After listening carefully, a doctor is able to perform a `miracle'

November 18, 2005|By FRANK D. ROYLANCE | FRANK D. ROYLANCE,SUN REPORTER

Family members wheeled the 76-year-old woman into Dr. Roger Kurlan's office, and it wasn't long before he recognized that she was going through a terrible time in her life.

She told the Rochester, N.Y., neurologist that she had recently lost her husband and was still grieving the day she stumbled down her basement steps, broke her right arm and bruised her leg.

She never fully recovered. Three months later, she had a tremor in her hand and jaw. On the rare occasions when she tried to walk, she could manage only a slow shuffle. Her doctor and a consulting neurologist told her she had a rapidly progressing case of Parkinson's disease.

For her, the unspoken prognosis was decline, dependency and death.

Kurlan is a professor of neurology at the University of Rochester School of Medicine and a Parkinson's specialist. But even he could not have predicted that this office visit would end in what a faith healer might claim as a miracle.

He told the rest of his patient's remarkable story in a recent issue of the journal Cognitive and Behavioral Neurology.

Parkinson's is a neurological disorder that results from a lack of dopamine - a chemical messenger that sends information to the parts of the brain that control movement and coordination. The symptoms can be tremors, loss of balance, instability and other progressive movement disorders.

Even with his patient's tremor, Kurlan said, "it was obvious to me from the start that this was not anything related to Parkinson's disease. ... It's not an illness that would progress so rapidly from no symptoms to being unable to walk." But he was a long way from solving the mystery.

He began by listening. Alert and conversant, his patient told him that until her fall, she had been living independently in her home and walking normally. After the fall, she was sent to a rehabilitation facility, where she was placed in a wheelchair. And despite four months of physical therapy, she remained unable to stand or walk without full support.

Walking difficulties - called gait disorders - are common among the elderly, Kurlan said. Many are "organic": They stem from such conditions as painful joints, inner-ear problems that affect balance, failing vision and depth perception, muscle weakness or neurological diseases such as Alzheimer's or Parkinson's.

But others are "psychogenic," growing from mental or emotional problems that can also cause blindness, weakness, even paralysis.

"The good thing about psychogenic gait disorders is that the underlying systems are intact. If you can get around, or over the emotional problems, there's no reason why the person can't be just fine," Kurlan said.

Talking it out

In his office, doctor and patient began to talk about her fall and her emotional response to it. Young people usually bounce back from a tumble and forget it. But a fall can take a severe emotional toll on the elderly. It can trigger fears of more falls and serious injury, a loss of independence and a fear of becoming a burden to others.

The woman's diagnosis of Parkinson's seemed hopeless. She was "worried she was going to end up in a nursing home, and she wouldn't be able to drive again," Kurlan said.

Her fear was a tantalizing lead, but he needed more. He asked her to get onto his exam table.

"She said, `I can't,' and she got very anxious. She actually started shaking," he said. She clung to her wheelchair and refused to get up.

Parkinson's patients, and others with organic gait disorders, "will struggle and get up, even though they're slow or have poor balance, they will give it the old college try," he said. "She didn't want to move from that chair. ... It was obvious she was scared to death of falling."

With his nurse, Kurlan managed to get the woman onto the table, and he began a detailed physical and neurological exam.

"People with Parkinson's disease develop rigidity; their muscles are fairly stiff, and it's not easy to move their limbs at the joints. She had virtually none of that," he said.

He checked her muscle quickness, strength, her sense of touch, balance and sensation. "She passed everything fine," Kurlan said.

After 20 minutes, he sat down with her and said, "I have very good news for you. Your nervous system is working perfectly fine. I don't find anything beyond perhaps the earliest features of Parkinson's disease."

The woman seemed relieved.

"We talked about her fall, and she openly admitted how devastating that was, how scary that was, and she knew she was dreadfully afraid of falling," Kurlan recalled.

They talked about how people can be "paralyzed" with fear, and he told her he thought that may be causing her inability to walk. "I said, `Here, I'll show you,' and I took her hand and got her up."

It was an informed act of faith. But it worked.

"She actually started walking right away," Kurlan recalled. "At first she was literally sliding her feet along the floor," short steps doctors describe as walking on ice, or "cautious gait." She still insisted on having someone to hold on to.

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