Phil,

I like most of the others feel that medication should come first.  The question
is Is the Tasmar going to be sufficiently effective.  I was in a similar place
several years ago and entered an Entacapone study.  It's benefits were mild to
moderate (when I was on the open-label part of the study).

BTW I would consider STN or Pallidal Stimulation before a Pallidotomy .  But then
I have a vested interest both emotional and (minimally) financial.  I was so
happy with the results I bought some stock in Medtronic Corp. the maker of the
stimulator.  The main advantage is that it is reversible as well as adjustable.
But I clearly have a bias here.

Charlie

Philip Connors wrote:

> Carol, my wife of almost 40 years, faces a very difficult decission and I
> sollict your input.
> I have been mostly, but not exclusively, lurking from the inception of this
> List.  I have learned more about PD than I ever wanted to know, but also many
> useful things also as my wife, Carol's PD progressed.  Again I ask for some
> timely input.  (ASAP as u will c below.)
> Quick Background:  Carol is 62, basically good health, X-cpt for...
> She is a young onset, symptoms mid to late 40's.  Always a very active,
> driven person.  We live in rural New England town, 3,500 popul. near
> Worcester, but with no public transportation.  She has her driver's license,
> but has stopped driving.
>
> Her main problems are Freezing, OFF periods, and dyskinesia.  We live in a
> 125 year old Victorian 3 story house in the center of the town.
> The most serious thing facing us is that Carol's neurologists suggested that
> she see the MGH surgeon, Dr. Reese Cosgrove, and he strongly suggests a
> pallidotomy.  (It would be done in the Fall.)  It will be her decision and it
> is not clear or easy.  (I ask that anyone who feels that they can contribute
> or constructively kibitz to do so as we prepare for next TUESDAY's app't with
> her neuro at Fallon HP.)
> An interesting spin occurred when Carol & I visited my sleep apnea doctor, a
> neuro, and when we were discussing things in my life that could cause stress
> - Carol's situation, including the potential pallidotomy, came up.  He asked
> if we had considered Tasmar and when we said that we had and Carol had used
> it, but her neuro had taken her off it when the liver damage fatalities had
> come up.  He said fine compared to another drug, but now we were comparing
> the Tasmar risk (which has apparently not continued with many patients using
> it under close liver function monitoring) to BRAIN SURGERY.  He then backed
> off and said that he did not want too interfere in some other DR's area, but
> suggested that we rethink it and discuss it (the possibility of restarting
> Tasmar) with Carol's local (15 years) neuro who we are seeing next week.

--
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Charles T. Meyer,  M.D.
Middleton (Madison), Wisconsin
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