Weaning Off Clonazepam = Thinking More Positively

I'm down to a half tablet at night now, starting today. I will stay on that for three days, and then I will be through with it. I sense the depression passing somewhat, but certainly not all of it. I was depressed before they put me on it, just not as much.

I've been trying to work off as much of my tension and fears in the yard the last few days. I've spread the rich composted "dirt" and planted Centipede seed there. I don't know if any of it will grow, but the weeds are sure enjoying the rich dirt. I can't very well pull the weeds, as the grass is still germinating. The idea is to let the growing grass choke out the weeds on its own. Since that section of the yard is pretty much finished, I've moved to a small section of grass at the front of the house. I'm wetting it down at night and then working on digging all the grass weeds out of it the next day. The hoeing is very therapeutic. It's kind of like a punching bag for me.

My biggest problem right now is that I can't get out in the yard without setting off a poison ivy outbreak, no matter how hard I try to stay away from it and bathe as soon as I come in. I've been super itchy now for some time, because I don't want to take any antihistamines on top of the Clonazepam.

I've been trying to read about Tardive Dyskinesia, which certainly seems to fit what I look like these days. I can't even spell it right half the time, but Google very nicely suggests how to spell it for me. If that's it, then I can add TD to my list of acronyms.

My mouth is definitely jerking and twisting more as the Clonazepam dosage is reduced in my system, but they have told me that there are other prescriptions they will try to reduce the tics and jerks, once I'm off this med. And I've started chewing sugarless gum a lot, too, as that keeps my mouth busy. I chewed so long last night I made my jaw hurt, but at least I didn't have my mouth pulling to the side and twisting all around. I will definitely be using this trick in public, as I am extremely self conscious about the way my face looks now.

Our wonderful pharmacist has printed out all the prescriptions I have been on since he opened his store some years ago. I haven't yet tried to track down where my records would be stored from the previous drugstore, but he suggested I try the CVS in a nearby town. We went without a drugstore at all for quite awhile there, as the previous pharmacist gave up his store to work for CVS. I haven't called yet, because it is likely a waste of time. But I will call. I'll just have to be in the mood to do it.

I've tried researching every medicine that I can remember ever being on, and a few are possible causes. But there's nothing to be done, other than try to deal with the symptoms. Tardive means it's a delayed reaction, so there is no med to "stop taking" to make the movements go away. Our family has always joked that an aspirin will put me to sleep, so I suppose it's not surprising that I would be one who had a delayed side effect to some medicine I've taken in the past.

I haven't been going to the Parkinson's forum. I just don't know what to say there any more. I guess I would still qualify for membership, since I'm dealing with a Movement Disorder of some kind, but I just don't feel like I fit right now.

Hubby has been a big help, and isn't mad at me any more about my reaction to the doctor's news. He's such a sweetie, and I know all this has been really hard on his emotions, too. I don't know what I would do without him.

I ran across a copy of Michael J. Fox's book, Lucky Man, at a yard sale not long ago, and I finished reading it last night. There were several things in it that made me feel better about myself. He talked about all the things he did to make his early tremors stop - how he tricked his brain - so he could hide it from the television and movie audience. That process of being able to temporarily stop a tremor with little mind and body tricks is one reason I thought I was suffering from a psychosomatic illness. I did not realize that at least some people with PD can consciously stop tremors momentarily. I have feared from the very beginning that being able to stop them for a brief while meant mine were not "real."

So, as it stands now, I don't have Peripheral Neuropathy, and there's no way of knowing if I ever did or not. I'm inclined to think I did, but all the super nutritious foods we have been eating for the last two years, plus the Turmeric and all the vitamins and minerals I take, just healed the nerve pathways.

Parkinson's is likely not the problem, although I have not ruled it out completely, as the doctor's always hedge what they say about that. I do have a Movement Disorder of some kind, and I am getting past the point of blaming it on myself. That's a good thing!!

Reading Fox's book helped me, so I hope that reading this blog can help someone, too.

I Have Been to THE Appointment

Well, we went Thursday to see Dr. Watts, the head of Neurology at the University of Alabama in Birmingham, who has a great reputation as a Movement Disorder Specialist.

