Hello Everyone;

My dad, 77/10, has recently dipped into a downward spiral. Prior to his
decline, he was managing fairly well, with my mother as his full-time
caregiver.

He had begun experiencing some mild hallucinations and paranoia over the
past 6-8 months, but nothing extreme, and usually only at night. He was
coping reasonably well with life and his illness.

His on/off times were fairly consistent with med intake. His med schedule
at that time was:

08:00 a.m. - 1 sinemet 25/100
08:30 a.m. - Breakfast
09:00 a.m. - 1-1/2 permax (.25)
             1 eldepryl (5 mg)
10:30 a.m. - 1/2 sinemet 25/100
01:00 p.m. - 1 sinemet 25/100
01:30 p.m. - lunch
02:00 p.m. - 1-1/2 permax
03:30 p.m. - 1/2 sinemet 25/100
06:00 p.m. - 1 sinemet 25/100
06:30 p.m. - supper
07:00 p.m. - 1 permax
11:30 p.m. - 1 elavil (25 mg.)

Daily Totals:   Sinemet:        Carbidopa:      100mg
                                Levodopa:       500mg
                Eldepryl:                       5mg
                Permax:                         1.00mcg
                Elavil:                         25 mg

He had been on this med schedule, with little variation, for approximately
2 years.

His recent decline was associated with my mother's recent hip-surgery. We
had arranged in-home care for dad for a period of 10 days while mom was in
hospital and at home recuperating.

During that time, dad's condition worsened to the point that he was
suffering more severe hallucinations and extreme paranoia. He saw animals
and people that didn't exist. He stopped sleeping. He believed that everyone
was conspiring
in a plot to injure him or take his home.

As this situation worsened, I became more involved, and discussed his
symptoms and medications in detail with his neuro and the temporary in-home
caregiver. It turned out that dad had been given additional sinemet in error
for several days. When his sinemet intake was stabilized, he improved, but
only slightly.

He became belligerent, increasingly irrational, and even frightening.
Because of his paranoid behavior, my mother chose to forgo her own health
needs and stopped all her in-home nursing care and physical therapy.

We hoped that my father could be admitted to the Duke University Medical
Center [where his neurologist is located - 50 miles away from us] for
evaluation of his meds, as well as evaluation of his psychotic behavior.

However, his neuro said dad could not be admitted unless there were an
acute "medical emergency"--i.e., unable to breathe, unable to swallow,
stroke, chest pains; any 'lesser' reasons would not be covered by dad's
health insurance,

He then suggested adjusting some medications over the phone. At first he
recommended cutting back on the permax only - 1 at 09:00 a.m.; 1 at 2:00
p.m.; 1/2 at 07:00 p.m. - an overall daily reduction from 1.00 to .63 mcg.
All other meds remained the same.

When there was no improvement after 4-5 days, the neuro recommended
stopping the Elavil at night, waiting 3 days, and then stopping the Eldepryl.

However, before these changes could be made, the paranoid/delusional
symptoms reached a critical point, and we felt he might be a danger to
himself [and others]. We had to have my dad involuntarily committed to the
psychiatric ward of a local hospital.

The psychiatrist there [who claimed to also be a board-certified
neurologist] made quite a few changes in medication.

He cut out the Eldepryl, the Permax, and the Elavil. He added Amantadine to
the original Sinemet schedule; he added the antipsychotic Risperidone; he
added the
mood stablizer Gabapentin.

He released my father within a week, claiming that his severe
delusional/paranoid behavior was med-induced, and most certainly would be
easily controlled with the changes he had made in meds.

The psychiatrist did not consult with my dad's neurologist, although he had
been asked to; and my dad's neurologist did not consult with the
psychiatrist, although he had been asked to.

Since dad was released from the hospital on July 10, his condition has
shown some improvement.

His hallucinations/delusions are milder; however, he continues to exhibit
paranoid behavior; he has become almost zombie-like. His on-time is next to
none; he literally falls on the floor and can't get up. He still stays
awake nearly all night, talking constantly. He refuses to submit to in-home
health care.

Within the last week, the psychiatrist has taken him completely off the
Risperidone and the Gabapentin. My dad now takes only Sinemet [the original
schedule] and Amantadine [100 mg. one time daily at 9:00 a.m.]. He also
takes .05 Synthroid [for hypothyroidism] once daily at 9:00 a.m.

My mother cannot care for him as she did prior to her surgery. We [my three
brothers and I] have investigated local nursing homes, but they won't admit
him to skilled health care because there is no acute medical emergency.

I guess my questions are:

How can I convince the neurologist and the psychiatrist to consult with
each other?

Why will his neuro not admit him to the hospital for evaluation unless
there is an acute medical emergency?

Why will a nursing home not admit him for skilled health care unless there
is an acute medical emergency?

If a man cannot care for himself, cannot walk, cannot feed himself, cannot
dress himself, cannot clean himself, cannot get himself on or off the bed,
and exhibits irrational, psychotic behavior, does this not constitute a
medical emergency?

Can my dad expect no more medical assistance than this?

I would be grateful for your thoughts, comments, advice.

Lucy Hartley