QUESTION: I have been waiting daily for you to discuss Parkinson's disease, which my spouse has. I am so disappointed at the treatments he gets - one drug to another, etc., with no real progress. Should I seek a specialist? - Mrs. V.L.
ANSWER: It's nice to have a physician who has treated Parkinson's, but almost any family physician has encountered it and is able to treat it. Neurologists are specialists in Parkinson's, and it sounds like you want the opinion of one.In all honesty, I should come to the defense of your doctor, who very likely is following standard guidelines insofar as drugs are concerned. This can be frustrating, but it does have logic.
You cannot cure Parkinson's, only control things, so a long-range perspective becomes paramount. For example, the strategy is to use the less dramatic drugs first to see if one or another or a combination is going to bring improvement. Eventually, you may have to turn to the more potent medicines. Levodopa is usually one of the last used, except when symptoms are severe upon diagnosis.
When all's said and done, the long-range goal is to employ the least harmful drugs for the longest possible period, saving the heavy artillery for later, when the patient may really need them. I am sure that if you address your concerns and doubts to the present doctor, he will explain all this to you. He may offer to have another doctor give a second opinion as to present treatment. Parkinson's is discussed in report No. 24. Order by writing Dr. Donohue/No.24, Box 830, Gibbstown, NJ 08027-9909.
QUESTION: When I lost my husband several weeks ago, I was in a terrible state, very depressed. I agree with you wholeheartedly in your encouragement of the cautious use of anti-depressants under these circumstances. My doctor wisely believes the same way. It helped me a lot. You didn't mention that one should go off such medicines gradually. Isn't that important? - Mrs. O.
ANSWER: I see no reason why a patient in situations like yours, where depression is so common, should not be treated the way your doctor treated you. Many people have the notion that such drugs are habit forming. They aren't, really.
Yes, with some anti-depressants, abrupt withdrawal can cause unpleasant reactions, so those drugs are reduced gradually. Another point I may not have made is that the patient must recognize potential side effects during therapy. Most of those are rare and occur in a small number of patients. I am thinking of drowsiness especially. If one drug causes trouble, others may not. Thanks for your pleasant note.
FOR MRS. C.O. - The drug you heard about is called clomipramine. Yes, it has been used with some success to curb compulsive pulling out of hair (trichotillomania). I cannot evaluate this therapy for you, but your own doctor can interview your daughter to see if she is a candidate for its use. Its apparent action lies in permitting the person to resist the urge to pull on the hair.
QUESTION: Discuss heel spur cause and surgery. - N.K.
ANSWER: The calcium deposit (the spur) is not the problem, but a sign of the problem, which is irritation and subsequent inflammation of tissue on the bottom of the foot. It centers on the heel-bone attachment. The pain ends with easing of the inflammation, as by changing shoes, use of padding, or cortisone injection. Only rarely is surgery required.
Dr. Donohue welcomes reader mail but regrets that, due to the tremendous volume received daily, he is unable to answer individual letters. Readers' questions are incorporated in his column whenever possible.