We were both very impressed with how personable he is. One of the other doctors on his staff did all of the preliminary questioning and testing. He was very easy to be with, too. Most of the tests were ones I have been asked to do many times in the last couple of years. A few were different. They both had me make big smiles with my teeth showing several times, which is not something I remember being asked to do by anyone else, and Dr. Watts had me repeat a few of the tests the assistant had already done.

They also gave me the impression that my family history of neurological problems is an important clue - mother with Senile Parkinson's or Alzheimer's - uncle with ALS - aunt with depression, drug addiction, alcoholism - grandfather was senile, possibly Alzheimer's? Until they asked lots of probing questions I had never connected my Grandfather's behavior and my Aunt's behavior as being pertinent. That's why doctors ask things over and over, isn't it.

Of course, they asked me a million questions about what my symptoms were like, and when and how they started, many questions asked several times. Some I could answer, and some I really couldn't. He was very interested in knowing about anti-depression and tranquilizer drugs I have taken in the past. I have been on several for short periods of time because of the stress of caring for our parents and our daughters, but I couldn't tell him much about which ones I have taken. I should be able to get that information from my Primary and from our Pharmacist, plus I rounded up a bunch of prescription bottles of them that I had kept - just in case.

Dr. Watts sat down right in front of me, looked me in the eye, smiled, and talked with me. I had no sense of him being in a hurry to move on to the next patient. That is so rare in doctors these days, and certainly not what I expected out of such a highly renowned specialist.

OK, so now to what happened. I put on quite a show of jerks, tremors, and facial tics the whole time, partly because I was so nervous about what they would find or not find. There is a big part of my mind that is just sure this has all been a psychological problem, but at least he never said that. At least not yet.

I gave a pint of blood in the lab (OK, so I'm exaggerating - but it was maybe 8 vials full), looking for some clue as to what is going on. He talked to me about the possibility of some kind of antibody/autoimmune problem where my own body is causing the problems. He also seemed to think it might be symptoms caused from one of the medicines I have taken in the past.

He has also ordered an MRI at UAB. He says their MRI equipment is different from others I have been in, in that it is more powerful and may see something that the others did not. Plus, it's been 2 years since I had a brain MRI, and whatever is going on might show up now that hadn't progressed enough to show back then. They will call me with that appointment, so I don't know when that will be.

He talked with his assistant, Dr. D, about lots of things it might be, with all kinds of medical jargon. Dr. D was jotting down notes the whole time and seemed to be making a list of possible diagnoses as they discussed my symptoms. Every once in awhile Dr. Watts would ask me to do something or ask more questions. It was exactly like watching a real live "HOUSE" team in action. When he was through talking back and forth with Dr. D, Dr. Watts gave us a layman's explanation of some of the possibilities. I am not going to list them, since obviously they can't all be it, and maybe even none of them are "it". I did come home and get busy Googling every term I could remember hearing them discussing. You knew I would do that, didn't you. LOL!

He did put me on a titrating dose schedule of Clonazepam, to see if that would calm down the jerks and tics. He said I would be sleepy with it at first, but that this would wear off as my body adjusted to it. I am to take 1/2 tablet at night for a week, then morning and night, and work up to 1 full and 2 halves a day. I have an appointment to see someone else in the practice in May to go over the findings. He said that Dr. D and Dr. Watts would be in on the conference with us at that time.

At this point about all I do know is that it is looking less and less likely that I have Parkinson's, but that I do have some type of Movement Disorder as yet to be named.

We've not told family or friends about all this yet. They know I had the appointment but not why I had it. We decided there was no point in making anyone else worry about all this. We will wait until we actually know something to tell them. I can write it all here, which helps me process it all, because nobody I know personally reads this blog.

Still Doing Without Parkinson's Meds

I've been off all PD meds now since Jan. 25, and not doing a whole lot differently now than I was when I was on the meds. That has several possible meanings, so it really doesn't tell me much.

It could mean that I don't have PD.
It could mean that I have PD, and I'm one of the people who is not helped by the usual or any meds.
It could mean that these symptoms are related to lumbar and cervical disk problems I have.
It could mean that it's all in my head - that it's psychosomatic.
It could mean I do have some kind of neurological problem that has not been determined at this point.
It could be that these symptoms are from the Peripheral Neuropathy that I definitely have.

Whatever it means, I'm certainly not able to decide, so I continue to count the days until I see the MDS in April.

I have had several "spells" lately when I felt particularly stressed emotionally. Trying to get our taxes done, and dealing with my insurance company about the TAP claim both increased my symptoms.

