Question: I have begun to have shaking in my right hand and a little in my right I am also getting a small amount in the left had. Both of these are ONLY when they are extended not when they are close. My current doctor is currently checking me for Parkinson's by given me the Levo drug. I have been taking this since wed and have seen no change except as the day goes on I feel bad. Didn't have tha before I started the drug. My TSH is 5.33 but my TF, Free is 1.25. I have also just drove 3200 mile to locations that were very stressful. In addition I became sick. just before I left on October 16 I had an injection in my left vocal cord because I was having a weak voice. It did help but not completely. The ENT said that was normal because they start with lower doses. We went on a cruise at the end of the 3200 drive and I felt terrible during the entire trip. I also began to feel dizzy which I still do. The dizzyness (Not spinning). I am wondering if that because of the trip and the stress during the trip I could have essential tremor and/or a THS related problem. I just don't want them to ignore these issues in their diagnosis which they seem to be doing. I am not opposed to continuing to look at the Parkinson question but, I don't want them to miss something in the process. Can you give me your feelings. I have attached some notes I gave to the Doctors but they didn't seem to want to read them. by the way the drug is Carbidopa-Lovo er 25-100

I will send the log. by placing it on here. The tremor in my right hand started on about December 14 ...see log below. Today they are very noticeable in my right hand to an extent probably twice what they were on December 14. I have noticed some slight tremor in my fingers in the left hand. Note that these are only in my fingers not in my wrist or entire hand. My fingers move sideways as well as up and down. If someone touches them they stop. Also if I type fast there is not a problem. If I go slow so I am not touching the keys all the time they mess up. I typically type 150 words. They are not present at rest only when extended. No stiffness in the extremities at all. And I am not unsteady on my feet. I have no trouble walking or driving. I have not stated any slowness of activity except in the evenings when I seem to have an overall anxity. I was taking Apralazom .25 mg to sleep but I stopped because of this. I took one this morning and am feeling better. The Apralazom was taken for making sure I sleep at night after the Heart attack in 2010. I never has drank XXXXXXX alcohol except for some wine and then only at functions. If would help I could drink some and see if it changes.

I know I can also have a scan done. I am thinking that would be good to eliminate the deficiency in dopamine allow me to continue on the essential tremor direction. I don't know if it is a good idea to just continue on the Carbidopa Levor medicine if it is not Parkinson's. I am afraid that the extra dopamine it produces could be harmful. U an going to try and just put the report in here since it may shed some light. Since I have taken the alprazolam I have felt much better. Still tremor in the right-hand fingers.

Medical History December 31 2014 to January 22 2015
Because of the unusual sequence of events I felt that it was best to provide this report.

December 31 2014 Report from Dr. XXXX
Note Glucose Serum high (see report) note this seems to be a trend.
2015 XXXXXXX 24th Dr. XXXXXXX XXXX tests Creatinine Serum is low (see attached Report)

September 16th Angiogram
Left side arm and shoulder pain. Nothing found on Angiogram
September 28th Upper GI Scope.
     Trying to find cause of Left arm and shoulder pain.

October 26th Vocal Chord Injection left side
Slightly dizzy somewhat after but on and off and not bad Did not think was serious enough to cancel trip.
The left shoulder pain and arm pain are now gone and did not return as of 12/22 2015

November 9th Leave for Des Moines Iowa (900 Miles)

November 17th Drive from Des Moines to XXXXXXX (315 Miles)

November 23rd Sick with dizziness (not spinning) and Right ear ache

November 25th Go to Urgent Care in Downers Grove
     They indicated I had disequilibrium Glucose serum, Creatinine serum were elevated (see report)
     Suggested if problem does not dissipate that I should go to ER

November 27th Went to ER because of no improvement and need to drive back to XXXXXXX next day
     The did Chest CAT Scan (See report)

November 28th Drive Home to XXXXXXX (800 Miles)
November 30th went to see Dr Hoffman on Ear Problem.
He scoped my sinus and voice cord. Said sinus were somewhat infected prescribed 14 day antibiotic (See Report)
November 30th Saw Dr. XXXX (see Report)
December 2 drive to Ormond Beach Florida for three day rest (470 miles)
(Jack hammers outside window entire time) Felt reasonably okay.
December 4th drive to Melbourne Florida (100 Miles)
Ear Hurting but not so dizzy.
December 5th Urgent Care in Melbourne Florida. Dizziness and ear problem.
Told to put norast drops in left ear for six times and take Sudafed. I had four pills left in the Medrol pack and she suggested taking them all at once. Continue taking antibiotic
December 5th Got flu shot and booster before cruise
December 6th Drive to Cape Canaveral Port Take cruise until Dec 13th
Dizziness was bad on the ship didn’t notice the shaking at this point
December 14th notice slight tremor in hands.
December 13th Drive home to XXXXXXX (600 miles)
Driving home felt really bad when we stopped for lunch. Dizziness – no appetite and very tired. Drove remainder of what home.

