I received another “NOTICE OF DENIAL” letter from my health insurance provider regarding yet another Parkinson’s drug that actually works for me. For those of you who are new readers, I receive these letters every year. They are a product of the ongoing feud about my course of treatment between my neurologist and the health insurance provider’s in-house pseudo-neurologist. A course of treatment that leads not to a cure but to an eventual decline brought on by a combination of the 56 symptoms listed below.
Neurologists have a small selection of drugs to choose from to treat Parkinson’s. These include several iterations of a carbidopa/levodopa mix, a few dopamine agonists, a few COMT inhibitors, and a few MAO-B inhibitors. All of these carry side-effects similar to the symptoms listed below. Herein lies the challenge for neurologists to design a treatment plan. A a neurologist has 56 symptoms to target with around a dozen arrows to shoot with.
Speaking of shooting, if I were prosecuting the murder case against Luigi Mangione, I would screen out any jurors who have received notice of denial letters. If you regularly receive these letters you could not help but be prejudiced against health insurance providers.
And no, I do not approve of Mangione’s actions. He was not justified in murdering someone over his health insurance. He would have been better off to have used his intelligence and social status to bring about insurance reform.
Still, the letters are an insult to my neurologist’s expertise and to my dignity as a patient, but I digress . . .
For my fellow members of the Parkinson’s club, I challenge you to review this list of Parkinson’s symptoms and determine if they left anything off. Just for the record, I have experienced around 95% of the symptoms at some point during the last 20 years though thankfully not at the same time. At present, I am probably experiencing a soft 35% on a daily basis.
From the National Institute of Health:
Not everyone experiences all these symptoms - at least not at the same time.
Symptoms vary widely in severity and progression.
Many non-motor symptoms can appear years before movement symptoms.
Early diagnosis and treatment can significantly improve quality of life.
Motor (Movement) Symptoms
Resting tremor (often starts in one hand)
Bradykinesia (slowness of movement)
Muscle rigidity (stiffness)
Postural instability (balance problems)
Shuffling gait
Reduced arm swing when walking
Freezing of gait (feet feel “stuck”)
Stooped posture
Small handwriting (micrographia)
Masked facial expression (reduced facial movement)
Soft or low voice (hypophonia)
Slurred speech (dysarthria)
Drooling (sialorrhea)
Difficulty swallowing (dysphagia)
Reduced blinking
Dystonia (muscle cramping or abnormal postures)
Reduced coordination
Difficulty turning in bed
Reduced automatic movements (e.g., less gesturing)
Cognitive Symptoms
Slowed thinking (bradyphrenia)
Difficulty concentrating
Memory problems
Executive dysfunction (planning, organizing issues)
Visuospatial problems
Hallucinations (often visual)
Delusions
Confusion
Dementia (in later stages)
Mood & Behavioral Symptoms
Depression
Anxiety
Apathy (lack of motivation)
Irritability
Mood swings
Impulse control disorders (e.g., gambling, shopping, hypersexuality)
Social withdrawal
Sleep-Related Symptoms
Insomnia
Excessive daytime sleepiness
REM sleep behavior disorder (acting out dreams)
Restless legs syndrome
Vivid dreams
Frequent nighttime urination (nocturia)
Sleep fragmentation
Autonomic (Body System) Symptoms
Constipation
Low blood pressure when standing (orthostatic hypotension)
Sexual dysfunction
Urinary urgency
Urinary frequency
Incomplete bladder emptying
Sweating abnormalities
Oily skin (seborrhea)
Temperature regulation problems
Fatigue
Sensory Symptoms
Reduced sense of smell (hyposmia or anosmia)
Pain (musculoskeletal or neuropathic)
Tingling or numbness
Visual disturbances (blurred or double vision)