The Tree Analogy

The physician still questions the diagnosis of Parkinson's disease. He comments microvascular disease, caused by years of high blood pressure, results in ischemic changes in the brain, that eventually presents in lower body parkinsonism. Today her blood pressure is 147/73 with blood pressure lowering medication. To explain, he gives the tree analogy. The trunks, the carotid and jugular, are strong and capable of providing nutrients to the limbs above; only the twigs at the very ends of the limbs suffer from too little circulation and those leaves grow yellow and eventually crinkle and die. Due to the way the pathway of nutrient flow, the illness affects the legs before the arms and face.

The patient comments she's afraid to go anywhere without the cane. Five days ago, she fell heading into her bathroom, her arms full of toiletries. The plastic containers were unharmed, but she bruised her body and self-confidence. The doctor explains when a patient complains of frequent falls, think of lower body parkinsonism.

Examining the patient, she has no shaking. He comments about a third of PD patients have no hand tremor. Hand movements and coordination are both good. When he asks her to strike her foot repetitively her tappings dwindle, the movements become smaller and diminish entirely.

There is little he can do to keep her from falling. Medications have little affect on balance. The clinician mentions physical therapy and comments Medicare will pay for two prescriptions of therapy per year. Therapists will also be able to judge whether she's suitable for a walker or other device. The patient comments about Tai Chi and how she'd like to enroll in a class, to improve her balance. The physician likes the idea and turns to Goggle to search for a nearby site where she can work on becoming more rooted.