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  1. excellence of the soul
  2. lost art of healing
    human touch
  3. symptoms
    • difficulties with attention, concentration, problem solving
    • depression memory
    • loss control of body movements
    • hallucinations/violent REM sleep
    • degenerative
    • eye sight
    • more than 1.5 million americans, 60,000 more cases diagnosed each year
  4. want to end life
    • when he can no longer control his bowels and bladder
    • holding onto dignity (spinning classes, yoga, play drums, shave, dress well)
  5. what has become as essential as medication
  6. if he can see glass, how come he doesn't know if it's upside down
    lost the ability to translate sight into understandable reality
  7. hyperkinesia
    extravagant, involuntary body movements and tremors
  8. dyskinesia
    • lack of body control
    • slurred speech
    • fine motor skills suck
    • balance is problematic
    • freezing gait
  9. ADLs
    activities of daily life, how does the disease affect it
  10. micrographia
    • writing too small to understand
    • hypotension (drops in blood pressure can faint)
    • drooling
  11. bradykinesia
    • slowness of thought, in execution of movement
    • voice modulation (becomes like a whisper)
  12. zoloft
    prescribed for depression, depressed sex life (didn't tell Vicky that he went off of it)
  13. cardiac syncope
    • on the morning of his wedding
    • drop in blood pressure, heart rate, loss of consciousness
  14. helen glaser
    registered nurse who worked with him
  15. felt hot in neck
    relaxation of blood vessels that accompanies a sudden drop in blood pressure
  16. bradyphrenia
    • slowness in response time in thinking
    • Growdon was the renewed neurologist
  17. three straws that broke his denial
    • helen's frank assessment
    • difficult meeting with all the groups peers
    • second opinion from another neurologist
  18. vicky
    interior design
  19. luxury that most PD patients don't have
    hired help
  20. two types of anger in their marriage
    • personal anger (anger directed at someone)
    • trying to recapture the past is lie trying to catch the wind in a butterfly net (vicky didn't want to see his videos)
    • situational anger: angry at the circumstances that they found themselves in
  21. how does he bolster his self-esteem
    reread his CV
  22. broyard when he was dying of prostate cancer
    i wish he would bored on my situation for perhaps five minutes, give me his whole mind, bonded with me for a brief space, survey my soul
  23. Dr Y
    listened to his voice, not just to his heart (which other doctors called a time bomb) and beau self ht optimism that he conveyed to him (Dr. Y had strong motivation b/c of family)
  24. what are overall disease management strategies that others have ignored?
    • exorcising anxiety and reducing stress
    • doctor has to convey conviction that if the patient follows the management plan, he will do well
    • if you let the patient speak unhurriedly, he will often tell you something essential to the diagnosis
  25. what two questions does graboys ask patient as window into their lives?
    do you look forward to going to work in the morning? do you look forward to going home at night?
  26. what request does Graboys wanted to ask his neurologist?
    have the doctor call him every month, wanted a guide (got call from 6 months to 3)
  27. Mrs H had heart and cancer and one day Graboys forgot to examine her heart
    if he could no longer be bothered to examine her heart, it meant the cancer was so serious that it had rendered her heart problem irrelevant
  28. how did Growdon open the conversation?
    how can i help you not whats wrong
  29. what did Growdon promise Graboys?
    to keep his records private, to be his advocate, do anything he could to keep his career
  30. Tom's last vestige of independence
    • drive
    • another car hit him in parking lot
    • hit cyclist without luminescent clothing
    • eliminate night time driving (making little concessions)
  31. how do the physicians that deal with terminal illness function
    maintaining a little distance
  32. what is the worst patient in Tom's mind?
    • doesn't follow management plan
    • tweak medications
    • don't want to take tests or lying on them
  33. what does writing this book mean?
    push back at the disease, get him up and go to work, be a doctor to his readers in a life where losing control is the central theme
  34. what was susan block's program?
    paired up first year harvard med students with terminally ill patients (importance of listening and compassion)
  35. what was the lucky situate with susan?
