Dilemma Revisited

Extrapyramidal Manacle

With trembling hands and knees that won't heal,
A diagnosis that my heart can feel,
Parkinsonism, born of medication's strife,
In this tumultuous journey of my life,
Seeking wisdom to decipher this medical rife.

The dilemma that confronts me, stark and clear,
Should I persist with the meds or take a pause and interfere,
Neurosurgeons and psychiatrists in their white attire,
Stubbornly persist that medicine is required,
And I must insist, this path is undesired.

Weight gain, high pressure, the side effects I bear,
A wellness plan, shadowed by despair,
My hands, once steady, now tremble and shake,
This course of action, I want to forsake,
For the sake of my health, a new direction to take.

Yearning to break free from the medication's chain,
To preserve my life, I strive to remain sane,
The challenge before me, an immense affair,
Seeking counsel from those who truly care,
A shield against false beliefs, I seek to prepare.

The decision I've made, a journey through the mist,
Balancing risks and benefits in this precarious twist,
To medicate or not, a complex reflection,
A life-altering choice, an introspective connection,
I tread forward, with cautious affection.

With my doctor's counsel, we cut the meds down,
Yet confusion reigned, casting shadows on my crown,
Inpatient care beckoned for medication's fine-tune,
Influencing my judgment under a crescent moon,
As medications accrue, our path to review.

Extrapyramidal Symptoms (EPS), they silently encroach,
Affecting my mobility, like a tightening coach,
Parkinsonism's grip, with stiffness it ensnares,
Limbs locked in rigidity, as if in unyielding snares,
Walking's grace erodes, replaced by hesitant stairs.

Tremors, a disconcerting dance of fingers and hands,
Fine motor skills falter in these unsteady sands,
Bradykinesia's curse, slowed movements, a plight,
Initiating steps, a battle, an arduous fight,
Walking's grace falters in the absence of might.

A shuffling gait, these hesitant steps now define,
Lifting feet becomes a challenge, as if we incline,
To gravity's unyielding force, we must now respond,
Walking's melody lost, in each hesitant bond,
A symphony of uncertainty, in each step, we respond.

Postural instability, a wobbly, precarious stance,
A fall's lurking shadow, like a cruel, twisted dance,
To stand and walk becomes an act of sheer grace,
With EPS as our foe, in this intricate chase,
We seek a path to regain our sturdy embrace.

In trembling hands and knees, we continue to strive,
Facing EPS's trials, in this ongoing dive,
With hope and expertise, we navigate the tide,
Seeking balance in this journey, side by side,
In the quest for mobility, we abide.

The poem conveys my internal struggle after being diagnosed with a Parkinson's-like illness called parkinsonism. The poem describes my physical symptoms and my difficult choices. The poem highlights the complexity of medical decision-making and the impact of illness on one's life.

Extrapyramidal symptoms (EPS) are a group of movement-related side effects that can occur as a result of taking certain medications, particularly antipsychotic drugs. These symptoms are often associated with disturbances in the extrapyramidal system, a neural network in the brain responsible for controlling and regulating voluntary motor movements. EPS can be distressing and affect a person's motor functions. One of the side effects of typical antipsychotic medications that can affect a person's ability to stand up and walk can are known as Extrapyramidal Symptoms (EPS). EPS encompasses a range of movement-related side effects that can be distressing and potentially impact a patient's mobility. One specific EPS that can affect standing and walking is called "Parkinsonism."

Parkinsonism is characterized by symptoms similar to Parkinson's disease, a neurodegenerative disorder that affects movement control. Some of the common symptoms of Parkinsonism caused by antipsychotic medication include:

Muscle stiffness: Patients may experience increased muscle tone, leading to stiffness and rigidity in their limbs. This can make it difficult to move and can affect their ability to stand up and walk freely.

Tremors: Shaking or tremors, particularly in the hands, can make fine motor skills challenging. This can affect balance and coordination while walking.

Bradykinesia: Bradykinesia refers to slowed movements. Individuals may find it difficult to initiate movements, take small steps, and experience a general slowness in their actions, which can impact their walking ability.

Shuffling gait: People with Parkinsonism induced by antipsychotic medications may develop a characteristic shuffling gait. This involves taking short, hesitant steps and having difficulty in lifting their feet off the ground, making it harder to walk smoothly.

Postural instability: Difficulty in maintaining an upright posture and balance can lead to falls when attempting to stand up or walk.

It's important to note that not everyone who takes typical antipsychotic medications will experience these side effects, and the severity can vary from person to person. Healthcare providers closely monitor patients on these medications and may adjust the dosage or switch to different antipsychotic drugs if these side effects become problematic. Additionally, medications known as anticholinergic drugs or medications that target specific aspects of the dopamine system may be prescribed to manage these side effects and improve mobility.

The management of Extrapyramidal Symptoms (EPS). EPS typically involves a combination of approaches, including dose adjustments of antipsychotic medications, switching to different antipsychotic drugs with a lower risk of causing EPS, and the use of adjunctive medications to alleviate specific symptoms. Here are some common approaches to manage EPS:

Dose Adjustment or Medication Switch: If a patient develops EPS as a side effect of antipsychotic medication, the first step is often to reduce the dose of the current medication or switch to an antipsychotic with a lower risk of causing EPS. Second-generation or atypical antipsychotics are generally associated with a lower risk of EPS compared to typical antipsychotics.

Anticholinergic Medications: Anticholinergic drugs, such as benztropine or trihexyphenidyl, are sometimes prescribed to counteract EPS symptoms. These drugs can help reduce muscle stiffness and tremors. However, they are not always effective and may have their own side effects.

Amantadine: Amantadine is another medication that may be used to manage EPS, particularly parkinsonism. It can help improve movement and reduce stiffness.

Benzodiazepines: In some cases, benzodiazepines like diazepam or lorazepam may be used to alleviate muscle rigidity and anxiety associated with EPS.

Physical Therapy: Physical therapy can be beneficial in managing the motor symptoms of EPS. It can help improve muscle strength, flexibility, and overall mobility.

Electroconvulsive Therapy (ECT): In severe caes of EPS or when other treatments are not effective, ECT may be considered as a last resort. ECT can have a significant impact on psychiatric symptoms but should be used cautiously and is typically reserved for cases where other treatments have failed.

EPS typically result from the use of antipsychotic medications, especially typical or first-generation antipsychotics, although they can occasionally occur with atypical or second-generation antipsychotics as well. The severity and presentation of EPS can vary from person to person, and not everyone who takes these medications will experience these side effects.

Management of EPS may involve adjusting medication dosages, switching to different antipsychotic drugs with a lower risk of EPS, and using adjudicative medications such as anticholinergic drugs to alleviate symptoms. It's important for individuals taking antipsychotic medications to be closely monitored by healthcare providers to detect and manage EPS early to minimize discomfort and complications.

In conclusion the stakes have been raised by the treatments provided by my healthcare team. As my ability to stand up and my shuffle increases we continue to titrate down from certain medications. With that said I'm taking a break from writing more newsletters, it has become difficult to get inspired.