Hello friends, Here is the manuscript of my next Parkinson's Mailbag for the PDF....Hope it helps. Ivan Suzman M A N A G I N G O U R M E D I C A T I O N S EVERY DAY IS DIFFERENT I think that most of us who are fighting Parkinson's Disease would agree that this disease is by nature somewhat capricious. The first symptoms a patient experiences are, commonly, not easily identifiable as Parkinsonian. They also tend to vary from day to day, and change quickly according to the emotional condition of the patient.. These fluctuations continue indefinitely, making the administration of medications very challenging. The same amount of medication in three consecutive doses may cause dyskinesia, or normal motion, or can be insufficient, and leave the patient stuck in a chair, unable to stand up. As a result, close monitoring of one's medications, which will vary tremendously in effectiveness even from one part of a day to a different part of the same day, is very necessary. Finding a precise pattern of medications that works well is somewhat like mastering an overhead volley of a tennis ball, which you try to deliver time after time to your opponent's baseline at the back of his court. LEARN THE WAY EACH PILL WORKS It is very helpful to know four characteristics of each medication you take. These are: - how long should you wait before expecting to feel the effects of a pill? - how long will a pill's positive effects last before another dose is needed ? - what do you feel happening to your body and mind when a pill is wearing off? - is your pill best taken between meals, on an empty stomach, or with food ? OUR OPTIONS ARE INCREASING . When I was finally diagnosed, in 1989, there were just five medications to try. These were Sinemet, including many variants, like the CR formula and generic equivalents, Parlodel (bromocriptine), Permax(pergalide), Amantadine, and Eldepryl, Now, there are agonists like Mirapex and Requip, COMT-inhibitors Tasmar and Comtan, GDNF, co-enzymes like Q-10, Vitamins, supplements, and naturopathic and homeopathic remedies to consider. I hope that readers will find the suggestions below to be helpful. As you will gain mobility, you will experience an improved outlook on life, as well.. SAMPLING THE MAILBAG,,,, WORK WITH YOUR PHARMACIST Marion Lundgren of Nova Scotia, now transplanted to Maine, urges us to use the same pharmacist for all of our prescriptions. Echoing her is Lillian Scenna , the Parkinson's social worker at Maine Medical Center, who said that your pharmacist is more likely to know about the cross-reactions and dangerous combinations of different drugs than your physician, who tends to know more about the specialized drugs of his or her area of practice. For example. Demerol can never be given if a patient is on Eldepryl, as this combination can lead to a heart attack.. Eldepryl is a good example. It is an MAO-b inhibitor. This means no Sucrets, no Robitussin DM, and no MSG for these patients. A long list of dietary rules also accompanies Eldepryl. Food additives can be very dangerous. L-dopa overdose is no laughing matter. Hot, spicy corn chips and potato chips, and some common chewing gums, like Trident and Dentine sugarless, carry warnings for phenoketinuric patients; I wonder about any implications for PWP's., as these foods are laced with man-made phenylalanine, the basic ingredient of Sinemet. PROS AND CONS OF GENERIC SUBSTITUTES Nina Brown of Texas suggests talking with your pharmacist about free or reduced cost drug programs. She suggests asking for generic drugs to save money.. She mentioned contacting Pfizer and other companies directly, and asking about their programs for people on fixed incomes. . I would add, try a generic if your physician is agreeable, but do not expect the consistency that you get with brand-name drugs. For me, generic carbidopa-levodopa 25/100, the Teva product thought to be equivalent to Sinemet 25/`100, was more comfortable to swallow, and gentler on my stomach. The Teva pill tended to crumble more quickly, and leave lemon-colored dust behind. In my trials, it was weaker. I had to add an extra quarter of a tablet to overcome my PD-related paralysis; this extra L-dopa caused me to sweat rapidly and uncomfortably. I decided that Dupont's. brand-name Sinemet is preferable, at least for me. KNOW AND PRINT YOUR OWN CHART Making up your own chart is almost like having your horoscope drawn.. My chart is displayed prominently on my refrigerator. I have taken the time to instruct my caregivers carefully. It is important to me that they. know my schedule of dosing. Barbara Davidson, at the University of Iowa, suggests giving your neurologist or physician a copy of your chart, both to save time and to have clarity when discussing your medications and their effects on you.. TAKE YOUR CHART TO THE HOSPITAL Hilary Blue of Virginia sent me a long set of guidelines for the PWP who is hospitalized. The most critical decision to be made is to continue your usual PD medications, by giving the nurses your chart, and firmly insisting that they follow it. They are not going to help you if they change things around. TIMING AND REMINDERS Nothing gives me more flexibility than taking my pills ON TIME Like other mere mortals, I do forget when I am distracted. A Waltham, Massachusetts medical manufacturer and mail-order company , Bruce, Inc., has two products in its catalogue that fascinate me. One is Bruce's Talking Pill Reminder System, selling for $29.95. It is designed to either beep, flash or speak to you with a talking , programmable voice, that it is time to take your medicines. Up to four reminders, at regular intervals, or at whatever times, can be pre-programmed. I know that there are alarm wristwatches that discretely allow you to be out and about, and remind you that is your medication time. I have not tried any, and would be interested in readers' comments. DISPENSING YOUR PILLS FOR THE WEEK Bruce, Inc.also offers an "Extra-Large Pill Dispenser" for $7.95. It has six compartments, self-stick labels, and holds about 20 small capsules or pills in each compartment The idea is to reduce the potential confusion that could come from handling multiple pill bottles on a shelf, table or loosely knocking about inside your purse or handbag. I carry my entire week's pills, 21 per day, in a 3" diameter pill container. It is made of clear, blue plastic, with seven compartments, each marked with a letter of the alphabet signifying the day of the week. It is donut-shaped and fits in my pocket. It is suitable for my busy lifestyle, and far preferable to elongated pillboxes that would pop out of my coat or shirt pocket easily. My current pillbox cost just $3.95 at a local Rite Aid drugstore. That is all the room we have this month. Thank you, contest winners Thea and Gordon Seese of Mt. Shasta , California, and all of you who answered the quiz about the ancient Greek orator, Demosthenes.. Your comments, dear Mailbag readers are always welcome. Until next issue, best wishes from your Mailbag editor and fellow patient, Ivan Suzman of Portland, Maine. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn