Father diagnosed with shy drager

  :    My dad has a 30 year hx of parkinsons.  Over the last year has has been having period of urinary retention , frequency, urgency and incontinence for which he was tx with flomax (with relief).  Over that last 2-3 months he has had a couple of falls which he described as different from his parkinsons related falls--there was no staggering or loss of balance-he just went down.  We recorded his BP sitting and standing and noted a SBP in 40's when up.  He was then hospitalized, and after realizing his orthostatic problems continued after the DC of flomax they gave the diagnosis of Shy-Drager.  Is that enough information to make that diagnosis. Are thre other test to confirm the diagnosis? What is the tx?
  : Is there a specialist there or close to the Cincinnati area that could help? Thank you.
  

[CCF MD mdf]

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It seems unlikely that your father has Shy Drager syndrome. The main reason is that people with Parkinson's Disease (PD) can and do get autonomic symptoms after several (certainly 30 is several) years of motor symptoms. It is true that Shy and Drager in the early 1960s described patients who had parkinsonian motor symptoms as well as autonomic symptoms, but this case would be a mis-application of the term Shy Drager syndrome. Actually, we no longer use that term, preferring instead the term Multiple Systems Atrophy (MSA) due to some recent (past 10 years) advances in our understanding of PD and related diseases.
The other reason that MSA is not likely is that 30 years is far too long to have it. We generally accept that PD does not shorten people's lifespan but MSA unfortunately does, and the mean survival from diagnosis is on the order of 10 years. Whether this can be affected by careful supportive treatment of autonomic dysfunction is not yet known.
As with PD, there is no real test that can be done - diagnosis of PD, MSA, or other parkinsonian syndrome rests on the experience of the doctor seeing you as well as (in a few cases) selected tests. I would expect that investigation of your father's autonomic control of his cardiovascular system (blood pressure, heart rate, etc) would be in order regardless of the diagnosis.
We offer all these services at CCF. Call 800 223-2273 and ask for neurology appointments at 4-5559. Tell them you want a movement disorders specialist. The autonomic tests might have to be done on a different day.
I hope this helps. I have no particular comment about the second post, though there too I wonder if the original diagnosis was correct. Diagnosis of autonomic function and dysfunction requires a great deal of expertise, and even experts can be fooled due to the complexity of illnesses. Time and re-evaluation usually clarifies diagnoses.
CCF MD mdf.