Issues of Hope

In the waiting room the older girl cares for her red- haired sister. The younger shines behind a fringe of bangs, her longer hair sweeps into a curl someone has taken the time to induce. She is not yet two and wears a pink dress. Her sister wears a white t-shirt with black graphics and her long pony tail hangs down her back. They are waiting for their mom. I am waiting for Parkinson's patients. We are still waiting an hour and twenty minutes later. They've found the bathroom and changed diapers. The younger has eaten cookies, torn pages from a magazine, crawled around the floor, peered through the glass window, giggled, fainted repeatedly into her sister's open arms, shrieked, cried, run out of the area provoking a chase, and tried to persuade her sister into taking off her bright pink belt, pointing to it, saying "Off. Mine."
Their mother appears suddenly in a motorized wheel chair. Though her face is glazed, I hear her say, 'shots in the back for pain' as her left hand motions to her spine and the older girl nods, concern in her features as she picks up the diaper bag, and scans the seats as they leave.

The PD patient arrives at last. He asks whether his wife may accompany him. She has an unlikely Spanish name. They have been married fifty years. I learn this in a tense moment between them when the doctor asks a question and they both volunteer information. He is from Spain, and his tone is sharp towards his spouse. His head and gesture of hand accentuate his request for her to let him speak. They were not born married, how old can they be?

He is fit and walks upright. They have come with questions and down loads from the internet about a doctor in Valencia, Spain who stumbled upon an apparent way to treat PD with an acupuncture needle in the ear; a non- invasive approach. This sets the doctor on a tangent about how he used to refer patients to an acupuncturist for tremor, but found patients were not greatly improved and how he works with a physician who used to be a neurosurgeon in China. Though he now works with rats, the Chinese doctor described a very special type of acupuncture in which a needle is inserted through the base of the skull into the brain; it has been used to cure blindness. In this country we call that neurosurgery, the doctor tells us.

The couple wants information. Fetal cell transplants, newer drugs? It has been a year since they were here. What about stem cells? In Santo Domingo they are giving PD patients infusions of stem cells, the patient tells the clinician.

"These are issues of hope." The doctor replies. If money is not an issue the doctor advocates 1200mg/ day of coenzyme Q10. Studies have shown some protective effects, but the pills are expensive and not covered by insurance. Azilect in place of selegiline will also improve slowing of the illness. Exercise is beneficial. The couple plans to travel to Valencia where they can obtain the Neupro patch in 8mg strength. The patch will also improve symptoms as the drug bypasses the digestive system and gets delivered through the skin continuously, avoiding pulsatile stimulation of dopaminergic neurons.

Though there is a patient in the room, the feeling is upbeat, healthy and striving. The disease has not settled in, and that is good.