2.5.1 Reflective exercise
Mr Smith is a 74 year old man diagnosed with idiopathic Parkinson’s who has been seen in clinic for the last 8 years. He is taking sinemet 125mg four times a day. He was diagnosed with prostate cancer last year and is now on anti-androgen hormone treatment. He had polymyalgia rheumatica 3 years ago and had steroid treatment for 18 months. He has some back pain. He drinks 3 units of red wine daily. He suffers with constipation which is easily managed with aperients. He is hypothyroid on monitored replacement therapy. He takes bendroflumethiazide for hypertension, zopiclone to aid sleep, as well as aspirin 75mg for secondary cardiovascular disease prevention. He comes to clinic and it is noted that he is shuffling more than he used to and now uses a stick to walk. Coming through the door he gets ‘stuck’ and freezes. There is no ‘wearing off’ phenomenon. On examination he is wearing bifocal glasses, but his eye movements are normal. He has Hoehn and Yahr stage 3 Parkinson’s and has a moderately stooped posture. He has moderate bradykinesia and rigidity of his upper and lower limbs, more evident on the left than the right, and no red flags to suggest an alternative diagnosis to idiopathic Parkinson’s. He weighs 57kg and is 1.59m tall. He reports his main problem as feeling ‘really unsteady’ and as a result he is less confident leaving the house to do his weekly shop. He has not fallen.
Think about what you have learned in Section 2 regarding factors which make someone with Parkinson’s more likely to have reduced bone health. Remember that bone health can be affected both by Parkinson’s factors and other more general factors. There are several things mentioned in the text which may increase Mr Smith’s chance of having reduced bone strength. In your reflective log, identify as many as you can, and make suggestions for reducing their impact. Write down anything else you would like to check.
Discussion
You probably spotted that he has a number of factors including:
- Parkinson’s itself
- levodopa medication
- hormone deprivation therapy
- alcohol intake
- previous steroid treatment
- reduced mobility and therefore likely lower sunlight exposure
NB an overactive thyroid condition (hyperthyroidism) worsens bone health, but underactivity (hyporthyroidism) does not (as long as it is not over-replaced).
You might also want to check if he has a family history of osteoporosis or hip fracture, and whether he has sustained a fracture himself in the past. You could also check that he does not smoke. You might ask whether he was prescribed any bone treatment when he had his steroid therapy, and whether he is taking any over the counter calcium or vitamin D.
2.5 Activity