But the worst was last Sunday during Sunday School. Our teacher was not there, but had left an outline of what she wanted us to discuss. We've done this before, as we are quite capable of carrying on a discussion on our own. For some reason, though, we weren't getting anywhere with the discussion, so they asked me to lead it. These are people I'm used to being around, I taught Sunday School for a long time before I had to stay home with parents, and I taught school for 29 years. Leading it meant moving from the back row I normally sit on, and sitting in front of everyone, instead. Trying to lead the discussion up front brought on the facial tics big time, and I was shaking much more than usual. The worse it got, the more self conscious I became of them seeing me jerk and shake, and that made it just that much worse. I finally just told them I needed to stop, because it was making me too nervous. Time was almost up, anyway, so that was the end of class.

It took me a long time to relax after that, and just thinking about it now is bringing back some of the stress.

I really don't think my symptoms are psychosomatic, but there's no doubt that stress makes them worse. That's why I'm usually at my worst at the Neurologist's office.

I've just bought a new laptop computer, and this one has the built in camera. I took a notion the other day to video myself while I worked at the computer. It was a very revealing look at my facial tics, even when I am busy and not particularly aware of them. Maybe I should save some videos and take my computer with me to the MDS appointment. Well, probably not, but I may keep some for myself, anyway.

Hubby and I talked about how I've been doing lately, and he is in agreement that I really don't seem much different off of the meds than I was when I was on them.

I continue to use the TENS device for my neck pain, as well as the Cervical Collar that I pump up, so it works like traction. I'm also doing the series of neck exercises daily, but we haven't started back to walking yet. Hubby is having a bad flareup with his back, and he's just not up to it right now. So, I piddle with the compost heap a couple of hours a week, and I am still working hard to get all our toys online in our shop catalog. That involves a good bit of shifting and lifting of tubs of toys, so I am getting some exercise each day.

All in all, I'd say my quality of life is better than a few months ago, at least, and for that I am grateful.

Went Off PD Meds Temporarily

I had my last PD medicine around 3:00PM Friday, so I have been without now for about 48 hours. I don't know how much of those meds are still in my system, but I suspect there's not much left.

So, how am I doing? Well, my right foot particularly, and the left to some extent, are shaking some, particularly when I stand in one place for more than just a few seconds. The wobbling foot and knee make my whole body rock rhythmically. It's nowhere near as bad as it looked in Dr. S's office Wednesday, but I was very nervous then, so the exaggerated gait was not overly surprising.

My right hand takes a notion to tremble off and on all day long, but I can usually stop it temporarily by thinking about it. Usually, I just start to jerk somewhere else, when I get one tremor stopped by relaxing and concentrating on just that one area. The facial and tongue tics seem to be worse, too, with me off the PD meds. Generally, I see an increase in jerkiness that moves from place to place as I consciously try to stop it elsewhere.

We haven't told anyone in the family about this possible change in diagnosis, and don't intend to, until it has been confirmed, and hopefully, we have a name for what is wrong with me.

I am going back on my Zelepar and Requip at 3:00PM today, and will stay one them at least until all the holidays are over with, and I am dismissed from PT. I probably will try going without again in February, just to see how I am doing then.

I wrote once before that having a neurological disease is like being in a clinical trial of ONE. It becomes very difficult to manage all the possible variables, and come to any kind of conclusion about the level of disability and what improves or aggravates the symptoms.

Doing Without PD Meds Today

I just have to answer this one for myself, before I drive myself crazy. I didn't take my last PD med last night, and I haven't had any this morning. It will take awhile for the meds to flush out of my system, but I need to know what I look like without them. It's just like most of the meds you see advertised on TV. Take this pill to stop twitching, but oh, by the way, this pill can cause twitching!!! So, if I didn't need them, they would give me the same symptoms as someone who did need them. Like I said, my brain is going around in circles over this, so I may not be making good sense right now.

I'm going to be in the house all day today, and I wanted to settle my mind on this before it was Christmas. It wouldn't do me any good to try to wait until after the New Year to experiment, because I start physical therapy for my neck on Jan. 2, and I sure wouldn't want to be playing around with my dosages then.

Of course I am still on all the other meds I take, for my digestive system, allergies, and bone density, plus the vitamins and herbs for general health and anti-oxidant benefits. Who knows, maybe that's all I need to be on, anyway. I hope to find out with this little experiment.

