rise and fall of the meds was almost eliminated with this product. You had a predictable response. The good news is that a new medicine is coming onto the market: Requip Extended Release. One pill a day supplies steady medication for 24 hours.