Sunday 23 February 2014

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Thank you for reading my blog, and thank you for being informed.  Educating the world about Parkinson's Disease, even one person at a time, will keep us, UnSHAKEable!  Please visit my facebook page which will provide information and links to read, and share. 


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Please continue to visit my blog.  When the soul is willing, and the fingers are moving, there will be new posts. Spreading the word about Parkinson's and staying, UnSHAKEable!  Visit often.

Tuesday 18 February 2014

The Disease is Progressive, the Meds are Not



                
  Picture or Photo of Healthy Brain Pills on white background. Close Up.February 18, 2014

Today I wanted to write about medications for Parkinson's Disease.  I find this a fascinating topic as the most commonly used medication was developed in 1967, and is still the medication most prescribed today.  But, slowly....at a snail's pace actually, science and research are beginning to open new options.

 There are two general approaches to the treatment of Parkinson's Disease  with medication. The first approach attempts to slow the loss of dopamine in the brain and are called, Agonists.  The second approach attempts to improve the symptoms of Parkinson's Disease by other means.


Dopamine agonists are drugs that activate the dopamine receptor. They mimic or copy the function of dopamine in the brain.
Requip, Mirapex, and Neupro are dopamine agonists.

Levodopa (also called L-dopa) is the most commonly prescribed and most effective drug for controlling the symptoms of Parkinson's disease, particularly bradykenesia and rigidity.Levodopa is transported to the nerve cells in the brain that produce dopamine. It is then converted into dopamine for the nerve cells to use as a neurotransmitter. Sinemet is made up of levodopa and another drug called carbidopa. Levodopa enters the brain and is converted to dopamine while carbidopa increases its effectiveness and prevents or lessens many of the side effects of levodopa, such as nausea, vomiting, and occasional heart rhythm disturbances.

Now with all that scientific rigamarole out of the way, I'll tell you about my personal experiences with these medications.

A person very close to me was diagnosed with Parkinson's approximately 9 years ago.  We will call him, Allen.  The Neurologist at the time prescribed the agonist, Mirapex.  Around this time, Mirapex was considered to be a miracle drug in the PD nation.  Without follow-up, Allen continued to take the medication which indeed improved the symptoms he suffered from the most.  The problem was, and a little known fact at the time, this medication would prove to do more harm than good.  The drug induced euphoric feelings and enhanced feelings of obsessive and compulsive behaviours.  As a result, many patients experienced heightened compulsions such as gambling, eating, and even sexual drive.  It was soon realized that this medication alone was responsible for many people losing their homes, going bankrupt, and having marriages and families torn apart.  

When I was first diagnosed and put on Levocarb, I pre-warned the Neurologst that I would, under no circumstances consider taking Mirapex, if it ever came to that down the road.  My Neurologist and Movement Disorder Doctor placated me by suggesting that if it ever had to become an option down the road, just the fact that I am aware of the dangers, and with their constant follow-ups, it may be something that I would have to reconsider.

Currently, I am taking Levocarb.  It has been very successful in aiding the symptoms of tremors, rigidity, and gait.  I do experience stomach upset when it is not taken with food.  The advice is for it to be most effective taken on an empty stomach, and on a low protein enriched diet.  This apparently aids in quick absorption.  Of course, me being me, I take it with a meal or snack...protein or otherwise.

Currently I take 2 tablets 5x per day, which is approximately every four hours.  What I am noticing is what we Parkies call, the wearing off effect.  That is, as it gets closer to the next dosage, you feel symptomatic prior to the next dose.  For example, about 3 1/2 hours into my dose (1/2 hr before next dose), my tremor starts getting a little anxious.  That is the tremor in my hand, and the tremor inside my body.  Inside my body, I call it, "that quiver feeling".  Once I take my dose, all is good in Parkieville for the next 3 1/2 hours.  

This, wearing off effect, can be even more pronounced when in a stressful state, or when one is just out of the usual routine.  That is why it is ever so important to have extra pills on hand at all times.  The Ministry of Health is even looking at the importance of Parkies enduring hospital stays, having their medication readily accessible to take on their own time, not in combination with other meds being distributed by nursing staff.  

The most current treatment for Parkinson's Disease is called, DBS, Deep Brain Stimulation. 
Surgery is required to implant the equipment that produces the electrical stimulation. You are awake during the procedure (your scalp is numbed and you won't feel any pain), because you must work with the surgeon in placing the electrodes where they will have the most benefit. A small hole is drilled in your skull, and tiny wire electrodes are placed in your brain. A small battery-powered device (generator) similar to a pacemaker is implanted in your chest and connected to the electrodes in your brain by a wire. The procedure usually takes 3 to 4 hours, although it may take as long as 8 hours.