We will be spending time with our older daughter and son-in-law here in town Christmas Eve, and then we'll drive to our younger daughter's home to spend with our grandchildren and her hubby. Then, a few days later, we'll be driving back for our grandson's birthday.

I don't want this nagging doubt hanging over me. I want to enjoy this family time, and the celebration of the birth of Jesus, without obsessing over this, the way I have the last few days. So, it's do without today, and maybe tomorrow, too, or wait until February or so. And I just emotionally can't wait that long. Did I say that patience is not one of my virtues?

My Pharmacist wears an S under his lab coat!!

Yep, as far as I'm concerned, he's Superman, ready at any moment to rescue this damsel from danger. I went to my Orthopedist today to get some relief from the painful neck spasms I've had for the last two weeks. He prescribed the muscle relaxer, Flexeril, which I have taken before, long before I was diagnosed with PD.

We dropped the prescription off on our way home, and DH went back to get it about an hour later. He came home with Methocarbamol, not Flexeril. Sure enough, I would have had a serious drug interaction with Flexeril and my PD meds. My pharmacist called the doctor and they found a muscle relaxant I could take, all before hubby ever got there to pick it up.

I think that makes three times in the last few months that my fantastic pharmacist has caught medicine errors that my doctors have made.

We live in a very small rural town, and we went without a pharmacist for quite a few years. When this one opened up shop, I told him the first time I went in there that he could depend on us to patronize his shop, even though we realized that we could buy cheaper at Wal-Mart or the chain store pharmacies. He's not open at night, or on Saturdays and Sundays, but I wouldn't trade him for anything. He more than pays for his higher prices with his service and the fact that we are close enough to walk to his store if we had to. The franchise pharmacies would require an almost hour round trip, which is no fun if you are miserable. Sure, there have been times when we had no choice but to patronize the big boys on the weekend or at night, but we try our best to give our local fellow as much business as we can.

I've said it before, and I'll probably say it again. Everyone should keep all their prescriptions medicines on file with one pharmacist, and make sure that pharmacist cares about you, and not just about making money!!

Drug Interaction Still Causing Problems

I went to the Gastroenterologist Wednesday afternoon, and he did X-rays of my abdomen to determine if I was as constipated as he thought I would be, based on my symptoms. He was surprised to find that nothing in my colon was hard or compacted. After examining me, he has come to the conclusion that my problem is caused by spasms of the digestive tract, rather than weak muscles, as he had been telling me it was. So, now he thinks my trouble is exactly the opposite of what he had thought previously!! He prescribed Triavil, which relaxes the colon muscles, and he said I should feel much better by Monday.

I've learned my lesson though, so I specifically asked him if he was sure I could take this med with my Parkinson's meds. He said he did not think this would be a problem, but to ask my pharmacist. Full of hope that he had found a way to stop my very uncomfortable situation, I called our drugstore on the way home to be sure he had it in stock. But, when hubby came back from the drugstore, he didn't bring in the prescription bag. He said the pharmacist said his computer all but crashed when he put in the medicine, it produced such a strong warning that this was a dangerous combination with my other PD meds!!

At first I handled the news stoically, but later on that evening I went through a rough time of being very depressed, with lots of crying. I called my doctor's nurse first thing Thursday morning to let her know I couldn't take it, and to remind her that he would see Selegiline listed in the interaction information, rather than Zelepar, which is just a dissolving form of Selegiline. I think that must be why he didn't realize I couldn't take it.

Anyhow, I haven't heard back from him yet, so DH and I decided it was time to take matters in our own hands. We went enzyme, herb, and spice shopping, as I have been doing some research on my own about Irritable Bowel Syndrome (IBS), and I found some things that should help, without causing problems.

Yesterday, I started taking Turmeric, St. John's Wort, and Acidophilus capsules. DH's Oncologist has had him on Turmeric ever since he had colon cancer, and his doctor had already suggested I use it. We had our usual Date Day today, and I continued to belch a lot all day, but did not have any nausea at all, or my usual sensation as if my food was sitting at the top of my throat all day. I'm encouraged that I will find a way to calm my system down and get things back to closer to normal, whether my Gastro can find a medicine I can take or not.