December 15th Dizziness continue went to Dr. Padhiar Noticed Tremors (see report)
Made appoint With Dr. XXXXXXX Neurologist Now scheduled for December 23nd

December 22nd Feeling of Nausea and many bowel movements but not Diarrhea
December 25. I have been taking medication for Parkinson’s since Wednesday. I take it at 8 am and 3pm each day. I have seen not change in the shaking. IN the morning when I wake up I see not shaking while lying in bed but as soon as I get up it starts. It is mostly when I each out to get something or when I am holding my hands out in front of me palms up. I also am having problems as the day goes on with just a strange overall body tension. Hard to explain. That has been happening since I started the medication. I have some trouble typing but not sever. My sister told me yesterday she has the same thing and has had it for some time. She is 81. She said her doctor diagnosed it as just getting older and that it was not Parkinson’s. I am concerned about my high TSH levels. I have also had tests that show that in my recent blood tests my Glucose serum is 1.42 is high and my Bun/Creatinine ratio was low.

Patient Name XXXXXXX XXXX. XXXX Patient Date of Birth XXXX
Patient Information for visit with Dr. XXXXXXX 12/23/15
The following is a synopsis of the symptoms I am having as well as those associated with Parkinson’s that I do not feel I have at this time. Note: One of my concerns is the speed with which change is taking place. A week ago the only noticeable symptom was when I put my thumb and forefinger together I could see some movement. Now I can see it visibly and feel it most all the time. I am having problems unscrewing caps on tooth paste, putting things into holders and that type of thing. That change has occurred in a matter of weeks.
Symptoms I observe
1.     Voice problem – began to lose voice diagnosed as a weak left vocal cord. Treatment was to inject the left vocal cord to bulk it up. After this injection was when these noticeable symptoms began. The results have been less than satisfactory since my voice continues to be weak with some injection of high peaks in my speech.
2.     Hand Tremors became noticeable after the injection.
3.     Tongue sometimes in the morning seems numb and stuck to the top of the mouth. Once I move it, the numbness goes away. Water also helps.
4.     Skin tone has changed on arms becoming more serrated
5.     Ability to taste food decreased after the injection. There has been a somewhat metallic taste in the background since that injection. This ability to taste has changed as the injection has become more distant. It is now more normal. However, I have noticed that when I eat the “bad taste” in my mouth returns.
6.     Appetite is good, but when I eat, I get lower intestine discomfort within a few minutes and thus I don’t eat much. I also feel full after a couple of bites and don’t want any additional food.
7.     Somewhat impaired ability to focus but that is also related to the lower intestine discomfort that becomes a great ongoing irritating distraction. When I do not have that feeling, which has become infrequent, I do not have the problem of focus.
8.     Slightly greater ability to forget things like turning off the water faucet. Happens more when I am thinking about something else so have attributed it to being normal and more of an aging function. This has become a minor problem since the injection.
9.     Tend to take a short nap in the afternoon which seems to provide more energy. This need for napping may be from boredom since it is only when I am not occupied with other functions and happens more today since I no longer go to the office.
10.     Sleep ability has become better since I stopped the Alprazolam
11.     Dizziness – not rotating but just unbalanced feeling. Does not make me unstable just uncomfortable. This SENSATION is almost always there. When I fasted for the study, I noticed that I was not dizzy until I ate something at which time the dizziness returned.
12.     At night, leg discomfort. I feel as if I need to stretch them beyond what they can be stretched. This stretching sometimes causes cramps in my right foot (assume related to surgery) Less often the cramp is in the left leg or both. These cramps are not severe. I have always had leg cramps. Now I seem to be able to stop them mid-stride rather than them becoming a major incident. This ability to stop them is not true of the foot cramp in my right foot. In the case of my foot cramps they go on for some time (Note the right leg has numbness and tingling as a result of 8/27/13 back surgery. That has been extensively evaluated.)
13.     Speech Changes. I do at times seem to have to search for words but not annoyingly so on a regular basis.
14.     I used to have constipation and infrequent bowel movement. However, since the intestinal problem has begun, I am having bowel movements without any constipation almost four or five times per day. One time I had a very runny form.
15.     I am currently being evaluated for Gallbladder issues. No results have been obtained.
16.     Note that since the heart attack in 2010, I have been having ED issues.
17.     I have noticed some problems with typing and using the mouse.
I do not experience the following:
1.      Small Handwriting (see 12 below)
2.     Loss of Smell – I did have loss of taste as listed above
3.     Trouble sleeping. Normally that is not the case. I used to have it all my life and took alprazolam. I have stopped taking the alprazolam, and my sleeping has actually improved without the negative effects of the drug.
4.     Constipation – I have always had a problem with this. Now however since the intestinal discomfort I have the opposite problem as noted above. (Note: I have significantly increased my intake of water. I have increased my water intake because I tend to drink too little which causes repeated dehydration some involving hospitalization. Also, I have had several lab reports with some indications of serum issues. (see lab results below)
5.     Masked Face. I don’t feel I have nor has anyone else commented on this issue.
6.     Dizziness when standing. I have slight dizziness all the time since the voice injection. Note comment 11 above.
7.     Stooping or hunching over- I do not have that symptom at this time.
8.     Slow Movement – I do not have that at this time.
9.      Rigid muscles – I have always had tight muscles that others such that chiropractors and massage therapists have commented. There doesn’t seem to be any additional tightness.
10.     Impaired Posture or balance. Do not seem to have any problems with that issue.
11.     Loss of automatic movements – have not had any of these symptoms
12.     Writing changes – Have not noticed any, but I almost always type rarely write. It has always been difficult for me to write. Thank God for the word processor!






