The Patchwork Quilt Disease

Throughout the many years of Michael's illness, seventeen since diagnosis, I have been learning steadily about Parkinson's Disease along with all the complicating illnesses Michael has suffered. It feels as though I am very slowly working on my medical degree acquired through the internet and my dog-earred Merck manual. It's like a patchwork quilt, each calamity and complication a new colour I add to the work, none of it seeming to connect until I stitch it all together into the big picture. Michael has truly been a study of diversity of ailments.

The latest piece being added is a chapter on the thyroid gland. I have to credit my friend who hadn't seen Michael in several weeks but noticed on a visit last weekend that there is a swelling in Michael's neck.  I hadn't seen it at all. Most days my head is down just getting through the rigours of life with a seriously disabled person and it worries me that I'm not seeing things anymore. Nevertheless, my friend did and I'm grateful for that.

On inspecting Michael's neck right after my friend left, I discovered a butterfly-shaped swelling below his Adam's apple. I felt my own neck to compare. Definitely a considerable enlargement in his neck. I hit the books and the internet, knowing only that the thyroid gland is situated in the neck and that hypo- and hyperthyroidism are associated conditions but I knew very few of the symptoms.

Now it turns out that days before this discovery we had visited Michael's neurologist.  When I told him about Michael's plummeting blood pressure and steps I had taken to reduce his heart medications, he knitted his brow and filled out a requisition for a series of blood tests, saying that perhaps the kidneys need checking, among other things. When the visiting nurse arrived last week to administer Michael's monthly blood test for agranulocytosis, a rare but severe side effect of the anti-psychotic medication Clozaril, I handed her the requisition for the other tests. I showed her the swollen thyroid. She noted that the doctor had ordered a number of tests to be run, including one for the thyroid.  Aha. Maybe the Good Doctor is already on to something without having been told about this new discovery.  That's why these guys go to Med school.

We have had no results back from the tests but in the meantime I hit the information highway. Various lights have gone on in my brain as I realized that this could have been an issue for a while, though I'd like to think that with all the bloodletting Michael has endured over the past few years, somebody would have discovered this if it had been a long-standing problem.

Among the various diseases associated with the thyroid, two basic ones exist:  hyper- and hypothyroidism. And these afflictions may not be easily discovered unless you have a sharp doctor who can piece together your symptoms. Many other diseases can mask this problem, including Parkinson's disease, I discovered. Conversely, a thyroid condition might mask underlying Parkinson's.

Hyperthyroidism, which very simply is where too much thyroid hormone is being produced, is characterized by fast heartbeat, high blood pressure, moist skin and increased sweat, shakiness and tremor, nervousness, increased appetite with weight loss and confusion just to name a few listed in my trusty Merck Manual.  Hypothyroidism, too little thyroid hormone, has an equally long list of symptoms: slow pulse, hoarse voice, slowed speech, constipation, confusion, depression, dementia, weight gain, loss of hair, especially eyebrows. You can see by the italicized symptoms a possible overlap with Parkinson's symptoms.

There is no doubt that Michael has Parkinson's Disease.  But the overarching nature of this disease that affects the entire body so completely makes it the big bully that pushes out the little guys and always cries out for attention. Symptoms that I have noticed lately, such as an annoying dry cough throughout the day, but especially at mealtime, and ridged fingernails, I have simply put down to the mysteries of PD and have discounted them somewhat. (Swallowing can be a serious problem for PD patients leading to weight loss for some.) But according to a couple of websites, these two symptoms might instead be an indication of a malfunctioning thyroid, namely hypothyroidism. Michael's overwhelming sluggishness, his very low blood pressure and at times low pulse rate might also be part of a thyroid problem.

We will find out soon enough whether the swollen thyroid gland is cause for concern and treatment. It will be interesting to see if there is improvement in any of Michael's symptoms that we have all just assumed were part of the Parkinson's quilt. Whatever the results tell us, if anything, my knowledge continues to grow.