I'm still very wobbly, though, so I used the cane just about everywhere we went today, and I'm using it in the house tonight, too. It may be that it's just going to take awhile to recover from the really bad state I was in Sunday, plus I may still have some of the Cortisol in my system. I'll have to see if I can find something about how long it stays in the system after getting an injection. Or, it may be that the St. John's Wort, added to my other PD meds, is giving me an overdose of Levadopa.

That's what makes figuring this all out so difficult, as too much PD meds makes for jerky movements, called Dyskinesia. If you've seen Michael J. Fox jerking around, you've seen it. When PWP have been on meds for a long time their systems process the Levadopa in a very unpredictable way, and you see these wild jerking movements. But early on, if the meds aren't strong enough, you see tremors. It's hard for me to tell if my wobbliness is tremor or jerking, so I can't tell, based on that, if I'm getting too little or too much Levadopa. My hands are only shaking ever so slightly, which makes me think I'm not getting too much. My Neuro will know when he sees me.

By then I should have heard from my Gastro doctor, and I'll know if the herbs are going to do any good or cause any problems. I will be doing more research, too, to be sure there are no contraindications of these OTC with my prescriptions.

Walking on Jello

The saga of drug interactions continues, evidently. I had a Celestone shot on Thursday to get the poison ivy under control, as a steroid shot always does the trick for me. My regular doctor has given these to me several times in the last few years, so I was not surprised when I woke up very nervous Friday. That's pretty much par for the course, plus they make it hard for me to sleep, too. So, I tolerated the shakiness Friday, and we continued with our Estate Sale hunting and went to see our younger DD for an overnight stay.

By Saturday morning I was even shakier, but we had a long way to drive home. I kept the way I was feeling to myself, figuring it would go away, and I did feel better after we ate a big breakfast. But, this morning, I was in really bad shape. I was shaking all over and holding on to furniture and the walls to get around. When my hubby got up several hours after me, I was worse. So, I called the Neurologist's answering service and the doctor on call promptly called me back. After listening to all this, he told me to go to the ER. He said he was concerned it was an infection (I didn't think so, but?) and they would be able to give me something to stop the tremors. So, we were off for the hour long drive to get to the ER, with DH trying his best not to show just how worried he was about me, and me trying my best to be still.

They took me right away, but it still took quite awhile to get the results from all the blood work they did. They did not find signs of any infection, and concluded, just as I had, that the steroid shot had precipitated this acceleration of my symptoms. So, armed with four prescriptions and orders to see my Neurologist this week, they sent me home.

So, at least for now, I'm back on Sinemet, which is the "Gold Standard" drug for Parkinson's. Since I was so nauseated with it when I took it for the Sinemet Challenge that confirmed my Parkinson's diagnosis, I had asked the ER doctor to also give me a prescription for Lodosyn, Carafate, and Phenergan. This is where my journal of everything that has happened since my diagnosis came in handy. I was able to show him in my journal that this is what my own Neurologist had put me on way back in September of 2006, when I got so nauseated with the Sinemet.

So, I'm typing this with a fairly steady hand, with all these extra meds in my system. I have an appointment tomorrow with my Gastroenterologist to find out what he thinks is going on with my digestive tract, and as soon as I know what is going on in that area, I will make an appointment to see my Neurologist.

This whole experience has been very upsetting to say the least, not only for me, but for DH as well. I hate it that he's having to take care of me the way he's had to. I hate it that I couldn't stop myself from shaking. I hate it that the ER guard came immediately, being so very solicitous, wanting to get me a wheelchair, as I was obviously so feeble looking, wobbly cane and all. I hate being this way. Today I got a glimpse of what the future holds. I hate it.

Can't Take Meds I Used to Take

I've been working out in the yard a good bit lately, as part of my exercise. I've made some headway with our yard, but I've also come in contact with poison ivy somewhere along the way. I am extremely allergic to it, so I'm broken out over a large part of my upper torso, front and back, on my neck and face, and even in my hair. I have no idea how that happened. We have new cats outside, too, and I may have picked it up cuddling them.

So, I pulled out my trusty Benadryl, in addition to the topical anti-itch meds I always have on hand. Benadryl makes me sleepy, so during the day I've always used something like non-drowsy formula Sudafed. When DH went to the store he couldn't find the exact same Sudafed I was about out of, so he took what appeared to be a similar medicine to the Pharmacist to make sure it was OK for me to take it. He made sure he told her I had Parkinson's, and she said it would be fine.