Lab Reports of Significance

Medical History December 31 2014 to January 22 2015
Because of the unusual sequence of events I felt that it was best to provide this report.

December 31 2014 Report from Dr. XXXX
Note Glucose Serum high (see report) note this seems to be a trend.
2015 XXXXXXX 24th Dr. XXXXXXX XXXX tests Creatinine Serum is low (see attached Report)

September 16th Angiogram
Left side arm and shoulder pain. Nothing found on Angiogram
September 28th Upper GI Scope.
     Trying to find cause of Left arm and shoulder pain.

October 26th Vocal Chord Injection left side
Slightly dizzy somewhat after but on and off and not bad Did not think was serious enough to cancel trip.
The left shoulder pain and arm pain are now gone and did not return as of 12/22 2015

November 9th Leave for Des Moines Iowa (900 Miles)

November 17th Drive from Des Moines to XXXXXXX (315 Miles)

November 23rd Sick with dizziness (not spinning) and Right ear ache

November 25th Go to Urgent Care in Downers Grove
     They indicated I had disequilibrium Glucose serum, Creatinine serum were elevated (see report)
     Suggested if problem does not dissipate that I should go to ER

November 27th Went to ER because of no improvement and need to drive back to XXXXXXX next day
     The did Chest CAT Scan (See report)

November 28th Drive Home to XXXXXXX (800 Miles)
November 30th went to see Dr Hoffman on Ear Problem.
He scoped my sinus and voice cord. Said sinus were somewhat infected prescribed 14 day antibiotic (See Report)
November 30th Saw Dr. XXXX (see Report)
December 2 drive to Ormond Beach Florida for three day rest (470 miles)
(Jack hammers outside window entire time) Felt reasonably okay.
December 4th drive to Melbourne Florida (100 Miles)
Ear Hurting but not so dizzy.
December 5th Urgent Care in Melbourne Florida. Dizziness and ear problem.
Told to put norast drops in left ear for six times and take Sudafed. I had four pills left in the Medrol pack and she suggested taking them all at once. Continue taking antibiotic
December 5th Got flu shot and booster before cruise
December 6th Drive to Cape Canaveral Port Take cruise until Dec 13th
Dizziness was bad on the ship didn’t notice the shaking at this point
December 14th notice slight tremor in hands.
December 13th Drive home to XXXXXXX (600 miles)
Driving home felt really bad when we stopped for lunch. Dizziness – no appetite and very tired. Drove remainder of what home.

December 15th Dizziness continue went to Dr. Padhiar Noticed Tremors (see report)
Made appoint With Dr. XXXXXXX Neurologist Now scheduled for December 23nd

December 22nd Feeling of Nausea and many bowel movements but not Diarrhea
December 25. I have been taking medication for Parkinson’s since Wednesday. I take it at 8 am and 3pm each day. I have seen not change in the shaking. IN the morning when I wake up I see not shaking while lying in bed but as soon as I get up it starts. It is mostly when I each out to get something or when I am holding my hands out in front of me palms up. I also am having problems as the day goes on with just a strange overall body tension. Hard to explain. That has been happening since I started the medication. I have some trouble typing but not sever. My sister told me yesterday she has the same thing and has had it for some time. She is 81. She said her doctor diagnosed it as just getting older and that it was not Parkinson’s. I am concerned about my high TSH levels. I have also had tests that show that in my recent blood tests my Glucose serum is 1.42 is high and my Bun/Creatinine ratio was low.