    • tom had know her a long time, she is bringing in her knowledge of the old Tom in treatment of the new
    • helped him to life beyond PD (make a list of things you would want to do if you retired)
    • emotional upheaval
    • to live with dignity
  36. writing the book is
    • therapeutic by putting words to feelings
    • and to remind Tom of his strengths and the way he continues to contribute
  37. what is one thing that brought tom solace?
    thinking about Caroline, allay anxiety
  38. asked Mr. B (appeared demented but he was in complete control of his faculties)
    • tom asked him to bring his family in 
    • joined by others in their struggle (unity)
    • family provides valuable information
    • family can benefit from doctor's counsel
  39. what can be interpreted from doctor's brevity?
    loss of hope
  40. tom was really good at judging other, what did dementia do to increase the burden of his illness on others
    his ability to assess and judge his own behavior was compromised b/c of dementia
  41. george graboys
    • stooped posture, mouth agape and shuffling gait
    • how do we deal with it: sustain Tom's ego and self-esteem
    • tom can't give deep answers anymore
  42. Jen (Vicki's daughter)
    • tom's situation gave her a heightened sense of vulnerability 
    • worried about mom needs support system, need to enjoy life
  43. carson (vicki's son) in CA
    • mom can't have the life she wanted to have
    • hindered her ability to tend to their concerns a little
    • raw deal (can't move on with something like this)
  44. olivia (vicki's youngest)
    • mom isn't living the life she thought she would
    • mom is quicker to anger
    • tom wants her to show him how to do things, instead of doing it for him
    • afraid mom will be alone
  45. what is tom's job with vicki's children
    • to break down anxiety 
    • for his own children, he yields as little to his illness as he can (try to be normal)
  46. team graboys
    • all the children and their husbands and tom cares for caroline
    • the new team includes the stepchildren
  47. penelope, oldest daughter
    • san francisco, law firm
    • worried initially about his depression, started to see him slow down
    • throw out love letters with Caroline
    • miss meaningful conversations with dad
    • not really become an adult until one loses a parent
    • cares about his grandchildren
    • wants them to move to CA
  48. patrick
    • normal part of aging, PD accelerates it
    • if they lived nearly, takes some of the emotional issues off of Penelope
    • worse things can happen, wish children could see the old tom
  49. sarah, vet
    • lost her father in some ways, tom was always the go to guy
    • try to treat him the same, but not always possible, try to laugh about it
    • tight with making sure he hasn't fell, ext
    • struggle to carve out a space for her own family
    • put a finger up in the air and draw a circle around his head (pull him out of his self-indulgent moments)
  50. tom (Sarah's husband)
    • provide companionship and support Tom
    • daughters expect a lot when they call, but he can't reciprocate
    • the legacy of tom is teaching his kids to ask questions (though he can't debate now)
    • uses humor to deflect stress
  51. what requires a great deal of energy from Tom?
    • struggle to remain engaged and active 
    • grandchildren motivates him
    • seeing him active is therapeutic for those around him
  52. what was the bargain tom was willing to make with dementia and PD
    • that it would be static
    • afraid that those around him will get worn down emotionally with time and he doesn't want to be a burden
  53. what is a worse symptom in LBD than AD?
    visual perception
  54. Franciscus boe
    first description of tremors in 1600
  55. 1817 james parkinson
    palsy: paralysis with tremors first to write essay on it
  56. charcot
    • late 1800
    • discovered effective pharmaoclogical treatments
  57. 1912 Lewy
    described cytoplasmic inclusions
  58. hornykiewicz 1960
    showed striatal dopaminergic depletion in PD
  59. 1957 carlson cotzias
    clincial applciation of L-DOPA
  60. Benabid DBS 1987
    deep brain surgery: electrodes to reverse damaged neurons
  61. garnett 1976
    f-fluoroDOPA (PET imaging)
  62. bjorkund 1970
    development of neural transplantation
  63. what percentage of population over 65 affected?
    • 1-2 %
    • most common movement disorder
    • 2nd most common neurodegenerative disorder after AD
  64. average age of onset
  65. what age does incidence/prevalence peak?
    • 70-79 at 100/100,000
    • the difference between them is that prevalence does not go down steep after this age (more people have it persistently)
  66. risk factors
    • age
    • male
    • family history (positive)
    • environmental factors (herbicides, pesticides)
    • race (not asians)
    • life experiences (stress)
    • less risk with smoking and caffeine
  67. clinical features
    • resting tremor
    • bradykinesia 
    • muslce ridigity
  68. rigidity
    muscle tone increased in flexor and extensor muscles provides resistance to passive movements, stooped posture, anteroflexed head
  69. where does first symptons occur
    • in hands or arms 
    • tremor disappears with purposeful movement 
    • essential tremor (shaking while doing activity)
  70. postural instability
    due to loss of postural reflexes (push and they fall)
  71. other clinical features
    • postural instability
    • dysfunction of the autonomic nervous system (impaired motility, hypotension)
    • depression
    • cognitive impairment
  72. REM behavior disorder
    premotor phase, possibly correlated with parkinsonism
Card Set:
2015-11-19 20:31:48

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