I hadn't even thought about checking for PD drug interactions, so I'm glad hubby did. Particularly since I did take one dose of the 12 hour Sudafed with Pseudophedrine Hydrochloride in it this morning, and I've felt yucky all day long today. When I looked on the new box to see how many to take, despite the fact that DH had asked the pharmacist if it was OK, there in fine print, among the list of conditions that made using it unsafe, was - you guessed it -- Parkinson's. The same warning was on my old box of meds, too, and I hadn't even thought to look. That's BAD.

So, I called our local Pharmacist to double check, and sure enough, I can't take it. DH has gone there now to get Chlorotrimiton, which has nothing but an antihistamine. It doesn't have any decongestant in it. My Zelepar is in the MAO class of drugs, so I have to pay attention to things like that.

As careful as I am to check on drug interactions with prescriptions, it never occurred to me to check out these over the counter meds, as I've taken this combination for poison ivy for years. BAD GIRL, BAD GIRL!!

I've hopefully learned my lesson, though, and will not let old habits take over again. Cause the old gray mare ain't what she used to be!!

Get Help Paying for Prescriptions IF YOU DON'T HAVE INSURANCE!!

One of my new Parkie friends that I have met on the PatientsLikeMe site is knoxgal. She posted an extensive set of links for places to go to get help paying for Parkinson's meds, for those who do not have insurance. Some of these sites are for other than just PD meds, too. I asked permission to copy her post for any of you who either need this information yourself, or know someone who could make good use of it.

Bridge to Access:


Azilect:


GlaxoSmithKline


Needy Meds:


Partnership for Patience Assistance


Johnson & Johnson:

This is what knoxgal has to say:

Every site is different as to what meds they will cover. Most require the same thing and I am offering this info through trial and error. To get started you will need to contact them to get an application. Fill out the application and note the requirements needed. Number 1 -- prescription. Number two--verification of income. Number three-- a copy of W2 for the last year. Later, they have requested the last page of my filing with the IRS, showing your income and the amount of your refund etc.

Please note every site requires something different, such as your income, employment status etc. Once you have all of your forms filled out, and documents together, you need to get these to your doctor for him to sign them and he will get them into the provider for you.

I have found that they are really good about automatically sending you refills. You don't even have to request them. You usually qualify for free meds or discounted meds for a year. After a year is up, you do need to reapply.

I hope this is helpful.

I should think there would be a lot of folks who would find this information helpful, and I want to thank knoxgal for allowing me to copy her post.

PS Just to give you an idea of what a neat site PatientsLikeMe is, here's the public part of my information on the site, plus you can see what other patients have made public, as well. Right now, they are set up for patients with ALS and MS, as well.

Parkinson's Patch Approved in USA

Neupro, a dopamine agonist delivered in patch form, has been available in Canada and Europe for some time, but now it has been approved in the USA. The Requip I am on is a dopamine agonist, so I should be a good candidate for the patch.

I was disappointed on doing some research to find that nausea is still one of the more common side effects. I was hoping that my tummy would not be involved, since it's not a medicine that is swallowed. There's also a fairly high incidence of irritation at the patch site, and users are not supposed to put the patch in the same place more often than 14 days apart. Most of the other side effects are true of just about all the Parkinson's medicines, from dizziness to low blood pressure on standing. As a dopamine agonist, there is a certain level of risk of obsessive behavior and also of suddenly falling asleep. Driving can be risky. Thank goodness we're both retired, because my not driving has really not been a real problem for us.

So, although I had planned on bugging the Neurologist to change me to the patch as soon as it was approved, now that I know a little more about it, I probably won't be in such a hurry to push for it.

If anyone reads this who has been on Neupro, or is now on it, please leave a comment about your results and/or side effects.

Zelnorm Is Taken Off the Market

When I refilled my prescriptions last week, my pharmacist sent me a note that our insurance was no longer covering Zelnorm. I found out today why. It has been recalled. Luckily, the Miralax is doing a good job of keeping my digestive system moving along smoothly, and I didn't have any problems stopping the Zelnorm. Thank goodness I didn't have any of the heart problems that some people were having with it!!

That's twice my pharmacist has come to my rescue. I can't reinforce enough my suggestion that you buy all your prescriptions from one drug store!

Cymbalta + Zelepar = BIG NO NO!!

