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The patient brought his wife, copies of MRIs, a DVD of the brain, and multiple copies of his medical records. The doctor of the day took the page listing all his symptoms. He admitted he'd been to several neurologists, Shands Hospital and the Mayo Clinic before arriving in the new examination rooms with the movement disorder specialist, one second year medical student, one undergraduate psychology student and a writer.

The list of symptoms was long. For some reason the first complaints he reported were not typical of PD; a feeling he was ill, that something was wrong. His mind felt clouded. He gave up exercising, believing he shouldn't do the things he used to do. No more rollerblading or riding the bike. He felt his ability to walk was different, compromised. The wife thinks his face has become unexpressive and blank. Maybe the largest problem is the high blood pressure- he takes four medications, and still the nursing staff recorded a diastolic pressure close to 180.

The wife is a nurse and agreed to monitor the blood pressure for a week and report on her findings. The doctor felt reluctant to prescribe medications until he was knowledgeable about the blood pressure and his heart, requesting an MIGB study.

Upon examination, he had no visible resting tremor, though his wife reported his left hand did tremble. With two arms outstretched, a fine shake quivered in the fingers of the left hand. Distracted by trying to pat and turn, pat and turn the right hand, the doctor felt some cogwheel rigidity at the muscles near the joint of the left elbow when moving the arm from flexion into extension.

As completely as possible the patient documented all the symptoms he experienced- from a strange feeling in the skin of his face, to nausea, to the certain feeling he had that there was something wrong with him. He even suggested that perhaps some symptoms were all in his head, because he'd lost the ability to distinguish the important symptoms from the ones that simply indicated he was sixty- five- like the crick in his neck he occasionally felt.

What could this doctor give him that other one's failed to do? The specialist in movement disorders told him he probably had a parkinsonian syndrome, which one was still unclear though he favored Shy- Drager, because it explained the blood pressure involvement. The physician gave him an hour. He sat with him and listened to him and his wife speak about the changes he's experienced. He ordered a heart test and requested monitoring of his blood pressure. Would this be enough?