I write the newsletter for the Parkinson Foundation of Harris Cty in
Houston and had the following in last month's newsletter.
The article has a chart in it that I've shown you a part of.
If you email me I will attach it for you in a Word file..
YOUR DOCTOR RELIES ON YOU
TO COMPLETE THE PICTURE
Do you leave your doctor's office frustrated
because a particular problem that occurs at home
isn't visible during your appointment?
Do you remember those important questions
you wanted to ask after you've left the office?
For you to be properly treated, it's vital your
doctor has the complete picture.
This questionnaire and the medication diary
are designed to help you keep track of your
concerns and questions. Make copies for your future use.
Fill it out and take it to your next doctor's visit.
1. Do you experience “off” times during the day?
?Yes ?No
If so, how many times a day?
_________________________________________
Do they tend to occur at the same times of day?
?Yes ?No
If so, what times of day?
_________________________________________
2. Are you experiencing any uncontrollable movements
(which are also called dyskenisias)?
?Yes ?No
If so, when do they tend to occur?
_________________________________________
3. How well are you sleeping?
Poorly Very well
1 2 3 4 5
Do you have difficulty moving when asleep or getting out of bed?
?Yes ?No
4. How would you rate your emotional outlook lately?
Quite negative Quite positive
1 2 3 4 5
5. How well are you speaking?
Not so well Quite well
1 2 3 4 5
6. How well are you walking?
Not so well Quite well
1 2 3 4 5
7. How much help do you need from others during the day?
Need help often Seldom need help
1 2 3 4 5
8. Questions my family and I have for my doctor:
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
9. Additional details and comments to remember:
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
MEDICATION DIARY
NAME ___________________________________________
Last First Middle
MEDICATION: STRENGTH
A = ____________ ( ________ )
B = ____________ ( ________ )
C = ____________ ( ________ )
D = ____________ ( ________ )
ON: You are able to move around well.
OFF: You move slowly or not at all.
DYSKINESIA: You are able to move well,
but are troubled by unintentional movements.
These movements are different from the rhythmic
trembling called tremor that's a symptom
of Parkinson’s disease itself.
(Write letter in square to designate when each medication
was taken and check other squares to show
when you eat or sleep.)
Date _________ 5:30 am 6:00 am 6:30 am etc., etc.
Dyskinesia
On
Off
________________
Tablets Taken A, B, C etc.
Asleep
Meal Time
________________
Sherry Macredes wrote:
> Hi everyone,
> I have been taking Requip and am now up to 3MG per day. I just started
> taking Requip after Mirapex didn't work. Now that I feel I'm up to a dosage
> that should show some results, I don't feel like it's working. When I call
> the neuro to report on meds if I'm having a bad day I tell him this stuff
> doesn't work, if it's a good day I think it's great. Last week I told him my
> answers may be incorrect because I don't consider the big picture and maybe I
> should keep a journal, he said great idea. Now I wonder how and what to
> record. How do you tell if you are slightly better or worse? Is there an
> exercise to gauge improvement? My problem is with loss of use of my left
> hand and muscle ridigity. The muscle pain is also a problem, how can you
> rate pain? When it hurts it's always a 10 on a scale of 1-10. I am also
> wondering just how much improvement I can expect. One neuro told me with the
> right meds I would be able to lead a "normal" life (yeah right), how do you
> define normal? Have any of you kept a pain journal? What did you use to
> rate your meds?
> Thanks for your input, from a newly dx PD'er.
>
> Sherry
