DEAR DRS. DONOHUE AND ROACH: My dad, age 77, has just been told he has Parkinson’s disease. We, his children, aren’t sure of the implications of this for him, our mother or us. Currently, he isn’t greatly impaired. He moves more slowly, but his thinking is clear. His hands don’t shake.

What can we expect? What is his life expectancy? How is this treated? — B.B.

ANSWER: Parkinson’s disease, PD, is estimated to affect a million North Americans. It’s a difficult illness — difficult to have, difficult to treat and difficult to understand. Most of the time, the illness strikes people over the age of 60, and most cases of Parkinson’s disease are not inherited.

The underlying problem is a depletion of dopamine, a brain chemical that is vital to smooth, coordinated muscle movement and to thinking. Four prominent signs distinguish this illness. One is tremor, a shaking of the hands when they’re at rest, as they are when they’re lying in the lap. The index finger and thumb constantly roll over each other. Muscle rigidity is obvious when a doctor tries to move the arms or legs of the patient. They tend to be tightly frozen. Parkinson’s patients find it hard to button a shirt or tie shoes. Bradykinesia, slowness of movement, is another sign of PD. Typically, patients walk with slow, shuffling steps. They’re quite prone to falls. As times passes, many patients develop trouble with clear thinking.

The treatments for Parkinson’s disease are many. Often the first choice is Sinemet, a combination of levodopa and carbidopa. It restores brain dopamine levels. I’ll mention some other drugs to give you an idea of available medicines, but I can’t elaborate on the way they work — space isn’t available for that. Amantadine, Artane, Requip and Comtan are but a few of the Parkinson’s medicines that can be turned to if Sinemet fails to bring a satisfactory response.

From the time of diagnosis, Parkinson’s patients average 10 more years of life. That’s an average, not a figure written in stone.

DEAR DRS. DONOHUE AND ROACH: Doctors, three, told me they thought I had ovarian cancer and that I needed urgent surgery. I was taken to surgery but I didn’t have ovarian cancer. I had a dermoid cyst.

How come three doctors, all of whom had me get ultrasounds, couldn’t diagnose this without sending me to surgery? I’m relieved that I don’t have cancer, but I wonder if there isn’t a simpler way to find the cause without cutting a person. — N.C.

ANSWER: Dermoid cysts contain cells that belong to skin, hair, oil glands, teeth, muscle, lungs and the digestive tract. Although ultrasound pictures of the ovary are able to furnish an answer on the nature of such a mass, the pictures don’t always provide a definitive answer.

In those circumstances, the best approach is to explore the ovary surgically so microscopic examination of the tissue is possible. Ultrasound provides information most of the time, but in some instances it still leaves a doubt in the doctor’s mind. The suspicion of cancer demands as great accuracy as possible. Sometimes visual and microscopic exams are necessary.

Dermoid cysts are almost always noncancerous.

DEAR DRS. DONOHUE AND ROACH: My husband and I are in the habit of taking a nightly walk. About four months ago, I started stumbling while on the walk. At first my husband said nothing. Then he asked me what was going on. I said I didn’t know. I have been klutzy all my life, but this was new.

He insisted I find out. I did. A neurologist made the diagnosis of an acoustic neuroma and sent me to a neurosurgeon, who wants to use the gamma knife for it. What exactly is that? — G.L.

ANSWER: The gamma knife isn’t a knife. It’s a special kind of radiation that targets a very specific body site so that adjacent tissues are not harmed by radiation. An acoustic neuroma is a noncancerous tumor that wraps around the hearing nerve and can produce deafness, trouble with maintaining balance, constant ringing in the ear or all three.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

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