I sent my DH to the drug store yesterday evening to pick up the prescriptions I had ordered earlier. When he brought the bag back, our local pharmacist had written a large note on it. It seems my Cymbalta and Zelepar can have a dangerous drug interaction. So, he didn't fill the Cymbalta, but told me to call my doctor.

Before calling the Neurologist, I thought I'd look up a little about this combination for myself on the Internet. Well .... I don't need to call the doctor!! Cymbalta is OUT!! Not only do the two cancel each other out, but the combination can cause something called Serotonin Syndrome/Poisoning, which can be fatal in its extreme manifestation. I have definitely had one of the milder symptoms, which I was blaming on the Zelepar, as it started after I started taking it. Out of nowhere, I would start sweating profusely and be so hot I just about couldn't stand it. I've mentioned this before, as it feels just like menopause hot flashes at their worst.

The Cymbalta prescription came from my General Practitioner, who prescribed it almost a year ago. The Neurologist had a complete list of my medications, so at least he should have known I was on it when he put me on Zelepar, which is the dissolving form of Selegiline.

So, as is so often true, it's the Pharmacist who is the expert when it comes to such interactions of medicines. This is the best argument I know of to use only one pharmacy for all prescriptions.

A Clinical Trial of One??

In a real Clinical Trial, doctors use a very large number of people, usually, but not always, divided into two groups. One group gets the medicine being tested, and the other group gets fake medicine, called a placebo. At the end of the trial, if the people getting the real medicine have improved considerably more than the group getting the placebo, the medicine is assumed to be the cause of the improvement. That's a good thing!

They use such large numbers of people to conduct these trials, because there are always going to be unforeseen situations that influence the effectiveness of the medicine for some people. Maybe a few of the subjects have an undiagnosed disease that makes even the best of medicines not work. Or maybe some of them are under a lot of stress that ruins their results.

When you see a new medicine being talked about with glowing praise of its effectiveness, you have to be very cautious about getting all excited about it. I have seen reports like that where the trial only had 16 people in it. That only gives doctors a hint that a certain medicine might be helpful. It's just not enough people to tell you much.

That's the problem with trying to find the right medicine for me, or any other PWP. We are, in a very real sense, our own Clinical Trial. The last time I was on Requip, I was terribly bloated, with horrible stomach cramps and gas. So, the Neurologist took me off of it, and he put me on Zelepar. That medicine dissolved under the tongue, so it doesn't bother the digestive system. My stomach improved tremendously. The question is, was that because of the Zelepar, or was it because, that same week, my Gastroenterologist changed the prescriptions I was taking for my stomach? Also, my symptoms were not alleviated as well when I was on the Zelepar --- BUT I had strep throat most of the time I was trying it, without knowing I was that sick.

There's no way to be sure, is there, with more than one medicine being changed at the same time, and with me being sick, too? I talked with my Neurologist yesterday about this, and the fact that I had gone back to 1 Requip pill a day for several days, because I ran out of the Zelepar samples before my appointment. Even though I had been on the Requip for several days, my stomach was doing just fine.

So, Dr. S. has prescribed another month of Zelepar, to give it a fair trial at helping my PD symptoms. If I am still not getting as good a results with it as I was the Requip, I am to add the old dosage of 3 times a day of Requip to the Zelepar, which I take 2 times a day. I don't see Dr. S. for 6 more weeks, to try to give me a chance to tell what is going to work best for me.

Parkinson's Disease is different from many diseases, where there is some MRI or blood test that will tell the doctor what is helping, and what is not. With PD, it really is up to me. I have to be the judge for myself if the Neurologist has prescribed the right medicine and the right dosage. Then he bases my prescriptions on his vast experience with many other PWP he has treated.

But it still boils down to a Clinical Trial of one - ME!

Results of Endoscopy and Ultrasound

Yesterday I had the Endoscopy and Ultrasound to try to determine why I'm having such a terrible time with the acid reflux. I've been diagnosed with GERD now for several years, so I generally know what I can and cannot eat. I really thought it was the Sinemet that set off the reflux, but my Gastroenterologist wanted to be sure it wasn't a lingering infection from the severe colitis I had been plagued with for so long.

