To Your Good Health: Movement Disorder Leads to Slow Decline

Dear Dr. Roach: My husband was diagnosed with progressive supranuclear palsy, or PSP. We have been told that it is rare and that there is no treatment and no cure.

Would you please explain the stages and progression of this disease?

What can be done to help with the various symptoms, and what should we expect?

Is there an average timeline of the disease’s progression?

We were told to discuss the possibility of a feeding tube in the future, but would that only prolong a decline that is irreversible?

Would refusing a feeding tube prevent any hydration and nutrition, or would my husband still be able to take these orally? — Anon.

Answer: I am very sorry to hear of your husband’s diagnosis, as PSP is a condition that progresses relentlessly.

There are several variants of PSP, with some differences in how soon certain symptoms occur. It may resemble Parkinson’s disease, especially at onset, but PSP is only 1 percent as common as Parkinson’s.

The predominant symptoms include loss of balance with falls, eye-movement weakness, weakened movements of the mouth, tongue and throat, and personality changes resembling depression.

The age of diagnosis most often is in the 60s, but it can happen as early as the 40s.

It is impossible to say what will happen in a given individual, but most people become dependent within six years of diagnosis.

There is no cure, but medications may be helpful.

Physical and occupational therapists are critical in helping maintain the ability to do day-to-day activities, and since swallowing problems are very common, dieticians can help slow the need for a feeding tube.

A feeding tube is placed when hydration and nutrition can no longer be safely given orally.

I have given just a brief outline of this condition.

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Dear Dr. Roach: I have just returned from seeing my doctor, and was told that the cause of what I experienced is a mystery!

In the late afternoon, my husband and I were sitting at the kitchen table. He noticed that a bruise was forming on my right temple — a dime-size purple mark, with a bump near the hairline. Over the next few hours the bruise grew larger, with red discoloration down the right side of my face, to the jaw. I had not been injured in any way, and it did not hurt!

I called a 24-hour advice nurse, and was told I probably had broken a blood vessel.

The next day, I called my doctor for an appointment, just to be on the safe side, but my doctor didn’t have anything to look at. When I got up, all the bruising and discoloration was gone!

She told me that there would still be some discoloration if it had been a broken blood vessel, so therefore it was a mystery. — C.C.

Answer: I agree with the nurse that it likely was a broken blood vessel, which can happen spontaneously to anyone. Once the blood is under the skin, it gets cleaned away by cells with enzymes that break down the blood. The color typically goes from dark red to green to yellow. This way, we can tell approximately how old a bruise is.

Very superficial bleeding also can move, as the blood literally gets pulled by gravity (which is why you had a darkening down to the jaw). I suspect that while asleep, the remainder got pulled into the hairline or lower down, where it could no longer be seen.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible.

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