When the device is turned on, it sends 100 to 180 electrical pulses per minute to stimulate the specific area of the brain. You can turn the device on and off by holding a magnet against the skin over the device. Newer models can be turned on and off with a small remote control unit. The device can be programmed so that it delivers the correct level of stimulation to provide the greatest relief of symptoms,

The big question now is what does the future hold for research.  Currently researches are looking at a Neupro patch.  It is similar to a nicotine patch in the way it delivers Levadopa.  The idea is to limit or diminish the wearing off effects.

A cure down the road?  Perhaps way, way, down the road.  The first step is for research to locate a Biomarker which would tell scientists the where, why and how of the disease.  But, seeing as this is research required on a working brain, the exhaustive research is quite difficult.

Until there is a cure, if ever, the most that we Parkies can hope for is a medication that controls our symptoms comfortably, and extensively.  There is always hope.  Thanks to Michael J Fox and his foundation, Parkinson's Disease is familiar.  He was young, vibrant....and is now the face of the illness.  Perhaps because of him, Linda Rondstatt, and Mahummad Ali, we Parkies may just experience scientific break through in our lifetime.  Until then, we just try to remain, UnSHAKEable.

Thursday 13 February 2014

A Crappy Day in Parkieville

                          

                                         
                                                                                                                                                                                          
Feb 13, 2014

It has been a crappy day.  I define a crappy day as one that does not bring me enjoyment.  It is one of those days where it suddenly hits you....."I have Parkinson's.  There is no cure.  It is progressing.  Wow.  I am only 49 years old".  Yes, all that hit me in a matter of moments.  So, the crappy day began.......

Sleep disturbances are hugely typical of PD.  From vivid dreams, to not being able to sleep, to incredible fatigue during the day that leads to restless nights.  And lets not forget the aches and pains, the stiffening of the joints, pain that is finally being recognized by doctors as typical PD symptoms.  Well, waking up after all of that did not get me off to a good start. 

When I first rise, at 8 am., I take my first dose of meds.  Now, let me step back a bit and remind you that I also have diabetes, and so with diabetes meds, my PD meds, my anti anxiety, anti cholesterol (as a preventative), anti this, and anti that....I take a total of 25 pills per day.  So, the bulk of the anti's are taken first thing in the morning.  I take them all at once, and down it with a big gulp of water.  With that done, I head back to bed, and quickly return to sleep until or around my next PD dose at or around 12:00 noon.

When I begin my day, on the second dose, I am somewhat human.  But today, and this is the crowning moment of all that went poorly in my day....I......you may want to sit down for this one.  I dropped a cup that had water in it, all over the floor.  I hope I prepared you enough for that one!!!  

It was not the first glass that I had ever dropped, nor will it be the last.  But it was that feeling of, "why can't I hold shit in my frickin hand," that brought me to my last nerve.  I just can not use my pincer grasp any more, and am constantly fumbling with things, knocking them over, or dropping them.  Most of the time it does not cause me grief, but today it was like a siren that went off in my head....this is going to be the best it will get.  I teared up.  Silly, but very real.  Today is the best day of the rest of my life.  It is no wonder that I wasn't wailing by this time! 

Frustration and apathy.  One or the other.  Or, both.  Those are the two constants in my world.  That dopamine stuff in my brain...the stuff my brain is lacking....well dammit!....I'd do anything to get some back.  Dropping that glass just raised my frustration level from 0-10 in 20 mili-seconds.  And usually when this happens, the frustration trumps the apathy.  Frustration wins every time.  It is my reactions to the frustrations that I try to control.  And, today, I was too apathetic to try to control them, so I did not have an "out burst", rather an "in-burst".  I let it eat at me...I kept the python at bay, and I just bathed in the feelings of a crappy day.

It truly is hard to describe how such a minuscule accident, could lead to a full blown crappy day....but it does.  The crap hits the fan when that minuscule moment rapidly reminds my brain that the PD is not going away.  It will not get any better.  Today is the best day of the rest of my life.  I tell myself that I do in fact have good days, but the apathetic squirt of a devil conscience that sits on my shoulder whispering to me, always, always tells me differently.  When you are suddenly confronted with reality, and your head and science are both in agreement to that fact, it certainly makes for a crappy day.

So, as I am nearing the end of my crappy day, I can tell you that nothing else was dropped.  Nothing broken.  Nothing spilled.  Just a fleeting moment of frustration that took my brain on a journey to reality.  The reality sucks, the apathy sinks in, and gloom settles over Parkieville, and all that I can truly hope for is that tomorrow I won't listen to my brain, or the little red devil on my shoulder, and that the python inside of me just pisses off for awhile.  Ooops, sorry about the language.  But I think along with the diabetes, PD, and remember the ADHD I developed, well, I think I have also developed Tourettes....SHIT!