Patient Name XXXXXXX XXXX. XXXX Patient Date of Birth XXXX
Patient Information for visit with Dr. XXXXXXX 12/23/15
The following is a synopsis of the symptoms I am having as well as those associated with Parkinson’s that I do not feel I have at this time. Note: One of my concerns is the speed with which change is taking place. A week ago the only noticeable symptom was when I put my thumb and forefinger together I could see some movement. Now I can see it visibly and feel it most all the time. I am having problems unscrewing caps on tooth paste, putting things into holders and that type of thing. That change has occurred in a matter of weeks.
Symptoms I observe
1.     Voice problem – began to lose voice diagnosed as a weak left vocal cord. Treatment was to inject the left vocal cord to bulk it up. After this injection was when these noticeable symptoms began. The results have been less than satisfactory since my voice continues to be weak with some injection of high peaks in my speech.
2.     Hand Tremors became noticeable after the injection.
3.     Tongue sometimes in the morning seems numb and stuck to the top of the mouth. Once I move it, the numbness goes away. Water also helps.
4.     Skin tone has changed on arms becoming more serrated
5.     Ability to taste food decreased after the injection. There has been a somewhat metallic taste in the background since that injection. This ability to taste has changed as the injection has become more distant. It is now more normal. However, I have noticed that when I eat the “bad taste” in my mouth returns.
6.     Appetite is good, but when I eat, I get lower intestine discomfort within a few minutes and thus I don’t eat much. I also feel full after a couple of bites and don’t want any additional food.
7.     Somewhat impaired ability to focus but that is also related to the lower intestine discomfort that becomes a great ongoing irritating distraction. When I do not have that feeling, which has become infrequent, I do not have the problem of focus.
8.     Slightly greater ability to forget things like turning off the water faucet. Happens more when I am thinking about something else so have attributed it to being normal and more of an aging function. This has become a minor problem since the injection.
9.     Tend to take a short nap in the afternoon which seems to provide more energy. This need for napping may be from boredom since it is only when I am not occupied with other functions and happens more today since I no longer go to the office.
10.     Sleep ability has become better since I stopped the Alprazolam
11.     Dizziness – not rotating but just unbalanced feeling. Does not make me unstable just uncomfortable. This SENSATION is almost always there. When I fasted for the study, I noticed that I was not dizzy until I ate something at which time the dizziness returned.
12.     At night, leg discomfort. I feel as if I need to stretch them beyond what they can be stretched. This stretching sometimes causes cramps in my right foot (assume related to surgery) Less often the cramp is in the left leg or both. These cramps are not severe. I have always had leg cramps. Now I seem to be able to stop them mid-stride rather than them becoming a major incident. This ability to stop them is not true of the foot cramp in my right foot. In the case of my foot cramps they go on for some time (Note the right leg has numbness and tingling as a result of 8/27/13 back surgery. That has been extensively evaluated.)
13.     Speech Changes. I do at times seem to have to search for words but not annoyingly so on a regular basis.
14.     I used to have constipation and infrequent bowel movement. However, since the intestinal problem has begun, I am having bowel movements without any constipation almost four or five times per day. One time I had a very runny form.
15.     I am currently being evaluated for Gallbladder issues. No results have been obtained.
16.     Note that since the heart attack in 2010, I have been having ED issues.
17.     I have noticed some problems with typing and using the mouse.
I do not experience the following:
1.      Small Handwriting (see 12 below)
2.     Loss of Smell – I did have loss of taste as listed above
3.     Trouble sleeping. Normally that is not the case. I used to have it all my life and took alprazolam. I have stopped taking the alprazolam, and my sleeping has actually improved without the negative effects of the drug.
4.     Constipation – I have always had a problem with this. Now however since the intestinal discomfort I have the opposite problem as noted above. (Note: I have significantly increased my intake of water. I have increased my water intake because I tend to drink too little which causes repeated dehydration some involving hospitalization. Also, I have had several lab reports with some indications of serum issues. (see lab results below)
5.     Masked Face. I don’t feel I have nor has anyone else commented on this issue.
6.     Dizziness when standing. I have slight dizziness all the time since the voice injection. Note comment 11 above.
7.     Stooping or hunching over- I do not have that symptom at this time.
8.     Slow Movement – I do not have that at this time.
9.      Rigid muscles – I have always had tight muscles that others such that chiropractors and massage therapists have commented. There doesn’t seem to be any additional tightness.
10.     Impaired Posture or balance. Do not seem to have any problems with that issue.
11.     Loss of automatic movements – have not had any of these symptoms
12.     Writing changes – Have not noticed any, but I almost always type rarely write. It has always been difficult for me to write. Thank God for the word processor!

I cant get the jpgs to go in so i am sending just the data below

August 31, 2015 all moral but Glucose, Serum 130 range 45 99
Creatinine serum 1.28 high is 1.27
EGFR is no XXXXXXX male 55 norm 58


same date TSH 5.330
T4, Free (direct ) 1.25


Lab Reports of Significance


     
Note: In the report below There have been several since the one below showing one or more of the issues highlighted.


     
Note: In the report below There have been several since the one below showing one or more of the issues highlighted.