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Ask Dr. Gott 8/8
No sure test for Parkinson's
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    DEAR DR. GOTT: I'm a 78-year-old male and have enjoyed relatively good health, allowing me to work several days every few months repairing knitting machines. I now take short, shuffling steps, stand in a stooped fashion and have a tendency to lose my balance. This has resulted in several falls.
    I see a primary-care physician at a VA clinic, a local internist, urologist, cardiologist and a neurologist. I have type-2 diabetes and have had episodes of atrial fibrillation in the past. My medications include metformin, simvastatin, warfarin, flecainide, a daily multivitamin and monthly vitamin B-12 injections. Further, I had partially successful atrial ablation in 2006 and cryotherapy for prostate cancer in 2007. My blood pressure readings and lab testing for diabetes are always great.
    After an MRI, I was told I do not have Parkinson's disease, but Parkinsonism symptoms. Two trials of carbidopa/levodopa gave initial improvement that faded after several days — even with dose increases.
    Do you have any thoughts on why my legs have become progressively weak? Any ideas would be appreciated.
    DEAR READER: You appear to be seeing the appropriate specialists to handle the plethora of medical issues with which you have had to deal. In spite of this, I will attempt to cover one issue at a time, so bear with me.
    Your type-2 diabetes is stable on the metformin dosage prescribed. The atrial fibrillation is held in check with the warfarin and flecainide. You don't indicate you have high cholesterol readings. I must interpret, therefore, that the simvastatin was prescribed for both your cardiac condition and diabetes. The vitamin B-12 injections and multivitamins are for fatigue and as a boost for what might be lacking in your diet.
    Now, on to the biggest issue. Symptoms of Parkinson's include tremor, rigidity, stooped posture, shuffling gait, fatigue, lack of facial expression and more. General weakness is relatively common with this neurodegenerative disorder.
    You appear to have several symptoms associated with Parkinson's disease but were not given a diagnosis as such. This leads me to believe that you may have some other condition causing them.
    Parkinsonism's symptoms can be caused by many conditions other than Parkinson's disease, including drug-induced Parkinson's, normal pressure hydrocephalus, vitamin deficiency, arteriosclerosis and more.
    You need to have a full neurological work-up including blood testing and a review of your current medications. There is no definitive test to diagnose Parkinson's disease, but there are tests for other disorders that can be performed to rule out other causes.
    Given the fact that you have symptoms of Parkinson's disease and have responded to dopamine therapy (even if for a brief time), you may truly have the disorder despite the fact that your MRI said otherwise. (Again, an MRI can't confirm or rule out Parkinson's; rather, it is based on symptoms, etc.)
    Get a second opinion from another neurologist, who might be able to help you more than your current specialist. Let me know what happens.
    To give you related information, I am sending you a copy of my Health Report "Parkinson's Disease."
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