Anyway, the tests showed nothing but irritation, not infection, and no sign of gall stones or anything like that, so it was the medicine after all. My own doctor had been called away, and one of his associates, who is not familiar with my case, did the endoscopy. His orders were to take the Parkinson's meds with meals, which, of course, I'm not supposed to do. He also prescribed Carafate and a week's worth of probiotics, and to continue the twice a day on Protonix. All this is designed to settle down my tummy and soothe my esophagus.

As for taking the PD meds with meals, I'm not going to do that, but I do eat crackers with them each time, to try to protect my stomach. Hopefully, by the time I'm weaned off the Sinemet and fully titrated onto the Requip, I won't have the conflict with the meds, anyway.

If I still have problems then, I'll have to try to get the Neurologist and the Gastroenterologist to talk to each other and decide what's best for me. I don't like being the go-between for doctors. They need to discuss this with each other!

I had read that Parkinson's meds and Parkinson's itself could cause a person to react differently to anesthesia. Well, there may be some truth to that. I slept until 6:30 PM yesterday evening after we got home from the endoscopy, and then I went back to sleep about 10:00 and slept all night until around 6:30 this morning!! I just about lost yesterday!! I'm fine today, with no ill effects at all.

Tummy's Been Worse

I ended up calling the Neurologist's call service, as stomach cramps have joined the nausea, even though I've been super careful with what I've eaten today. I've had crackers with the Sinemet, too, but nothing's helping.

I was extremely impressed with how quickly I got a call back from the doctor on call this weekend. He's phoned in a prescription to our pharmacy, on the chance they leave an answering machine on when they're not open. I'm to call the drugstore in the morning to see if they got the message. If not, I'll have to phone the doctor's office in the morning, and they'll call in the prescription. All this rigamarole, because we live in a little town that's lucky to even have a drugstore at all, even if it is closed at night and on the weekend.

In the meantime, he told me to not take any more Sinemet until I get this new medicine. I will be taking it with each dose of Sinemet from now on. He said the name of the med, but I forgot it by the time I got off the phone.

If I Could Dance ... I Would!!!

I went to the Neurologist today, and I feel like I had a very productive visit this time. He is agreeing with the diagnosis of Peripheral Neuropathy, but he thinks something else is going on at the same time, as not all my symptoms seem to fit that diagnosis. First of all, the heavy metals test came back negative, so we don't have to worry about the EPA site, at least. All the other blood tests came back OK, too. One test is having to be done again, as the lab goofed on that one.

Anyway, he's given me a prescription for Sinemet to take for three weeks and then see him again to see if it makes a difference in my walking. This is a Parkinson's medicine, which is what I've thought he was thinking all along, since Mama had Parkinson's. She didn't have tremors, and I've only had some shakiness when I was weakened by the colitis or really tired.

I finally feel like I'm getting somewhere!!! At least in 3 weeks we'll know if it's Parkinson's or something similar, and I really think it is. I'm looking forward to being able to walk better. I know I shouldn't be getting my hopes up so, but right now I'm almost ecstatic!

Great Visit from DD

The TV's back on, I'm back on the computer, the cat is satisfied that there are no strangers in the house, so everything's back to the status quo.

It sure was wonderful, though, for today and yesterday afternoon on, to have our younger DD home for a quiet visit. I think it did her as much good as it did me. We didn't go anywhere, and we really didn't do anything. We just sat on the sofa and chatted, if the spirit moved us, or just enjoyed doing nothing.

She leads such a hectic life, between work and chauffeuring three active children here and yon from one practice to another, plus her part of the housework. Being still, with nobody hollering Mama! was probably quite restful for her. And I just enjoyed being with her. For all that it came because of serious illness, I did get to spend a lot of time with our older DD this last year, and I was missing spending some time with our younger DD, too.

Nothing has changed, leg wise. My digestive system continues to behave itself, and I'm eating normally now. Of course I'm still on the high powered medicines. I'm to report my progress to the Gastroenterologist's nurse tomorrow, and she'll tell me what to cut back on next.

We watched a little bit of the MDA telethon today. I thank God for two healthy children, who have grown into loving women, who are good people. Both have a strong faith in Jesus, and they are both married to Christian men. All three of our grandchildren are healthy, and they are saved, too. Yes, we have much to be thankful for.

For those parents who are struggling through the anquish of seeing that precious little one be diagnosed with a serious illness, my heart cries out for you. I can't begin to understand how you feel, but I can pray for you. May God be with you today in a close and intimate way. Amen.