Wednesday 12 February 2014

The Important Roles of Caregiver

Doctors diagnose, nurses heal, and #caregivers make sense of it all. #caregiver    February 13th, 2014  


















Yes, it has been awhile since my last post.  Much has occurred, and really, very little has occurred.  But one consistent thing that remains in my mind daily, is the need, and/or importance of having a caregiver.  Right when you think to yourself, "There is nothing I can't handle on my own...", you get a really  good dose of reality....usually in my mind it a a good swift, kick in the pants.

With the diagnosis of Parkinson's Disease comes the quick realization that it is assumed you have a designated caregiver.  Now, who in the world would volunteer for such a title, is just beyond comprehension for me.  But it even becomes further evident, that Parkinson's and caregivers are two terms that will go hand-in-hand in the land of the Parkie,

Caregivers have a job much like a tight rope walker.  Falling a little bit to either side will have horrible consequences.  You see, we Parkies, who may have been very kind, gentle, soft-spoken, and easy going, prior to diagnosis, possess this ugly twin who will rear its ugly head more often than not, as the disease progresses.  It really is not anything we are proud of, nor seem to have control over.  It is just...well....kinda, is just, there.

You see, frustration consumes me.  My world has become slow.  So any pressure to move faster, speak quickly, think rapidly, just creates like this bio hazard haze that envelopes me and unleashes the angry python inside of me, who will strike its victim, swiftly and angrily, but then quickly retreat.  My tongue has become the python.  In the midst of a friendly conversation among family, or friends, I may suddenly blurt out, "just a minute, just a minute, you are interrupting me.....". or a swift, "let me finish!", which by all accounts, is not the norm for me.  Hence I blame the python for striking yet again. But my caregiver is very aware of this frustration, and he will move the conversation in a way that only he can, and my little outburst, will be but a blip on the radar. 

The Caregiver becomes a very important piece of the PD puzzle.  He/she is present at doctor appointments.  This is most important when the Doctor, Neurologist, or Movement Disorder Specialist is speaking.  To me it is the sound of, Charlie Brown and Lucy's classroom teacher...."wa...whaaa.waa..wa...waah".  My focus has now become the tremor in my hand.  It  is acting squirley for no apparent reason, or my mind wanders, trying to think ahead of the doctor, trying to contemplate the correct answer to his next question.  The Caregiver, in this case, is the one who collects the information, and relays it back to me at a time when they will have my full attention.

 I think I have developed ADHD along the way, for even when I should be focused, my extremities that are actually taking on a life of their own, become my preoccupation.  While Charlie Brown's teacher (perhaps today it is my Neurologist) is "wa...wah...waaaing"... I am noticing that if I try to stop my hand from tremoring sideways, it squeaks its way out anyways, moving up and down.  Hhhmph...I never realized.....oh...did that doctor just say, exercise?????  At another appointment while listening to wa..wah..., I realized that my leg does indeed tremor...mildly...but whoa...look at that!  Oops...I think the doctor just said something about 5x per day? 

My caregiver has learned that it really isn't a challenge to relay the information to me,  IF,  I am able to focus, which really requires timing.  No appointments before noon, thus allowing for my second dose of meds to kick in.  And definitely prior to 4:40 when I wind down after my third dose.  Is there a perfect time???  Absolutely!  If the moons align, and I take my first meds at 8:00 am, and am able to go back to bed until my 12:00 noon dose, which would make my third dose, say, 4:00, then by all means....2:36pm  is a great time for a doctor appointment!!  My caregiver knows this, so usually we reflect on the important information the doctor presented, at 2:36 when the moons have aligned and I began my day at 8:00 am.  He knows my schedule like the back of his hand.

My caregiver helps make things easier for me, but is also the only person who can push me to my limit, without sending me over the edge.  He is particularly good at convincing me that I should go for my walk.  I guess at some point during one of my doctor appointments, the conversation became how important it was for me to continue to use my legs as much as possible.  I think that was the day I noticed that if I put my right foot flat on the ground, my ankle will swivel...but doing this to my left foot,  absolutely nothing. Huh....who would'a thought?!?    Sometimes, my caregiver forgets all the tip-toeing around, and just gets to the point, "use it or lose it", and walks away.  Wow....that was mean.  I have PD don't cha know!? 

Now that I ponder the idea of caregiver, I guess I never actually asked mine if he wanted to be one.  Sure, I left the door open when I was diagnosed, and suggested that if the future terrified him, I would not hold it against him to walk right out.  He did not.  He said we were in it together, to the end.  So, I guess I just kind of granted him the title of , Caregiver.  Lucky guy! 

On a serious note, the role of caregiver is vital.  It is someone who attends support meetings, doctor appointments, and the one who helps keep you on track, whether it be medications, appointments, or daily routines.  The caregiver is the tightrope walker, who knows how to balance you, and your life.  It is your voice when you have none, your strength when there is none, and your shoulder when you need one.  My caregiver certainly walks the rope, and even when I give him a nudge, he holds strong, keeps his balance, and gets me back to where I need to be.  He is the perfect act in one three ring circus that has become my life.