Doctors reply

I took my dad to the doctor, and I told the doctor that I doubt whether the medication is having any good affect on my fathers health and he told me that I was being 'rude'. But I do have doubts about my fathers response to levadopa,

[1953bullard]

I would change neurologists. I had to fire my first one.

[Greenday]

Your doctor should follow up with a UPDRS exam (Unified Parkinson's disease rating scale) en.wikipedia.org/wiki/Unifi... designed to assess and evaluate by interview and clinical observation PD patients.

Doesn't hurt to seek for a second & third opinion. A good doctor should always be able to listen patients, use recommended for the disease tools and exams and adapt their medication accordingly.

[lempa_nik]

If your doctor said something as caustic as that, then his bedside manner is right up there with the likes of Dr. House and Doc Martin. If he also talks to his own wife like that, then it's no surprise that he doesn't have one

[Hidden in reply to lempa_nik]

Pardon me I couldnt understand what you mean by Doctor Marten? Unfortunately he did get angry at me when I told him that I doubt that the medication (stalevo) is having any impact on his state as I see no improvment in my fathers state and infact my father seems to have more walking problems after the meds. But the doc got angry at me and said I was being 'rude' by not trusting him etc

[Seamus606 in reply to Hidden]

Doc Martin is a fictional UK drama series, the title character is an abrasive seaside GP.

Good on you for questioning the Meds, I told my neuro straight, that the Meds she prescribed me were useless (for me)

You must always push and question everything.

[Hidden in reply to Seamus606]

exactly I am in turkey, but the more I push and the more I question the doctor gets irritated and says Im being rude..he is not open to critisicm ...

[park_bear in reply to Hidden]

That unnecessarily defensive behavior not a good sign - you were merely giving a report. If a medication is making a patient worse instead of better the doc needs to deal with it. Change MDs if you can.

[Hidden]

yes I can not talk to him about my concerns worries ..he just says hes not interested in my anxieties and says its rude that I dont trust his medical opinion, but I see my father at home and to be honest I have not seen any improvement , especially in his slow movement and slow walks

[Greenday in reply to Hidden]

Stalevo is actually the combination of 2 main PD drugs:

Sinemet (Levodopa, Carbidoba) + Entacapone.

How long your father has been taking this drug? Does your father experience tremors? Maybe he needs re-adjustment in dosage

Did you doctor exclude other PD pathologies such as MSA? Some PD syndromes have lower response in Levodopa administration.

I recommend visit a PD movement specialist

[Hidden in reply to Greenday]

my father has been taking these meds for 2 months, but he has no tremors..the doctor had an MRI scan thats all and a pyhsical examination by doctor. But since these meds he is slower in walking and talking and his face has a mask

[Hidden in reply to Hidden]

what is an MSA? no my father didnt have that

[Greenday in reply to Hidden]

Multiple System Atrophy (MSA) , also PSP, DLB, CBD belong to Parkinson's plus syndromes emedicine.medscape.com/arti... . MSA resembles to PD but recognized by rapid progression of the disease, poor response to levodopa drugs and sometimes no tremors. It may present autonomic features such as urinary retention or incontinence or orthostatic hypotension

Parkinsonian symptoms can occur frequently in multiple system atrophy (MSA). Approximately 10% of patients with a diagnosis of Parkinson disease are found to have MSA at autopsy.

emedicine.medscape.com/arti...

Clinical differentiation of Parkinson disease from MSA is very difficult

Especially in the early stages of the disease, it is extremely challenging, even for the experts in the field to detect with MRI techniques the specific atrophies caused in msa and PD syndromes and differentiate them from PD. emedicine.medscape.com/arti...

* A better way to differentiate Parkinson's from other PD syndromes is the use of 23I-IBZM SPECT or preferably the FDG-PET scanning, which produces more accurate results emedicine.medscape.com/arti...

Those scanning techniques can measure the postsynaptic dopaminergic function (D2 receptors) which more affected in parkinson's plus syndromes

DATSCAN is another examination tool, commonly used to measure the presynaptic dopaminergic function (D1 receptors). It can verify the presence of a dopaminergic disease but cannot differentiate Parkinson's from other syndromes.

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Regarding PD drugs: many doctors are cautious when administering levodopa drugs to first time patients. Initial prescription may start with the lowest dose possible which may be ineffective for the patient. This allows for the body to build tolerance to levodopa and the doctors to observe for possible side effects. The dosage is gradually increased until a clinical improvement is observed.

[Hidden in reply to Greenday]

Thank you so much for this

[ddmagee1]

You are reporting to the doctor, that you don’t see improvement in movement function for your Dad, with the use of the prescribed medicine. Does the Dr. see improvement? Does your Dad feel improvement? I would think the Dr. would listen to what you have to say and give you an answer, as to what his plan is to check on improvement and the use of medicines, in the care of your Dad, rather than stating that you were being “rude”. That sounds like a “cop-out” to me. If your Dad is not responding to Carbidopa/Levodopa/+Entacapone, then you deserve an answer, as does your Dad, as to why? Since this Dr., as you say, does not respond well to criticism, and you are not getting answers to your questions, perhaps seeing a movement disorders specialist ( another specialized neurologist ) would be a good idea. I would check credentials and recommendations, to ensure a good experience. Diagnosing PD and neuro-degenerative diseases can be very challenging, along with treatment programs for them. Having the right specialist can make all the difference for a patient and his family. I hope you will be able to get another opinion, and that a correct diagnosis and treatment program will happen for your Dad. My daughter went through a similar situation with me. It took nearly 6 years to get the right diagnosis and treatment for my PD symptoms. It was a rough time for me, my daughter, and my family.

[Hidden in reply to ddmagee1]

Thank you so much for your kind reply